AccountId: 011433970860
ContactId: 7bf3bd33-290f-4ccc-870e-234164c23c98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322929 ms
Total Talk Time (AGENT): 189597 ms
Total Talk Time (CUSTOMER): 94909 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/7bf3bd33-290f-4ccc-870e-234164c23c98_20250218T21:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from Ortho now. I just wanted to verify a patient's eligibility and benefits for an urgent care, uh, visit, please.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information for members, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It is 1548445. M as in Mary, L as in Larry, and the number 8.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and [PII], is this, OK, so first off, any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. So she is a subscriber now this policy number that you provided me though, it's an old policy, it's no longer active with it, it has a term date of [PII]. The current active policy is going to be 0245.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 0245.
[AGENT][NEUTRAL] 853 4.
[CUSTOMER][NEUTRAL] 853 4.
[AGENT][NEUTRAL] Yes ma'am, and that one has an effective date of [PII].
[AGENT][NEUTRAL] And it is active?
[AGENT][NEUTRAL] And one moment while I get that information pulled up please.
[CUSTOMER][NEUTRAL] And and it ends in MO8, right?
[AGENT][NEUTRAL] Well, you're gonna have an ML 8 for inpatient and or an ML 7 for outpatient. It'll be the same at the end.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, got it. OK. Outpatient's name MLA and then could I get uh the group ID number please?
[AGENT][NEUTRAL] 21,780.
[CUSTOMER][NEUTRAL] Um, OK, and he is covered. This will pick up any co-pay, deductible or co-insurance?
[AGENT][NEUTRAL] OK, now you
[AGENT][NEUTRAL] Just one moment and let me get that policy's information pulled up. OK, now you said that [PII] was the patient. That's a female.
[CUSTOMER][NEUTRAL] Oh, sorry. I'm sorry, what's?
[CUSTOMER][POSITIVE] Correct, mhm.
[AGENT][NEUTRAL] Oh, I'm sorry. Well, you threw me because you said his. So she.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, um, my head is everywhere.
[AGENT][NEUTRAL] Uh-huh. I just wanna make sure we're talking about the correct patient, so.
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] [PII] is the, the patient. Is that correct?
[CUSTOMER][NEUTRAL] Alright, yes ma'am.
[AGENT][NEUTRAL] Yes, and she is the policy holder, OK, so just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're needing outpatient benefits on the supplemental policy, is that correct?
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max of $5000 per calendar year for covered outpatient services and there is no.
[CUSTOMER][NEUTRAL] 101
[CUSTOMER][NEUTRAL] I'm sorry, you said how much?
[AGENT][NEUTRAL] Her outpatient benefit max per calendar year for covered outpatient services is $5000.
[AGENT][NEUTRAL] With no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Alright, do you know how much has been used by any chance?
[AGENT][NEUTRAL] And it's for
[AGENT][NEUTRAL] This year's
[CUSTOMER][NEUTRAL] Urgent care.
[AGENT][NEUTRAL] Yes, ma'am, but for this, for [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEGATIVE] As of now, there have not been any benefits used.
[CUSTOMER][POSITIVE] OK awesome and I'm sorry I missed your name.
[AGENT][NEUTRAL] And because this
[AGENT][NEUTRAL] My name is [PII], and because this is a supplemental policy to the primary insurance, when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] Along with the claim and then uh once we have processed our claim LVM we do have a portal that you can check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK, perfect. And can I get a reference number and [PII], is it [PII] or [PII]?
[AGENT][NEUTRAL] Neither [PII]
[CUSTOMER][NEUTRAL] Oh OK and what's the initial to your last name please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And of course, and can I have a reference number please?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Awesome Miss [PII] have a great rest of your day thank you.
[AGENT][POSITIVE] OK, well, thank you so much and if that's all I can help you with, I hope you have a nice evening as well and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] All right, bye bye.