AccountId: 011433970860
ContactId: 9181ceb0-1b5a-4c98-922f-a928156c45f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264390 ms
Total Talk Time (AGENT): 108577 ms
Total Talk Time (CUSTOMER): 117537 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/9181ceb0-1b5a-4c98-922f-a928156c45f7_20250204T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? I'm calling to verify um the coverage for a patient.
[AGENT][NEUTRAL] OK, I'm happy to check on coverage. What's the patient's policy number?
[CUSTOMER][NEUTRAL] The patient's policy number is 01845813.
[AGENT][POSITIVE] Thank you so much and if you don't mind, can I grab your first name?
[CUSTOMER][NEUTRAL] My first name is [PII]. Can I have yours?
[AGENT][POSITIVE] Yeah, absolutely. My name is [PII].
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Perfect, OK.
[AGENT][POSITIVE] Thank you so much. And then if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, name is [PII]. Date of birth is going to be [PII]. Yes, of course. Can I have your name please?
[AGENT][NEUTRAL] All right, [PII], let me repeat this policy number. I copied down 01845813.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't think you do it. I didn't forget to do it.
[AGENT][NEUTRAL] That doesn't match that member's information.
[CUSTOMER][NEUTRAL] [PII] 5 1068.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Um, and.
[CUSTOMER][NEUTRAL] Let me see, it says here that he has a new policy number, um, but we don't have that new policy num I don't know the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The one that we have here is 01845813.
[AGENT][NEUTRAL] Let me do a search by.
[CUSTOMER][NEUTRAL] I don't know if it changed.
[AGENT][NEUTRAL] Yeah, let me do a search by name, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What state does he live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] 103.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, so I, it's actually, so it's 1854813. I had 5813.
[CUSTOMER][NEUTRAL] 181854813.
[AGENT][NEUTRAL] So 1854813.
[CUSTOMER][NEUTRAL] And that's his new mem um insurance ID?
[AGENT][POSITIVE] Yeah, that's the correct number that.
[CUSTOMER][NEUTRAL] Do you have the group number? Does it stay the same?
[AGENT][NEUTRAL] Yeah, it should let's see, group number is 15493.
[CUSTOMER][NEUTRAL] OK perfect and um is it active?
[AGENT][NEUTRAL] Yes, he is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course it is, you know.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yes, um, how many visits does he get per calendar year?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it's.
[CUSTOMER][NEUTRAL] He's a.
[AGENT][NEUTRAL] So the patient's plan looks like it has an outpatient benefit amount max of 7900 for the calendar year, doesn't look like there's a limit as far as office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][POSITIVE] OK perfect and you guys cover um.
[CUSTOMER][NEUTRAL] Up to all of that?
[AGENT][NEUTRAL] Yeah, so we cover deductible, co-pay, co-insurance. The primary does not because we're the secondary up to 7900.
[CUSTOMER][NEUTRAL] Deductible copays and what else?
[AGENT][NEUTRAL] Uh, deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. You have a great day.
[CUSTOMER][NEUTRAL] OK, can I have a reference number?
[AGENT][POSITIVE] Yeah, absolutely. Call references my name with my last initial than today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] Likewise.