AccountId: 011433970860
ContactId: a1a5acd0-5868-46b1-83f7-f684ea9363c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268579 ms
Total Talk Time (AGENT): 91341 ms
Total Talk Time (CUSTOMER): 98300 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/a1a5acd0-5868-46b1-83f7-f684ea9363c4_20250224T20:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes ma'am, I'm calling to get eligibility and benefits for a patient.
[AGENT][POSITIVE] All right. I'm happy to check on eligibility and benefits today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I would
[CUSTOMER][NEUTRAL] We don't have her policy number, but we do have her date of birth and social.
[AGENT][NEUTRAL] OK, what's the social?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] so really on now.
[AGENT][POSITIVE] All right, thank you so much. Let me do a search by this here. Give me one moment.
[CUSTOMER][POSITIVE] You all right.
[AGENT][NEUTRAL] What's the patient's first and last name?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] And are you looking for medical or dental coverage today?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Medical. OK. What's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] All right, thank you so much. So [PII] does have an active medical plan with us. The effective date is [PII]. Do you need the policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, policy number is going to be 02.
[AGENT][NEUTRAL] 58.
[AGENT][NEUTRAL] 462 7.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And um if you don't mind me asking what's your all's payer ID?
[AGENT][NEUTRAL] Payer ID is going to be uh let me double check on this 11 2nd, one moment, sorry.
[CUSTOMER][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] Might be a different one. Let me see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I and I'm wondering if it's a network thing and that's what's wrong with my.
[CUSTOMER][NEUTRAL] Just fill out the very top and sign the bottom down there. We don't need all the other.
[AGENT][NEUTRAL] So for this member's plan, you're gonna use payer ID 64556.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And with the billing address be [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mm. Mhm. Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, uh, what's the benefits for PCP?
[AGENT][NEUTRAL] Uh, let's take a look here.
[CUSTOMER][POSITIVE] You're welcome thank you
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, so it looks like under the member's plan they're allowed up to 5 visits per year and the benefit payment per visit is $75.
[CUSTOMER][NEUTRAL] OK, and then $75 for each visit. Now, anything, anything over there, um, I know as far as the visit, probably get adjusted off, but as far as like uh labs and injections, the patient is responsible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah that would be up to the facility or provider if they wanna build them for the difference.
[CUSTOMER][POSITIVE] OK, alright, I got you.
[CUSTOMER][NEUTRAL] Alright, and, and she, she still has 5 visits remaining.
[AGENT][NEUTRAL] Yeah it looks like she hasn't used anything thus far this year.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][POSITIVE] Alright, yeah, we'll go.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] I