AccountId: 011433970860
ContactId: aa4b8a79-d459-43b9-9017-c2ab1a70f73f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287000 ms
Total Talk Time (AGENT): 119466 ms
Total Talk Time (CUSTOMER): 130167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/aa4b8a79-d459-43b9-9017-c2ab1a70f73f_20250404T18:56_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, one second, uh, OK, and what is it again? [PII].
[AGENT][NEUTRAL] Mhm. [PII]
[CUSTOMER][NEUTRAL] [PII] OK, and the last initial is [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] First initial and last.
[CUSTOMER][NEUTRAL] OK, great. And my name is [PII] I'm calling from SSM Sle Care and I'm calling to verify eligibility on a member. Can I give you the member's ID number, please?
[AGENT][NEUTRAL] Sure, [PII]. Well, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure 314.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now I need the policy number.
[CUSTOMER][NEUTRAL] 02265947
[AGENT][NEUTRAL] Please verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, she does have a new policy number.
[CUSTOMER][NEUTRAL] OK, and what is the policy number?
[AGENT][NEUTRAL] It is 02556232.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 62025562.
[AGENT][NEUTRAL] 32.
[CUSTOMER][NEUTRAL] 32 is the ID number and what's the group number?
[AGENT][NEUTRAL] OK, let me get that for you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is 22517.
[CUSTOMER][NEUTRAL] 22517 correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And OK and what type of plan is this?
[AGENT][NEUTRAL] This is secondary gap insurance. Um, we cover the copay, the co-insurance, and deductible after the primary insurance processes the claim for our coverage services.
[CUSTOMER][NEUTRAL] OK, and is this something that the patient has to send?
[AGENT][NEUTRAL] Um, the patient can send, but normally the provider files the claim. What they'll do is send the claim form along with the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK and uh is the.
[CUSTOMER][NEUTRAL] Uh, let me see, and the address is [PII].
[AGENT][NEUTRAL] Right, in [PII].
[CUSTOMER][NEUTRAL] Uh huh and is the payment uh paid to the provider?
[AGENT][NEUTRAL] If the provider files the claim, then yes, ma'am, we'll send the payment directly to the provider.
[CUSTOMER][NEUTRAL] Um, exercise, follow the exercise. I'm sorry. OK. And is there any type of uh co-pay?
[AGENT][NEUTRAL] Um, no, ma'am. What we do is normally
[CUSTOMER][NEUTRAL] Specialists of PCP.
[AGENT][NEUTRAL] Yeah, what we normally do is cover the um co-pay, coinsurance and deductible. If it's covered under this policy, let's see. Well, actually, under this policy for co-pays in the office, there's no coverage, but for the charges that goes towards the co-insurance and the deductible, that is covered under this policy after the primary insurance processes.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alright, great, and uh [PII] is um effective and what's the effective date?
[AGENT][NEUTRAL] Um, the effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK, and is there a reference number for this call?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, that'd be all, thank you very much.
[AGENT][POSITIVE] Yeah, thank you, [PII], for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm, thank you.