AccountId: 011433970860
ContactId: 7be0444c-0746-4a0a-9fc3-780dffed5125
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311109 ms
Total Talk Time (AGENT): 168187 ms
Total Talk Time (CUSTOMER): 98301 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/7be0444c-0746-4a0a-9fc3-780dffed5125_20250109T20:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. I've got a provider on the back line who's wanting to get eligibility and benefits on the insured.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number is 248.
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] 39.
[AGENT][NEUTRAL] Alrighty, [PII], and who do I have on my line?
[CUSTOMER][NEUTRAL] You're speaking to [PII].
[AGENT][POSITIVE] OK, go ahead and give it to me then, no problem.
[CUSTOMER][POSITIVE] All right, here she goes. Thank you and have a good day.
[AGENT][POSITIVE] You're welcome. You too, [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, [PII], this is [PII] over in claims department. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, I'm checking for an eligibility and benefit status for the patient.
[AGENT][NEUTRAL] OK, go ahead, [PII], and give me your patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] Uh, uh, can you please repeat the question? Sorry for that.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, you're asking for the patient's name and date of birth?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, thank you. It's [PII], [PII], is the patient's date of birth.
[AGENT][POSITIVE] Alrighty, thank you so much for that information, [PII]. Now go ahead and give me a good return telephone call number while I'm pulling this information up for you, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, you need the callback number, ma'am?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Alrighty, thank you so much for that information. OK, I do see that [PII] is the insured on this medical supplemental plan. I do show the original effective date is [PII]. She is current and active, but I must advise, excuse me, I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, before that, uh, you said that a patient is inactive. Did I hear that correct or, uh, she's still active?
[AGENT][NEUTRAL] She is active, yes, she is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, and, uh, can you also help me with the patient's group number?
[AGENT][NEUTRAL] Yes ma'am, let me get over to that screen. Her group number is 21585.
[CUSTOMER][NEUTRAL] Uh, and this, uh, is this a PPO plan?
[AGENT][NEUTRAL] No, ma'am, this is her medical supplemental plan.
[CUSTOMER][NEUTRAL] Medical supplement. Just a second, please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, and can you also please help me with the, uh, claims mailing address and the payer ID, please?
[AGENT][NEUTRAL] Yes, ma'am. Payer ID is 60801.
[AGENT][NEUTRAL] Mailing address is to APL claims department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 8 [PII].
[AGENT][NEUTRAL] We are in [PII] City, [PII].
[AGENT][NEUTRAL] And our zip is [PII].
[CUSTOMER][NEUTRAL] Thank you for this information and I also wanted to ask you, uh, this patient have any deductible amount?
[AGENT][NEUTRAL] You want to know what is that benefit are you trying to get today, [PII], inpatient, outpatient, office visit?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, actually, I'm checking for the inpatient and, uh, I just wanted to know the deductible amount of the patient, ma'am.
[AGENT][NEUTRAL] Uh, let's see for inpatient and of course I can always take this information cannot guarantee payment over the phone. Now what we are, [PII] is her medical supplemental plan, so anything for sickness and injury that is applied towards her deductible.
[AGENT][NEUTRAL] Co-pay or co-insurance is what we would pick up and pay on and for inpatient there is no deductible, no pre-cert, and she has a $5000 benefit payable per calendar year for inpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for all this information. Can you also please help me with the call reference number for our call?
[AGENT][NEUTRAL] Well, is that all that I can help answer for you today, [PII] and [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes.
[AGENT][NEUTRAL] Alrighty, we don't give call reference numbers, but you can use my name in today's date and my name is [PII].
[CUSTOMER][NEUTRAL] Can you please spell that for me?
[AGENT][NEUTRAL] Yes, ma'am. [PII]
[CUSTOMER][POSITIVE] Oh, thank you so much and have a great day.
[AGENT][POSITIVE] You as well, and thanks for calling APL [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.