AccountId: 011433970860
ContactId: 80fdec7d-58c1-4374-b130-c6470b4b5c34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1190910 ms
Total Talk Time (AGENT): 224668 ms
Total Talk Time (CUSTOMER): 543058 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/80fdec7d-58c1-4374-b130-c6470b4b5c34_20250509T15:35_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good. Good morning, [PII]. My name is [PII]. We're the provider. Um, I have, I'm calling for patient eligibility benefits. I have 12, I have 5. I have 5 patients. Can you, are you able to help me with 5 patients for patient eligibility benefits?
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that with a C or a K?
[CUSTOMER][NEUTRAL] With a K, and just, just want to confirm, are you OK with helping me with 5 of them?
[AGENT][NEUTRAL] And the policy?
[AGENT][NEUTRAL] We can.
[CUSTOMER][POSITIVE] OK, perfect. Thank you. You're the best. OK, so the first one is 01659207 MLA.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me the others, but just give me the numbers before the M.
[CUSTOMER][NEUTRAL] OK, OK, you just want the numbers 01659207.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is it one policy number and families, uh, dependents under the policy or you have 5 different policy numbers?
[CUSTOMER][NEUTRAL] I have, I just have other different policies.
[AGENT][NEUTRAL] OK, go ahead and give me the other policy numbers.
[CUSTOMER][NEUTRAL] Oh, I would have to we have to do one at a time. I can't just open all of them at once.
[AGENT][NEUTRAL] Your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, the current policy number is 22505.
[AGENT][NEUTRAL] 695.
[CUSTOMER][NEUTRAL] Oh, OK, hold on, hold on one second. He has, he has a new policy because his date of service was [PII].
[AGENT][NEUTRAL] The current policy number.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK, because it it it instead of service was 323.
[AGENT][NEUTRAL] OK, are you checking claim status or eligibility dates?
[CUSTOMER][NEUTRAL] Eligibility and benefits, but I'm just letting you know his state of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the current policy for that date of service.
[AGENT][NEUTRAL] It's 250.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] 5695 it became effective [PII].
[AGENT][NEUTRAL] And it's currently active.
[CUSTOMER][NEUTRAL] OK, perfect. I can't, he gave us the wrong one. I, yeah, yeah. OK, so 2505695. And does he have an outpatient urgent care coverage for his gap plan with you guys?
[AGENT][NEUTRAL] Mm, OK, so will you be needing benefits as well in addition to eligibility?
[CUSTOMER][NEUTRAL] Yes, yes, for, for, and it's gonna be for the other plans I have as well, same thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. It'll be urgent care for all of them?
[CUSTOMER][NEUTRAL] I, I, I think so. I have to take a look at the other accounts, I believe so, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the maximum outpatient benefit is up to $2500. This is a per calendar year benefit.
[AGENT][NEUTRAL] And information provided is verification, not a guarantee of payment?
[AGENT][NEUTRAL] And I'll check to see if any of that has been used.
[AGENT][NEUTRAL] Uh, so far we've paid out $60 of that policy maximum.
[CUSTOMER][NEUTRAL] OK great so he has no no copay, right?
[CUSTOMER][NEUTRAL] I'm sorry, I'm, I'm not, I'm sorry, he's, he's fully covered, right? for outpatient urgent care?
[AGENT][NEUTRAL] The maximum benefit is up to $2500 per calendar year.
[CUSTOMER][POSITIVE] OK, perfect. So he, he is, he is covered then.
[CUSTOMER][NEUTRAL] OK, um, and his group name is City of [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And group number is 16944, right?
[AGENT][NEUTRAL] Yeah, the information on the card is still the same even though the policy changed.
[CUSTOMER][NEUTRAL] Yeah, I don't have the card. I don't have the card scanned in, so I, I, I'm, I'm just, I'm just repeating what they put into the system and he's and he's, yeah, he's the subscriber, right? [PII]?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And your surname [PII]?
[AGENT][NEUTRAL] TO first initial last name is [PII]
[AGENT][NEUTRAL] And if we could move to the next policy number, please?
[CUSTOMER][NEUTRAL] 00 OK.
[CUSTOMER][NEUTRAL] OK, hold on, give me one second to pull it up, hold on.
[CUSTOMER][NEUTRAL] Just let me I have to save this for a second that way we can go on to the next one just 1 2nd, OK.
[AGENT][NEUTRAL] And I place you on a brief hold?
[CUSTOMER][POSITIVE] Oh, OK, no problem, thank you.
[AGENT][POSITIVE] And I'm ready for the next one.
[CUSTOMER][NEUTRAL] OK, right, and these are the data plans correct?
[AGENT][NEUTRAL] This particular policy is I'll have to verify when I pull up the policy number.
[CUSTOMER][NEUTRAL] OK, perfect. So yeah, my system is still now the system isn't like me time. OK, so let me, it's still loading. Alright, so let's see if it's loading now.
[CUSTOMER][NEUTRAL] Alright. Everything it's been today this morning has been a rough morning. Our systems have been slow. Nothing's been everything's been so slow. OK, perfect. So the next one is, is gonna be, OK, let me pull up his name.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, his policy number is going to be and is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes, I'm sorry for the hold. OK, policy number is 01 I'm sorry 02129225.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The policy effective date is [PII].
[AGENT][NEUTRAL] Uh, the policy is active at this time. This is a Metlink policy.
[AGENT][NEUTRAL] And the maximum benefit is up to $500 per occurrence.
[CUSTOMER][NEUTRAL] OK, so I, I have a question for you. So when you say Min, is that like, is that like another gap gap plan?
[AGENT][NEUTRAL] Yeah, it's a medical supplemental gap policy.
[CUSTOMER][NEUTRAL] Oh, supplement. OK, yes, and then another gaps, another gap policy. OK, perfect. And is he the subscriber for this one?
[AGENT][NEUTRAL] He is.
[CUSTOMER][POSITIVE] OK, perfect. And then what is the group name?
[AGENT][NEUTRAL] Tinsley advertising group number is 17243.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry, you broke up. What I'm sorry, what is the group name again?
[AGENT][NEUTRAL] Kinsley advertising.
[CUSTOMER][NEUTRAL] Kinsley, K I N S L E Y.
[AGENT][NEUTRAL] T as in Tom, Tinsley.
[CUSTOMER][NEUTRAL] Oh, Tinsley. OK, T I N S L E Y?
[AGENT][NEUTRAL] Advertising
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the group number is 17243.
[CUSTOMER][POSITIVE] OK perfect let me go ahead and save this OK and he's a subscriber for this one.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] You see me.
[CUSTOMER][NEUTRAL] [PII] A reference number is your name and today's date.
[CUSTOMER][NEUTRAL] OK 0509.
[CUSTOMER][NEUTRAL] 2025. OK, let me see something here.
[AGENT][NEUTRAL] And the disclaimer will be quoted for each each since it's this one call we've quoted the disclaimer.
[CUSTOMER][NEUTRAL] Yes, and for this one, right, I, I, I didn't even ask, he had the um outpatient urgent care coverage.
[AGENT][NEUTRAL] OK, so the outpatient benefit that I provide includes urgent care.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh OK OK perfect just wanted to double check. Alright, so let me go ahead and save this one and go on to the next one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's loading.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. 44 12 2025.
[CUSTOMER][NEUTRAL] From from [PII]
[CUSTOMER][NEUTRAL] Alright, and this is our gap plan verification.
[CUSTOMER][NEUTRAL] Gap plan.
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, and revalidate.
[CUSTOMER][NEUTRAL] Alright, let me pull up the next one.
[AGENT][POSITIVE] I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] OK, the next one her name.
[CUSTOMER][POSITIVE] Yes, thank you. OK, the next one.
[CUSTOMER][NEUTRAL] Oh I wanna go through.
[CUSTOMER][NEUTRAL] It's loading.
[CUSTOMER][NEUTRAL] OK, next one is gonna be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the next one.
[CUSTOMER][NEUTRAL] OK. This one's gonna be.
[CUSTOMER][NEUTRAL] Same benefits for outpatient urgent care and her policy number is 2406309.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], born on [PII].
[AGENT][NEUTRAL] OK, thank you. The policy effective date is [PII].
[AGENT][NEUTRAL] Policy is active?
[AGENT][NEUTRAL] And the maximum outpatient benefit.
[CUSTOMER][POSITIVE] OK perfect policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The maximum outpatient benefit is up to $1500.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][POSITIVE] OK, so that, OK, so perfect. So she does have that outpatient coverage again, correct?
[AGENT][NEUTRAL] The maximum outpatient is up to 1500 per calendar year.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Thank you and what is her group name and group number for this one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 15185 is the group number?
[CUSTOMER][NEUTRAL] 1515185. OK. And her, the group name, please?
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Oasis outsourcing.
[CUSTOMER][NEUTRAL] Oasis you said?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Out OT sourcing is that one word or two words?
[AGENT][NEUTRAL] One word.
[CUSTOMER][NEUTRAL] O U T S O U R C I N G.
[AGENT][NEUTRAL] Outsourcing
[CUSTOMER][NEUTRAL] Did I spell that right?
[AGENT][NEUTRAL] Out and then source in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. Let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see here alright.
[CUSTOMER][NEUTRAL] Yep, got it. OK, and she's and she's the subscriber.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0509.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, see.
[CUSTOMER][POSITIVE] OK, hold on. Alright, perfect, let me see this one.
[CUSTOMER][NEUTRAL] Let's see verified, um.
[CUSTOMER][NEUTRAL] OK rings loading.
[CUSTOMER][NEUTRAL] Yeah, and this is a gap plan OK verified United.
[CUSTOMER][NEUTRAL] I spoke
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] From APL and verified patient gap plan. OK, perfect.
[CUSTOMER][POSITIVE] Alright, perfect. Let me see. Alright, the next one, you have 2 more to go.
[CUSTOMER][NEUTRAL] Alright, the next one, his name is gonna be, let's see, it's loading.
[AGENT][NEUTRAL] The policy number first.
[CUSTOMER][NEGATIVE] Yes, it's just the system's loading very slow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I appreciate all your help.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I, I always tell you, I always, when I, I always tell you when I call you guys, you guys are very popular. A lot of people like you guys.
[AGENT][POSITIVE] Oh, great. That's good to hear.
[CUSTOMER][NEUTRAL] OK manual.
[CUSTOMER][NEUTRAL] Yes me here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, so this one.
[CUSTOMER][NEUTRAL] His, his, his policy number is gonna be.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1233 277.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, let me give you the current policy number.
[CUSTOMER][NEUTRAL] Oh, OK, OK, right, so his date of service was [PII], so he had a new policy number for that date of service.
[AGENT][NEUTRAL] The current policy number is 260.
[AGENT][NEUTRAL] 83
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 35
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The effective date is [PII] currently active.
[CUSTOMER][POSITIVE] Thank you and the same, the same benefits for outpatient urgent care and he's fully covered for that?
[AGENT][NEUTRAL] The maximum outpatient benefit is up to $750 per calendar year.
[CUSTOMER][NEUTRAL] OK, perfect, thank you. OK, and what is the group name for this one, [PII]?
[AGENT][NEUTRAL] 16714 is the group number?
[CUSTOMER][NEUTRAL] I'm sorry, 16, sorry, say one more time. 16.
[AGENT][NEUTRAL] 714.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The spelling of the group is the spelling of the group is T as in Tom, E as in Edward.
[CUSTOMER][NEUTRAL] And the group name?
[AGENT][NEUTRAL] Double R as in Randy A.
[AGENT][NEUTRAL] B as in boy, A N K.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK perfect and he's still a subscriber for this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] K T O N Y A 0509-2025.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect and let me go ahead.
[CUSTOMER][NEUTRAL] And see
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see verifying.
[CUSTOMER][NEUTRAL] Yeah and verify patient gap plan.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] Alright, let me, alright, we're almost there.
[CUSTOMER][POSITIVE] Alright, perfect, it did not go through.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] OK, so our last one, woohoo, the last one and that's exciting. OK, then her her policy number is gonna be.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] Oh it's loading uh it's stuck.
[CUSTOMER][NEUTRAL] OK, the last one's gonna be.
[CUSTOMER][NEUTRAL] OK, her policy number is 002565 I'm sorry, 563633.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEGATIVE] Oh, you know what? I think they put the wrong.
[CUSTOMER][NEGATIVE] I take that back. I think they gave this is for the wrong I think this is for the wrong thing. I think they put the wrong, no this is wrong wrong I think they put the wrong plan. Her name was [PII].
[CUSTOMER][NEGATIVE] No, no, they put the wrong plan code. Uh, no, never mind.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that was it. Thank you for everything, [PII].
[AGENT][POSITIVE] All right. You're, you're welcome, [PII]. Thanks for calling APL. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.