AccountId: 011433970860
ContactId: ac592669-81d6-4803-b7c9-1c5c366c9f06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290079 ms
Total Talk Time (AGENT): 108997 ms
Total Talk Time (CUSTOMER): 138128 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/ac592669-81d6-4803-b7c9-1c5c366c9f06_20250423T13:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hi, and I'm sorry, did you say your name is [PII]?
[AGENT][NEUTRAL] Um, it's [PII]
[CUSTOMER][NEUTRAL] Oh, [PII], I'm sorry about that. [PII]. This is [PII]. I am with Quorum. I do want to let you know that the call is being monitored and recorded for quality and training purposes, and EV, if you don't mind, can I also get the initial of your last name, please?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] Thank you. I'm calling in reference to a mutual client. We were provided this insurance information, and I was looking to get coverage, uh, eligibility and benefits for oral internal nutritional formula. Is that something that would be covered under this?
[AGENT][NEUTRAL] Well, I can assist you with that. I can look it up for you. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that is [PII].
[CUSTOMER][NEUTRAL] My five digit extension is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure, so the policy number we were provided is 60801.
[AGENT][NEUTRAL] OK, that's our payer ID. Um, do you have the member's social or either name and date of birth? I can look them up that way.
[CUSTOMER][NEUTRAL] I have the name and date of birth.
[AGENT][NEUTRAL] OK. What's the last name?
[CUSTOMER][NEUTRAL] So first name is [PII].
[CUSTOMER][NEUTRAL] First name is [PII] and it's spelled like the [PII] [PII]. Uh it's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And last name, uh it's [PII]
[AGENT][NEUTRAL] So that's
[CUSTOMER][NEUTRAL] There's another num uh ID number here too. I'm sorry, go ahead.
[AGENT][NEUTRAL] So that's V E V like Victor, or B like boy?
[CUSTOMER][NEUTRAL] Uh, D as in Delta. I'm sorry.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] Oh, no worries.
[AGENT][NEUTRAL] OK. And what's the date of birth?
[CUSTOMER][NEUTRAL] Uh, for [PII] it is [PII].
[AGENT][NEUTRAL] OK, thank you. I found him in our system and just let me advise you that verification of coverage does not guarantee payment of claims. Um, would you like his policy number or her policy number?
[CUSTOMER][POSITIVE] Yes please, yes, thank you.
[AGENT][NEUTRAL] Um, the number is 022-03102.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. No problem. And the effective date on this policy was [PII]. The policy is still active. And where would these services take place? Um, inpatient, outpatient, or in the office?
[CUSTOMER][NEUTRAL] So this is for oral internal nutritional formula and we'll ship it directly to their home today. They're going to self-administer at home with no nursing or consultation.
[AGENT][NEUTRAL] OK, yeah. Cause under this policy, this is for secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible for services that the primary insurance company covers first. And um the, it also needs to be related to an illness or an injury.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It sounds like it's for feeding it's formula.
[CUSTOMER][NEUTRAL] OK, yeah, this is.
[CUSTOMER][NEUTRAL] Right, this is for internal feeding so it wouldn't be covered.
[AGENT][NEGATIVE] No, ma'am. It sounds like something that wouldn't be covered.
[CUSTOMER][NEUTRAL] OK, alrighty, well, um, E, I think that's all I need, so you said this is like a gap plan.
[AGENT][NEUTRAL] Yes, ma'am. It's Medical Gap Insurance.
[CUSTOMER][POSITIVE] Alrighty, I'll make a note of that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All righty. I will let them know that um it's only covered for illness or injury, not for internal feeding.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, well thank you so much [PII] for looking into it. Is there a reference number for the call today?
[AGENT][POSITIVE] Yes, you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, you've been great. I appreciate it. You have a great rest of the week and be safe.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you.