AccountId: 011433970860
ContactId: 854311e0-1ca0-4e06-a349-be25e0f6a83a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336730 ms
Total Talk Time (AGENT): 114485 ms
Total Talk Time (CUSTOMER): 124006 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/854311e0-1ca0-4e06-a349-be25e0f6a83a_20250401T14:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, yes ma'am, Ms. [PII]. My name is [PII]. I'm calling from a provider's office and I have a mutual patient that I need to verify eligibility on for a spouse.
[AGENT][NEUTRAL] OK, may I have a callback number?
[CUSTOMER][NEUTRAL] Uh yes, callback number is [PII], no extension.
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, policy number is.
[CUSTOMER][NEUTRAL] 01691413.
[AGENT][NEUTRAL] And may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth. Oh, I'm sorry. No, that's not my patient. My patient's name is [PII] or [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you, and you're calling in for eligibility for this member?
[CUSTOMER][NEUTRAL] Uh yes
[AGENT][NEUTRAL] OK. So for this member, it does show that it's currently active. The effective date is [PII]. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Alright, the only other thing that I need to verify would be max and deductible.
[AGENT][NEUTRAL] OK, let me pull that up for you and also would you like a fax that for this number?
[CUSTOMER][NEUTRAL] Uh, sure, yes ma'am.
[AGENT][NEUTRAL] And may I have the fax number?
[CUSTOMER][NEUTRAL] Uh yes, fax number is [PII].
[AGENT][POSITIVE] Thank you, and I will get that fax submitted over to you. I'm pulling that information up for you now as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. For the calendar year max, the member has up to $1500 and then they do have a $50 deductible, but their deductible does not apply to any preventative services.
[CUSTOMER][NEGATIVE] And they have that full 1500 remaining and deductible not met.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] That is correct. As of right now, the member has not used any of their benefits.
[CUSTOMER][POSITIVE] Alright, yes ma'am, and bite wing is in pro would all be 100%.
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] And you said bite wings?
[CUSTOMER][NEUTRAL] It'sam and Prey.
[AGENT][NEUTRAL] Is it for 12, or 4?
[CUSTOMER][NEUTRAL] Uh, 4
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Prophy and that is for an adult.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And what would be the code for the exam?
[CUSTOMER][NEUTRAL] 01 0120.
[AGENT][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And those are considered up under the preventative expenses. So that is considered.
[AGENT][NEUTRAL] At 100% and there's zero waiting period for the preventative.
[CUSTOMER][NEUTRAL] Alright, perfect, yes ma'am, and I believe we're out of network, if I'm not mistaken, um, and just to clarify you said preventative is 100% deductibles basic and major only, um, before I check the network, um, can I verify if she has any history on file?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For us we're not showing any history for this member.
[CUSTOMER][NEUTRAL] Alright, yes ma'am, and then we be considered out of network? I believe so, but I just wanna make sure.
[AGENT][NEUTRAL] This policy, it um does not constitute if it's for in or out of network so.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] It's just based off of the members benefit policy.
[CUSTOMER][POSITIVE] All right, perfect. Yes, ma'am. And how about um a reference number?
[AGENT][NEUTRAL] Yes, the reference number will be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] All right, you said that last name was [PII]?
[AGENT][NEUTRAL] H as in Henry, yes.
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you so much, [PII] for calling American Public Life. You have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.