AccountId: 011433970860
ContactId: b32cc752-9e73-4c14-b66b-feb4a880028a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345899 ms
Total Talk Time (AGENT): 140407 ms
Total Talk Time (CUSTOMER): 118239 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/b32cc752-9e73-4c14-b66b-feb4a880028a_20250214T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from Tri County Pediatrics. Um, I was just calling to get the eligibility and benefits of a patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well I can verify benefits and eligibility for you, Ms. [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Will it be the employee ID? No.
[AGENT][NEUTRAL] No, ma'am. On the card, do you see a policy slash cert number or um in hospital outpatient benefit cert number starts with a 01 or 02?
[CUSTOMER][NEUTRAL] No, I don't see that on the card.
[AGENT][NEUTRAL] OK. What's the patient's name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Rainy, um, it's rain and then E Y.
[AGENT][NEUTRAL] OK. And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, Mr. [PII], give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And when you're ready, Miss [PII], I can give you the policy number with us.
[CUSTOMER][NEUTRAL] OK, you say you can give it to me?
[AGENT][NEUTRAL] Yes, ma'am. I can get that uh policy number to you.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, it's 257-3800.
[AGENT][POSITIVE] And effective.
[CUSTOMER][NEUTRAL] 2,573,800
[AGENT][NEUTRAL] Yes, ma'am, um, but the effective date of [PII] and the policy is active. And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what benefits you're needing for this patient?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well visits, sick visits and immunization.
[CUSTOMER][NEUTRAL] Uh, so what's the name of the insurance?
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] APL
[CUSTOMER][NEUTRAL] APL, OK.
[AGENT][NEUTRAL] OK, uh, let's see, not a guarantee of payment, just a verification of coverage. Uh, with the policy for 6 visits, uh, the max payable is up to $50 per visit and they have a max of $4 per calendar year.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] You said $50?
[AGENT][NEUTRAL] Uh yes, ma'am, $50.
[CUSTOMER][NEUTRAL] Max 4 per year.
[AGENT][NEGATIVE] And I don't show they have any wellness benefits and immunizations are not covered under the plan.
[CUSTOMER][NEGATIVE] You said no wellness visits, no benefits.
[CUSTOMER][NEUTRAL] And not cover immunization.
[AGENT][NEUTRAL] Uh yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, what's your name? I'm sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] TQQ. OK. Do they need a PCP?
[AGENT][NEUTRAL] Uh, no, ma'am, it's not required.
[CUSTOMER][NEUTRAL] Do they have any deductible and amount me?
[AGENT][NEUTRAL] Uh, no, there's no deductible on the policy.
[CUSTOMER][NEUTRAL] OK, let me make sure I got some any co-pay or coinsurance?
[AGENT][NEUTRAL] Uh, no, ma'am, we just pay that max of $50 and then any balance remaining would be patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect, thank you. um, what address do I use to bill the claims?
[AGENT][NEUTRAL] Uh, it should be [PII].
[CUSTOMER][NEUTRAL] One second, [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Say that last part again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and this phone number, the phone number [PII] is a good number, right?
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] [PII] and just one last thing just to make sure that we are in network with them.
[AGENT][NEUTRAL] Uh, we don't have a network. Um, insurance can go to, um, multi-plan provider, but it doesn't affect how much we will pay on the plan. It just helps. If they go to a multi-plan provider, it's like a repriced or discount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate you.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] No problem have a good one.
[AGENT][NEUTRAL] Mm bye.