AccountId: 011433970860
ContactId: 7ba43276-3dbd-42e6-803a-ed122d6803f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274579 ms
Total Talk Time (AGENT): 108040 ms
Total Talk Time (CUSTOMER): 134410 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/7ba43276-3dbd-42e6-803a-ed122d6803f5_20250129T13:56_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from Doctor [PII]'s office in [PII]. I have a patient, um, who has Blue Cross Blue Shield of Michigan. You want the ID number?
[AGENT][NEUTRAL] The patient's policy number, yes.
[CUSTOMER][NEUTRAL] Yes, F like in Frank, S like in Sam, O like in Oscar, H like in Harry, 10730926.
[AGENT][NEUTRAL] Is that the number for Blue Cross or American Public Life?
[CUSTOMER][NEUTRAL] Blue Cross.
[AGENT][NEUTRAL] OK, you're speaking with American Public Life.
[CUSTOMER][NEUTRAL] Uh, well, that's the number on the back of her card.
[AGENT][NEUTRAL] What number is that? That you mean the policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] No, the telephone number on the back of her card is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, on the front of the card, is there a policy certificate number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Can you read to me what's on the front of the card?
[CUSTOMER][NEUTRAL] What's APL stand for?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] That's OK, that's on the top of her card.
[AGENT][NEUTRAL] OK, so the policy certificate number should be near the bottom of that card. It's maybe an outpatient and an inpatient policy er number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see, hold on a second.
[CUSTOMER][NEUTRAL] Let's see what I got. OK, got it. So you want the outpatient, it's 12.
[CUSTOMER][NEUTRAL] 63347 M like in Mary, L like in Larry, H.
[AGENT][POSITIVE] OK, thank you and what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] 0 my god [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. What are the last four digit?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. One moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. The last name is [PII] Birthday [PII].
[AGENT][NEUTRAL] OK. And how can I help you, [PII]?
[CUSTOMER][NEUTRAL] So she went online and saw that we were part uh participating in this plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I need to check that out.
[AGENT][NEUTRAL] Uh checking, you're checking to verify if you're part of the network or are you checking benefits?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] I'm checking if we're part of the network.
[AGENT][NEUTRAL] OK, so this is a, a Metlink policy which is secondary to her major medical policy, I think you said Blue Cross. So there is no network affiliated with our plan. We followed, follow the major medical.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Um, she needs a test done and I need to see if I can get a prior authorization if we are participating in this plan.
[AGENT][NEUTRAL] So when you say participating, there is no contracted providers for this policy. There, she can see whoever she wants. Um, our decision is based on the major medical when they process the claim. Um, is a test in an outpatient facility or is it or a diagnostic facility? OK, I can give you the outpatient, I can give you the outpatient benefit.
[CUSTOMER][NEUTRAL] Is there any way
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's an outpatient.
[AGENT][NEUTRAL] If you want that, it's up to $3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be fine.
[AGENT][NEUTRAL] OK, it's up to $3000 per calendar year. Prior authorization is not required.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the information provided is verification, not a guarantee of payment. This policy is a supplement policy to her major medical policy.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so this is a supplement, not of the Florida Blue. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, any other questions I can assist with today, [PII]?
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.