AccountId: 011433970860
ContactId: 9408cccc-34a9-4421-ba60-bf44fc4ab477
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451339 ms
Total Talk Time (AGENT): 145375 ms
Total Talk Time (CUSTOMER): 115690 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/9408cccc-34a9-4421-ba60-bf44fc4ab477_20250514T17:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from office, and I need to obtain eligibility for a patient. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, the callback number is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, the facility number is Mercy East Ambulatory Services.
[AGENT][NEUTRAL] OK, and may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02.
[CUSTOMER][NEUTRAL] Yeah, just a moment. Yeah, the policy number is 02134924.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And the patient name is?
[CUSTOMER][NEUTRAL] Yeah. [PII].
[CUSTOMER][NEUTRAL] And the date of birth is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] Alright, I do show that this policy for [PII] is no longer active. The policy terminated on [PII].
[AGENT][NEUTRAL] And there are no active policies on file at this time.
[CUSTOMER][NEUTRAL] Got it. And may I know the effective date of the policy?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah, and the term that is [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, got it. And I do have a particular data service. Could you please check whether the patient is active for the data service?
[AGENT][NEUTRAL] OK, let me put my note in here real quick and I'll check for you.
[CUSTOMER][NEUTRAL] OK, let me put my notes here real quick and I'll check for you.
[CUSTOMER][NEUTRAL] And also, could you please check whether this patient will cover medical and uh urgent care?
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what was the data service that you wanted me to check on for you?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Yes, the policy was active at that time.
[AGENT][NEUTRAL] And let me check the benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It can be just a moment.
[AGENT][NEUTRAL] OK, and you said this was for outpatient services?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is just to verify benefits. It's not a guarantee of payment. The member did have outpatient uh services for.
[AGENT][NEUTRAL] Benefit amount of $3400 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah, got it, sorry. And this patient will cover urgent care, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] I'm sorry, can you
[CUSTOMER][NEUTRAL] Yeah. Will this patient will cover urgent care?
[AGENT][NEUTRAL] Uh, let me look and see on the policies certificate and see if urgent care is covered under this policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's gonna be just a moment while I pull it in for you.
[CUSTOMER][POSITIVE] Yeah, take your time to.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me pull up the fee schedule schedule of benefits.
[AGENT][POSITIVE] Yes, this um policy does help with urgent care.
[AGENT][NEUTRAL] For sickness or injury.
[CUSTOMER][POSITIVE] Yeah thank you so much [PII].
[CUSTOMER][NEUTRAL] Yeah, got it all. And may I know the claim mailing address?
[AGENT][NEUTRAL] Yes, sir. The address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that is going to be in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, got it, [PII]. And may I know the timely filing limit to submit a claim?
[AGENT][NEUTRAL] Yes sir, um, we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] You don't have family filing limit?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][POSITIVE] And thank you for patiently waiting to, and
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] May I know the, yeah, may I know the time to submit a claim from uh those data service?
[AGENT][NEUTRAL] We do not have a timely filing limit as long as the insured was active on the date of service, you can submit a claim at any time.
[CUSTOMER][NEUTRAL] We do not have a time limit.
[CUSTOMER][POSITIVE] Yeah, got it.
[CUSTOMER][NEUTRAL] And yeah, I got all the information to you. May I have your call reference number?
[AGENT][NEUTRAL] Yes, sir, you can use my name and today's date.
[CUSTOMER][POSITIVE] Yeah. Thank you for your assistance. Have a great day. Bye-bye for now.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for calling APL. I hope you have a wonderful day too. Bye-bye, sir.