AccountId: 011433970860
ContactId: a0eb7407-489a-496b-a0bf-28752036aa80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212190 ms
Total Talk Time (AGENT): 136572 ms
Total Talk Time (CUSTOMER): 45253 ms
Interruptions: 0
Overall Sentiment: AGENT=2.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/a0eb7407-489a-496b-a0bf-28752036aa80_20250217T14:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, I'm calling to verify um a member's eligibility and.
[CUSTOMER][NEUTRAL] Uh, benefits
[AGENT][POSITIVE] Yes, ma'am. I will be glad to help you. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh name is [PII].
[CUSTOMER][NEUTRAL] Policy number I have is 017.
[CUSTOMER][NEUTRAL] 294
[CUSTOMER][NEUTRAL] 39 M as in Mike L as in Lima, the number 7.
[AGENT][POSITIVE] Alrighty, thank you so much for that information, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. Now your patient's name and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], that's spelled [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Alright, [PII], it looks like [PII] is the insured on this medical supplemental plan, and you did say you want to get benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, because I do show this number's terminated, so let me just double check and make sure she didn't flip to a different number it looks like perhaps she did so hang on, let me do some checking right quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you ma'am. 202.
[AGENT][NEUTRAL] Yeah, she did flip to a different number. So I am going to give you the correct policy number now that did go into effect 81-2024. So her policy number is going to be 025.
[AGENT][NEUTRAL] 38201.
[CUSTOMER][NEUTRAL] OK, 02538201?
[AGENT][NEUTRAL] That is correct, yes ma'am, and I do show this medical supplemental plan went into effect. A 1-2024 it is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want uh benefits. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, what exact benefit are you needing today, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, outpatient hospital.
[AGENT][NEUTRAL] All right, get over there. OK, now, [PII], what we are is, of course, her medical supplemental plan too, her primary major medical insurance company.
[AGENT][NEUTRAL] Now what we would pick up and consider would be anything for sickness and injury that is applied towards her deductible, co-pay or co-insurance and her primary insurance carrier. Nothing routine here is covered no matter what. Now her outpatient benefit here is no pre-cert, no deductible, and she has a $500 max benefit payable per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that all that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yes, and do you issue a call reference number?
[AGENT][NEUTRAL] No, we don't give call reference number, [PII], but you can use my name on today's date and my name is [PII], spelled [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes, ma'am, [PII], and thank you for calling APO. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.