AccountId: 011433970860
ContactId: 835ad7bf-5827-4b1b-a6b8-ac8631a16504
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204429 ms
Total Talk Time (AGENT): 109738 ms
Total Talk Time (CUSTOMER): 103838 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/835ad7bf-5827-4b1b-a6b8-ac8631a16504_20250122T23:06_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from Nevada Nephrology Consultants. I wanna know if the patient is eligible to be seen with one of our providers here. They have an appointment.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that today. um, so we're looking for eligibility and benefits.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect and do you mind if I have your name please and a good call back number?
[CUSTOMER][NEUTRAL] Yes, [PII] callback number is [PII].
[AGENT][POSITIVE] Perfect and.
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] Policy number it is 02567567.
[AGENT][POSITIVE] Perfect, let me get that pulled up for you.
[CUSTOMER][NEUTRAL] to actually cancel a prescription that would call them.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] The Valsartan
[AGENT][NEUTRAL] And would you be able to verify your patient's first and last name and date of birth for me please?
[CUSTOMER][NEUTRAL] Yes, the patient's um last name is [PII] and then date of birth. Date of birth is [PII].
[AGENT][NEUTRAL] All right, perfect and your patient is current and active with an effective date of [PII] and then benefits, um, what sort of benefits were we looking for today?
[CUSTOMER][POSITIVE] OK, alright, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, he's gonna be seeing the nephrologist, so I can give you our tax ID number and our provider's name.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, so we'll work with any provider as far as his policy goes because it's just a limited supplemental policy, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm assuming it's outpatient. Is it gonna be in a physician's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, and do you know, and if you don't know, that's OK. Um, do you know if it's for accident or sickness treatment?
[CUSTOMER][NEUTRAL] Just for sickness treatment.
[AGENT][NEUTRAL] Sickness, OK, so he does have an outpatient accident and sickness treatment benefit, um, that he can use up to 4 times a year for $50 each visit.
[CUSTOMER][NEUTRAL] For follow up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and if you need.
[CUSTOMER][NEUTRAL] OK, so he will be covered and the copay will be $15?
[AGENT][NEUTRAL] No, no, we're just a limited supplemental policy, so he has a $50 benefit. He can redeem 4 times a year in a physician's office for accidental sickness or treatment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] HTN
[CUSTOMER][NEUTRAL] OK, so whatever else it's then they would it'll be whatever is not covered, it will be billed to them, right?
[AGENT][NEUTRAL] So because we're a supplemental policy we can't determine patient responsibility so whatever is not covered, it would be up to the provider to decide what to do afterwards with that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, but we, they are contracted that's all I wanted to know like they are contracted and they, they can use this insurance.
[AGENT][POSITIVE] They absolutely can use it, yes, they're current, they're active, um, and then if you guys have not ever filed a claim with us before, you would just submit your W-9 with your first claim and we'd be able to make benefits payable to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Fair
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, sounds good thank you.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you so much for calling APL and you have such a fabulous day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.