AccountId: 011433970860
ContactId: a76677e0-a067-4afe-9fe9-f55cfa39a0bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463390 ms
Total Talk Time (AGENT): 205448 ms
Total Talk Time (CUSTOMER): 129522 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/a76677e0-a067-4afe-9fe9-f55cfa39a0bd_20250512T20:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I'm calling from Ortho now. I wanted to verify a patient's, um, eligibility and benefits for a gap insurance for urgent care.
[AGENT][NEUTRAL] OK, you're wanting to, OK, so you're needing eligibility and benefit information, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. Would you please spell your first name for me?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][POSITIVE] OK, thank you. And a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy.
[CUSTOMER][NEUTRAL] And I'm sorry I missed your name.
[AGENT][NEUTRAL] [PII] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], um, so the member ID number is 01.
[AGENT][NEUTRAL] Albia.
[CUSTOMER][NEUTRAL] 509. Hi, can you hear me?
[AGENT][NEUTRAL] No. LB, your voice, well, I can now, I couldn't. I heard 01 and then your voice went out.
[CUSTOMER][POSITIVE] Oh, I'm so sorry, can you hear me now?
[AGENT][NEUTRAL] I can hear you at the moment. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, 01638509 ML 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] And any information Evia that I do provide for you will be a verification of benefits and not a guarantee of payment. What is the patient's name and their date of birth?
[CUSTOMER][POSITIVE] Bless you.
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show she is the subscriber on the supplemental policy and yes ma'am, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And she has an outpatient benefit maximum per calendar day for covered outpatient services of $500 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][POSITIVE] OK perfect so she'll be completely covered for an urgent care visit?
[AGENT][NEUTRAL] Again, I cannot guarantee payment. I can only provide you the benefit information on the policy. We'll have to receive the claim along with her primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] Oh, OK, so it doesn't tell you if it covers for urgent care or not.
[AGENT][NEUTRAL] Urgent care is one of the places of service that can be reviewed under this benefit.
[CUSTOMER][NEUTRAL] Perfect. And then do you mind me having the initial to your last name please? Thank you. Give me a second, um, the initial to your last name and a reference number please.
[AGENT][NEUTRAL] The initial to my last name is [PII]. My name and today's date will be your call reference number and I'll be uh also once if you all receive, I'm sorry if you all submit a claim to us for review once it's been processed, we have a portal that you should be able to check claim status in and the website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] Perfect question for you. I do have her son here. Her son is under her husband's um insurance, but they don't have the APO card. Is there any way that we could look them up by name and date of birth?
[AGENT][NEUTRAL] I can't search my date of birth, um.
[AGENT][NEUTRAL] I can try by the name if it's a if it's a very common name yeah I may not be able to without the either the father's social. do you have the father's full social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I have the son's name and date of birth.
[AGENT][NEUTRAL] OK, again I can't search my date of birth so let I can try by the name, give me just one moment.
[CUSTOMER][NEUTRAL] Oh OK, OK, sure.
[AGENT][NEUTRAL] And what is the last name?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] The uh sorry, the name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What is the father's name?
[CUSTOMER][NEUTRAL] Um, my father's name is.
[CUSTOMER][NEUTRAL] Sorry, I think it's [PII]. Let me double check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] OK, and then what is, and same with this one any information provided would be a verification of benefits and not a guarantee of payment. What is [PII]'s now, how did you spell his name?
[AGENT][NEUTRAL] Spell his first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. You just didn't give me the [PII] a while ago. OK, that's why I was asking you to reverify it. OK, so just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that he is covered under the father's plan and the policy is active, effective [PII]. The correct policy number that you should have for him is 01638500.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And the group number 22609 as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the benefit information is the same, the outpatient benefit max per calendar day for covered outpatient services is $500 with no deductible.
[AGENT][NEUTRAL] And we will have to have a copy of the primary insurance explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Awesome thank you so much, [PII] would you mind just sharing the payer ID number for me please?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] 60801 thank you so much have a great rest of your day.
[AGENT][POSITIVE] Well, you're very welcome and if that is all that I'll be that I can help you with today. Thank you for calling APL and I hope you have a nice rest of your day also.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Uh bye bye.