AccountId: 011433970860
ContactId: ad2bc745-2f2e-49a5-91aa-65acecba5e04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217720 ms
Total Talk Time (AGENT): 69996 ms
Total Talk Time (CUSTOMER): 71414 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/ad2bc745-2f2e-49a5-91aa-65acecba5e04_20250428T19:46_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling in from Doctor [PII]'s office. He's a cardiologist. I would like to get some eligibility and benefit details for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits. Do you have a good callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] The one I have on file is 301.
[CUSTOMER][NEUTRAL] 435
[CUSTOMER][NEUTRAL] 49,100.
[AGENT][NEUTRAL] Um, that's, uh, not one of our policy numbers. Uh, could that be the social maybe? Or do you have the social?
[CUSTOMER][NEUTRAL] I don't have the social, that's what's coming up as.
[CUSTOMER][NEUTRAL] Member ID policy number.
[AGENT][NEUTRAL] OK, and what's the last name? Or the, do you have a group number?
[CUSTOMER][NEUTRAL] Group number is 15434.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me give you the policy number. It is 258.
[AGENT][NEUTRAL] 0082.
[AGENT][NEUTRAL] Yeah, it looks like this policy is effective [PII], currently active.
[AGENT][NEUTRAL] And is this for outpatient benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. It's not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Get that pulled up. One moment.
[AGENT][NEUTRAL] OK, for his outpatient benefits, it is a $500 covered benefit per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does he need any authorizations for imaging?
[AGENT][NEUTRAL] Uh, no, no office is required, and this is a secondary policy. So after primary insurance processes the claim, this would pick up to $500 per occurrence, um, of deductible or co-insurance.
[CUSTOMER][NEUTRAL] So this is a secondary insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll contact the patient and this is the one we have as primary, so that's why I was calling in.
[AGENT][NEUTRAL] And I showed
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][NEUTRAL] OK, I do show the primaries through Aetna.
[CUSTOMER][NEUTRAL] OK, um, we did search him up through the Aetna, um, ability portal, and it's coming out as inactive, so that's why he provided this information.
[AGENT][NEUTRAL] Oh, OK. OK. All right.
[CUSTOMER][POSITIVE] Thank you so much for your help though.
[AGENT][POSITIVE] OK, thank you for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.