AccountId: 011433970860
ContactId: 8692a3ee-fbab-4075-bd2b-2d917aa575a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334279 ms
Total Talk Time (AGENT): 99858 ms
Total Talk Time (CUSTOMER): 146727 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/8692a3ee-fbab-4075-bd2b-2d917aa575a3_20250409T12:33_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, good morning, [PII]. This is [PII] in customer service. I had a call from the provider's office with [PII] on the line, um, checking the eligibility for a patient with policy number.
[CUSTOMER][NEUTRAL] 255.
[CUSTOMER][NEUTRAL] 2722.
[AGENT][NEUTRAL] And what was her name?
[CUSTOMER][NEUTRAL] Um, [PII] on the line and the patient's name is [PII]. Um, she has been um she verified the name and date of birth already.
[AGENT][NEUTRAL] OK, and does she have a callback number?
[CUSTOMER][NEUTRAL] Um, I grabbed the one she's calling from.
[AGENT][POSITIVE] OK, I'll get it from her then. Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling to see if a member is active for uh their policy that for the data service that we're trying to build a claim for.
[AGENT][NEUTRAL] OK, and do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's area code [PII].
[AGENT][NEUTRAL] And that was on [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. Um, you were just needing the benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm just needing to know if the member is active for uh [PII] claim.
[AGENT][NEUTRAL] Yes, ma'am, she is.
[CUSTOMER][NEUTRAL] OK. Can you give me her effective date?
[AGENT][NEUTRAL] Her effective date was [PII].
[CUSTOMER][NEUTRAL] [PII], is she still current or did it term or?
[AGENT][NEUTRAL] She's still active. Yes, ma'am.
[CUSTOMER][NEUTRAL] She has this insurance as a secondary to her primary Blue Cross this, um,
[CUSTOMER][NEUTRAL] Does this policy pick up uh like the copay, co-insurance or deductible for the primary?
[AGENT][NEUTRAL] It picks up any deductibles, co-pays, or co-insurance only, and any benefits given over the phone is not a guarantee of payment. Is it for outpatient, inpatient, or doctor's office?
[CUSTOMER][NEUTRAL] It's for a doctor's office.
[AGENT][NEUTRAL] OK, the actual office visit is
[CUSTOMER][NEUTRAL] OK. Does she have a copay with this policy?
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The actual office visit itself is not covered.
[AGENT][NEUTRAL] If she has any services done in the doctor's office, now that would be covered, but the actual office visit itself is not covered.
[CUSTOMER][NEUTRAL] Just like the procedures are.
[CUSTOMER][NEUTRAL] Uh, I'm gonna put a note here, office visit not covered, but services like as far as uh injections like for.
[AGENT][NEUTRAL] X-rays, things like that.
[CUSTOMER][NEUTRAL] Um, and she came in for upper, upper respiratory infection and they gave her like, uh, they swabbed her for like the flu. Is that covered under her plan?
[AGENT][NEUTRAL] Yes ma'am, it would be covered under her outpatient benefit and we pay up to $2550 per calendar year.
[CUSTOMER][NEUTRAL] 2550.
[CUSTOMER][NEUTRAL] Is that like a uh
[CUSTOMER][NEUTRAL] Out of pocket expense or is that like a uh.
[AGENT][NEUTRAL] That's the maximum, the maximum we'll pay in one calendar year.
[CUSTOMER][NEUTRAL] What kind of benefit is that?
[AGENT][NEUTRAL] For anything they apply to the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that's what I needed to know.
[CUSTOMER][NEUTRAL] OK. And then um.
[CUSTOMER][NEUTRAL] Can I get a
[CUSTOMER][NEUTRAL] A reference number for the call or do you not provide reference numbers?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Before I hang up, um, can I get the claims address for where we should send the claims?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And do you have a payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that's what I needed to know and then you said that to use your name and today's date for the reference number?
[AGENT][POSITIVE] Yes, ma'am. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you for your help. You have a good day.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.