AccountId: 011433970860
ContactId: 90146c2c-a021-4bfc-9693-90ba032036da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 381850 ms
Total Talk Time (AGENT): 169282 ms
Total Talk Time (CUSTOMER): 156949 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/90146c2c-a021-4bfc-9693-90ba032036da_20250319T17:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I have a patient who has AvMed Primary, but she's telling me now she has American Public Life as secondary, but she's not sure what her ID number is. If I give you her name, date of birth, can we kind of figure it out?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, give me one moment please, and before that, may I have your name?
[CUSTOMER][NEUTRAL] Sure, it's [PII] [PII] initial [PII]
[AGENT][POSITIVE] Thank you [PII] and what is your callback number as well?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][POSITIVE] Thank you very much. And what is the patient's last name?
[CUSTOMER][NEUTRAL] It's two names. First name is [PII]
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] OK, is that [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's it.
[AGENT][POSITIVE] OK, thank you and what is the first name? thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you very much one moment please.
[AGENT][NEUTRAL] OK, and if you would also verify her date of birth.
[CUSTOMER][NEUTRAL] Uh, I'm showing [PII].
[AGENT][POSITIVE] OK, thank you very much for that information, [PII]. I was able to locate her. Thank you for the information. Let me provide you with her policy number, OK?
[CUSTOMER][POSITIVE] Oh, OK, good, good.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, it is 246-207-7.
[CUSTOMER][NEUTRAL] OK, uh, now does this policy have a group number?
[AGENT][NEUTRAL] It does. Let me get that information for you as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. The group number is 24891.
[CUSTOMER][NEUTRAL] 2424891. OK, got it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, now her policy shows effective as of, I'm so sorry, shows effective as of [PII] and this policy shows active as your supplemental medical and what benefits can I give you today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] She is having um.
[CUSTOMER][NEUTRAL] She's having two procedures, uh, a colonoscopy and upper endoscopy. Now looks like the colonoscopy will be covered at 100% from the primary insurance, but the endoscopy is going towards the deductible. My thing is, uh, does she have a limit as to what the American public will cover?
[AGENT][NEUTRAL] Uh, yes, she does. Now whether it should be performed inside a doctor's office or a facility?
[CUSTOMER][NEUTRAL] No surgical center.
[AGENT][NEUTRAL] OK, one moment with those benefits for you for outpatient.
[AGENT][NEUTRAL] Please, thank you. Please note verification of benefits provided does not guarantee payment. We will pay up to $2000 for the calendar year for covered outpatient services, and with this plan, she does not have a deductible or any other pocket to meet with us. We pay up to $2000 until that has been exhausted. Now if you would like, I can check to see if anything has been met towards that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh sure that'll be great.
[AGENT][NEUTRAL] For this year, OK.
[AGENT][NEUTRAL] And currently she has not met anything towards that $2000 for the calendar year for [PII].
[CUSTOMER][NEUTRAL] OK, so whatever the primary doesn't cover, it'll go towards that $2000 OK.
[CUSTOMER][POSITIVE] All right, that makes some sense.
[CUSTOMER][NEUTRAL] Because the patient wasn't even aware of what her ID number was, uh-huh, nothing new.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, would you like our billing address, um, mailing address, payer ID, fax number? Do you have the information?
[CUSTOMER][NEUTRAL] Uh, let me see if we have it in our system. We have [PII].
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Um, it was [PII]. However, that has been updated. Let me provide you with our updated information, OK? It is now APO claims [PII].
[CUSTOMER][NEUTRAL] Is that the correct address?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me see if we also have that um address in there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Give me a second because I'm looking it up by.
[AGENT][POSITIVE] OK, of course, take your time.
[CUSTOMER][POSITIVE] Yeah we do OK perfect.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] Alrighty then I got the right one in there, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome, we also have a payer ID and a fax number if you like those as well, yeah.
[CUSTOMER][NEUTRAL] Uh, a what now?
[AGENT][NEUTRAL] Payer ID for electronic claims submission.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] No, we have it. Is it 60801?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yeah we have that in there too OK I just wanna be sure since we had several addresses which one actually is the correct one to send the claim? OK perfect alrighty uh what's the initial to your last name?
[AGENT][POSITIVE] OK awesome.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] I'm like
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so all I need is a reference number?
[AGENT][NEUTRAL] We do not provide reference numbers like that you can use my name in today's date, please.
[CUSTOMER][POSITIVE] Oh, got it. OK, very good. Thank you so much for the information.
[AGENT][POSITIVE] You're very welcome, [PII], and thank you very much for calling APL. Have a good day. Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.