AccountId: 011433970860
ContactId: a407fbf6-bc86-4db2-848e-10542b56a99e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 531479 ms
Total Talk Time (AGENT): 159882 ms
Total Talk Time (CUSTOMER): 162942 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/a407fbf6-bc86-4db2-848e-10542b56a99e_20250122T21:32_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello, this is [PII].
[CUSTOMER][NEUTRAL] You said my last name [PII]. I'm calling on a recorded line for quality and training purpose for Doctor [PII], and I need to obtain medical benefits and eligibility for a patient.
[AGENT][POSITIVE] OK, yeah, [PII], I'd love to help you with eligibility and benefits today. And do you mind if I really quickly grab a good callback number?
[CUSTOMER][NEUTRAL] Sure. Callback number is [PII].
[AGENT][POSITIVE] Perfect. And
[AGENT][NEUTRAL] What is your member's policy number today that we want to look at?
[CUSTOMER][NEUTRAL] Well, it is.
[CUSTOMER][NEUTRAL] 01852130 M as in Mike.
[CUSTOMER][NEUTRAL] L as in Lima
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][POSITIVE] I appreciate that. Thank you very much. And let me get that policy pulled up for you.
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would you be able to verify for me please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The person's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Perfect. I do see [PII] here. Her, um, policy is current with us. She has an effective date of [PII], and you said you were needing benefit information as well, is that correct?
[CUSTOMER][POSITIVE] Sure, you're, you're right.
[AGENT][POSITIVE] Perfect, are we looking for inpatient or outpatient benefits today?
[CUSTOMER][POSITIVE] Well, it's an outpatient benefit.
[AGENT][NEUTRAL] Perfect. I do wanna let you know any benefit information I give you over the phone will be a verification of coverage and not a guarantee of payment. I do have, um, Miss [PII]'s outpatient benefit listed as $7000 per calendar year.
[CUSTOMER][NEUTRAL] One second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting.
[AGENT][POSITIVE] Oh my pleasure. Is there anything else I can do to help you, [PII]?
[CUSTOMER][NEUTRAL] Sir, um,
[CUSTOMER][NEUTRAL] May I know if the plan still active?
[AGENT][POSITIVE] Yes, it is active.
[CUSTOMER][NEUTRAL] Uh, then, are you secondary for Medicare?
[AGENT][NEUTRAL] We are a secondary insurance, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I know what's the specific name?
[AGENT][NEUTRAL] And what name, my name?
[CUSTOMER][NEUTRAL] Specific plan, I mean, sorry, specific plan name.
[AGENT][NEUTRAL] Oh, the plan name, yes, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, uh, like, is there, is there any other alphabetical name for this?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Plan G, F, J. Is there any other alphabetical number that?
[AGENT][NEUTRAL] It might say SFS like Sam Fox, Sam.
[CUSTOMER][NEUTRAL] Sorry, please can you repeat that?
[AGENT][NEUTRAL] Yes, it might say Medin, it might say SFS S like Sierra, F like Fox, S like Sierra.
[CUSTOMER][NEUTRAL] 11 2nd, sorry.
[AGENT][POSITIVE] Take your time.
[AGENT][NEUTRAL] Urgent need for funds.
[CUSTOMER][NEUTRAL] So, uh, sorry, I don't get the, the plan types, specific plant name like
[CUSTOMER][NEUTRAL] Is it standard or non-standard supplement plan?
[AGENT][NEUTRAL] You know, I'm not sure what a standard supplement plan is or a nonstandard we're like a gap insurance.
[CUSTOMER][NEUTRAL] It's a grab my insurance, right? And hold on a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] What you gave me is uh the plan name, the specific plan name is [PII] E D L I N K, right? Before what, what you, what do you give me before?
[AGENT][NEUTRAL] Yes, that is, it's a Medin plan.
[CUSTOMER][NEUTRAL] So there is no alphabetical plan over there, right, like plan A, plan B, plant J, plant K, plan F. There's no alphabetical name like that.
[AGENT][NEUTRAL] So there's not an alphabetical name to it. There is a subtext that says plan 7000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any group number for billing purpose?
[AGENT][NEUTRAL] Yes, the group number is 24,050.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] Will you follow Medicare guidelines?
[AGENT][NEUTRAL] Do we what?
[CUSTOMER][NEUTRAL] Will you follow Medicare guidelines?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Don't think of the supplemental insurance that we do follow.
[CUSTOMER][NEUTRAL] Will you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We will cover Medicare Part B, deductible and co-insurance.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me take a look at this particular policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It looks like this particular policy is set to follow their United Healthcare major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] And um, so, uh, will you coordinate with uh primary insurance?
[AGENT][NEUTRAL] And can you repeat that question? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, can you coordinate with primary insurance?
[AGENT][NEUTRAL] Can we code it with primary insurance?
[CUSTOMER][NEUTRAL] Will you coordinate with primary insurance?
[AGENT][NEUTRAL] Oh, so.
[AGENT][NEUTRAL] We're the secondary to their primary insurance. So their primary insurance should be United Healthcare, and then we follow secondary to that to help pick up and pay for the cost of the co-pay, the co-insurance or deductible.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you please uh spell out your name, and can I have the reference number, please?
[AGENT][NEUTRAL] Yes, my name is [PII], last initial [PII], and then the reference number is my name, my last initial and today's date.
[CUSTOMER][POSITIVE] Well, [PII], thank you so much for assisting with the information. Have a great day ahead. Take care and bye-bye for now.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] Thank you [PII] you take care as well bye bye.
[CUSTOMER][NEUTRAL] Bye.