AccountId: 011433970860
ContactId: 87bc2186-6665-4073-85f7-bd20e6dc3b20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550580 ms
Total Talk Time (AGENT): 192777 ms
Total Talk Time (CUSTOMER): 268963 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/87bc2186-6665-4073-85f7-bd20e6dc3b20_20250609T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII], we're the provider. Can you please help me with 2 numbers for their patient, uh, eligibility and benefits?
[AGENT][NEUTRAL] May I please have a callback number and the provider's name?
[CUSTOMER][NEUTRAL] So callback number is [PII].
[AGENT][NEUTRAL] And the provider?
[CUSTOMER][NEUTRAL] South Miami Hospital.
[AGENT][NEUTRAL] And may I please have the policy number?
[CUSTOMER][NEUTRAL] OK, for the, for the first one, OK, let me go ahead and pull it up.
[CUSTOMER][NEUTRAL] OK, the first policy number is gonna be.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's loading.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, OK, it's gonna be, where to go? 002464798 ML8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, hold on one second. Patient's name is [PII], [PII].
[AGENT][NEUTRAL] And you're calling in for eligibility and benefits, is there a specific benefit you're calling in for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome and for this policy, the member does have a new policy number. Are you ready for that?
[CUSTOMER][NEUTRAL] Oh, OK, hold on, give me 11 2nd, hold on one second, please. Um, well, so their, their data service was 57-2025, so they have a new policy number for that data service.
[AGENT][NEUTRAL] Yes, are you ready for that policy number?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] The policy number is 0250.
[AGENT][NEUTRAL] 1817 and it is showing that the effective date is [PII].
[AGENT][NEUTRAL] And for the outpatient benefits, verification of coverage does not guarantee the payment of the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The member does have up to.
[AGENT][NEUTRAL] $2500 per calendar year.
[AGENT][NEUTRAL] That will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only, it will not cover any preventative or wellness.
[CUSTOMER][NEUTRAL] OK, so all outpatient, outpatient is covered?
[AGENT][NEUTRAL] As long as it's for sickness and injury and not preventative or wellness.
[CUSTOMER][NEUTRAL] OK, this is for urgent care, so urgent care is included.
[AGENT][NEUTRAL] As long as it's for sickness and injury.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let me see what he came in for one second, let's see.
[CUSTOMER][NEUTRAL] He had hiccups and lightheaded.
[AGENT][NEUTRAL] OK, that's the only information that I disclosed as long as it's not preventative and wellness, the member does have those available benefits.
[CUSTOMER][NEUTRAL] So is that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, as long as it's not for better and wellness. OK, so that's OK then then he's fine.
[CUSTOMER][NEUTRAL] Um, then let me go ahead and make a note.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And how do you spell your name?
[AGENT][NEUTRAL] It is spelled [PII] with the last initial of the [PII] and today's date as the call reference.
[CUSTOMER][NEUTRAL] Thank you so much, [PII]. OK, let me go ahead and add it. 0609, and this is their meddling policy, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] All right, perfect. I'm gonna go ahead and save this one and we'll I'll go on to the next one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Just double checking everything. I got everything. I didn't miss anything? OK.
[CUSTOMER][NEUTRAL] Let me make a note.
[CUSTOMER][NEUTRAL] Let's see, did you have a nice weekend?
[AGENT][NEUTRAL] Yes, how about you?
[CUSTOMER][POSITIVE] Yes, thank you, went by very fast.
[AGENT][NEGATIVE] Yes, it didn't seem like I was off work at all.
[CUSTOMER][POSITIVE] Right, I'm like, oh my [PII], we can go by faster, faster than the whole work week.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But, but we're, we're in [PII], so it's it's just been a very hot weekend here.
[AGENT][NEUTRAL] Yeah, this, this summer weather is, it, you can tell it's becoming summer, should I say. You can really tell.
[CUSTOMER][NEUTRAL] Mhm. Are you in [PII] as well?
[AGENT][NEUTRAL] No, I'm not in [PII], in [PII].
[CUSTOMER][NEUTRAL] Ah, is it hot there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, you know, you know, you know the heat.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Patient Medicare.
[AGENT][NEUTRAL] But see, you all don't get like the cold weathers or anything, do you?
[CUSTOMER][POSITIVE] No, no, you know, it's funny. People think when it's 60 degrees here we're cold, it's like you don't know how cold it is.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, so no, I mean you step outside, uh.
[CUSTOMER][NEGATIVE] Uh, you know, you're right, you're just, you're just sweating.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEGATIVE] So no fun.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so let me go ahead on to the next one, Tarika, OK.
[AGENT][POSITIVE] OK. I'm ready.
[CUSTOMER][NEUTRAL] Uh, yes, one second. Everything has to load.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I tell people all the time, you know, you guys are very popular.
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Which is very, very good.
[AGENT][NEUTRAL] Yes, it is, and I.
[CUSTOMER][NEUTRAL] I never, I never heard it. I never heard of it until I started working in this job.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I used to work for Cigna Healthcare for the for dental.
[AGENT][NEUTRAL] For dental, OK. How did you like it?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Crazy.
[AGENT][NEUTRAL] Oh, look you so.
[CUSTOMER][NEUTRAL] Crazy, yeah, every day was a crazy day.
[AGENT][NEUTRAL] Got you. OK.
[CUSTOMER][NEGATIVE] I would start [PII] at [PII] every morning, you know, because I had so much to do trying to help the dentist and everything, and it's like, but they didn't, you know, they, they don't understand, right? They don't go to school to be managers, right? They don't know how to run a business, so it's just and then it's never their fault. It's always my fault and it's like, listen, doctor, don't go there.
[AGENT][NEUTRAL] Right, right.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEGATIVE] Don't go there
[AGENT][NEUTRAL] Like you, you were just trying to do your job.
[CUSTOMER][POSITIVE] She she's she's laughing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So, for this one, OK, it's 1341924.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] at [PII].
[AGENT][NEUTRAL] And you're needing the outpatient benefits for this member as well?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the effective date, it is, go ahead.
[CUSTOMER][NEUTRAL] And is
[CUSTOMER][NEUTRAL] Uh no she is she the subscriber as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] And for the effective date it is showing that the policy is currently active, showing [PII] 23 for the starting dates.
[AGENT][NEUTRAL] And for outpatient benefits, verification of coverage does not guarantee the payment of the claim. This member does have up to $6000 per calendar year in which that will also go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It would not cover any preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Yes, and then is her grouping ADP Total Resource Services Inc?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. For this memory, it is showing [PII] and Company.
[CUSTOMER][NEUTRAL] OK, and in Company Inc? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and the group number is 16411?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, and you said she's the subscriber and this is her meddling policy. OK, perfect. Alright, thank you [PII] for everything. I hope you have a great afternoon.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Same to you and thank you so much for calling American Public Life, [PII]. Enjoy the rest of your day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.