AccountId: 011433970860
ContactId: b8085e4b-beea-462b-b69f-e52f42cd80ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 757179 ms
Total Talk Time (AGENT): 216893 ms
Total Talk Time (CUSTOMER): 184714 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/b8085e4b-beea-462b-b69f-e52f42cd80ab_20250408T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, I am calling from Harro Medical Center. I am trying to get um.
[CUSTOMER][NEUTRAL] Verification eligibility for this patient.
[AGENT][NEUTRAL] OK. And then did you say your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]? OK.
[AGENT][POSITIVE] Yes, I can help you with verification and eligibility today.
[AGENT][NEUTRAL] Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] 02549386
[AGENT][POSITIVE] OK, thank you. And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] OK. And then patient's first, last name, and date of birth, please?
[CUSTOMER][NEUTRAL] Oh, I'm gonna spell her first name, [PII]
[CUSTOMER][NEUTRAL] The Last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] OK, let me read this policy number back to you, um.
[AGENT][NEUTRAL] It is 254-938-6.
[CUSTOMER][NEUTRAL] 0254 it's a 0 on the front I'm not sure if that's a.
[AGENT][NEUTRAL] OK. Yeah, we don't really use those zeros. I don't have that person on this policy number.
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] I don't have this, this person is not listed on this policy.
[CUSTOMER][NEUTRAL] OK, so on the car she gave me, I guess it says employee or spouse. I'm assuming she's a spouse because it has an insurer named [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could that be a reason?
[AGENT][NEUTRAL] Yes, um, but even spouses are typically listed on the policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I don't know if she just doesn't know.
[CUSTOMER][NEUTRAL] 2542.
[CUSTOMER][NEUTRAL] 254-938-9
[AGENT][NEUTRAL] Uh, OK, let me try 89.
[AGENT][NEUTRAL] Let's see, just one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's a [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, I'm sorry, I can't pronounce it.
[AGENT][NEUTRAL] Uh yes, I don't blame you. Um, so [PII], that's the information you gave me, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this is, this policy is correct, OK.
[CUSTOMER][NEUTRAL] Really quick question I'm not sure um.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] When we do claims, I, I, who do we send it to because I'm trying to look you up in my system to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I put American public life and it's not.
[CUSTOMER][NEUTRAL] Pull it or generate anything.
[AGENT][NEUTRAL] So, it's, it's [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you see APL at the top?
[CUSTOMER][NEUTRAL] No, so I'm trying to through my system and we usually just put like the insurance name and like let's say United Healthcare and it'll generate it will just, but when I put a.
[CUSTOMER][NEGATIVE] It's not really giving me like any.
[CUSTOMER][NEGATIVE] Options, I mean it's giving me a lot of options just not your guys' option if that makes any sense.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Um, but I can always, you know, add it and stuff like that.
[AGENT][NEUTRAL] OK, so it's just [PII] and then once you're on the website on the far right there is claims and forms.
[CUSTOMER][NEUTRAL] something that we never.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you just looking for the claim forms?
[CUSTOMER][NEUTRAL] Um, no, no, no, I was try I was trying to see under um.
[CUSTOMER][NEUTRAL] The actual name to like send the claim it will would it be to the [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, and I just wanna verify her, sorry, sorry, I got sidetracked trying to multiize here. I'm just trying to see if she's eligible. She's here for a new patient visit for to establish care with one of our providers.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] OK, yes, I can. Let me check her.
[CUSTOMER][NEUTRAL] And what is the
[AGENT][NEUTRAL] And it's let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So her policy is active.
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She is eligible.
[AGENT][NEUTRAL] Yes, she is. Mhm.
[CUSTOMER][NEUTRAL] Does she have any copay or any um.
[CUSTOMER][NEUTRAL] And that
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Just one second. I can look for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and you're needing outpatient benefits? I'm assuming she's in office.
[AGENT][NEUTRAL] Right now.
[CUSTOMER][NEUTRAL] Yes she is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Are you married, single?
[CUSTOMER][NEUTRAL] you need
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Do you mind if I just put you on a brief hold and I'm going to look deeper into her policy really quick, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi, thank you for holding so.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It looks like the patient has accident and sickness.
[AGENT][NEUTRAL] Uh, surgery benefits. So a surgery in hospital, which would be outpatient facility or freestanding outpatient surgery center, surgery in a physician's office. So the hospital outpatient facility and the free-standing outpatient surgery center is 3000 per day.
[AGENT][NEUTRAL] And that's maximum of one day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so I'm so sorry she's just here to establish care with the a primary doctor.
[CUSTOMER][NEUTRAL] Like a regular office new patient clinic sorry.
[AGENT][NEUTRAL] Yeah, I'm, I'm not seeing.
[CUSTOMER][NEUTRAL] Would that make any difference?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] That could be a possibility she's not covered.
[AGENT][NEUTRAL] Yes. Uh.
[AGENT][NEUTRAL] So with this plan, it's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] So it's like a limited medical policy.
[CUSTOMER][NEUTRAL] She's recover.
[CUSTOMER][NEUTRAL] OK, so she probably just covered for hospital, right?
[AGENT][POSITIVE] Yes, correct. Mhm.
[CUSTOMER][NEUTRAL] OK, that's fine um can I get uh your name and a reference number please?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, of course. Uh my name is [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then last initial is [PII], and then it would be today's date.
[CUSTOMER][NEUTRAL] OK, so it's [PII]?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] Or just [PII] OK alright so she's just uh.
[AGENT][NEUTRAL] It would just be [PII], sorry. Mhm.
[CUSTOMER][NEUTRAL] OK, for [PII] or [PII]?
[AGENT][NEUTRAL] Yeah. [PII].
[CUSTOMER][POSITIVE] All right, and she's on the cover of for hospital right, perfect, thank you.
[AGENT][NEUTRAL] OK, thank you for calling APL. Is there any further questions?
[CUSTOMER][POSITIVE] No problem bye bye.
[CUSTOMER][POSITIVE] Uh, no, that'll be for today. Thanks.
[AGENT][POSITIVE] OK, yeah. Have a good day. Bye.
[CUSTOMER][NEUTRAL] You too bye.