AccountId: 011433970860
ContactId: b8350f8a-acdb-4019-8317-1477fb70ee02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603270 ms
Total Talk Time (AGENT): 207581 ms
Total Talk Time (CUSTOMER): 247193 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/b8350f8a-acdb-4019-8317-1477fb70ee02_20250317T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII], and I'm calling from Sims Murphy Clinic Department of Insurance and verification. I needed to verify, uh, patient's benefit. If I could, that there'll be a new patient with us, and they're trying to, uh, get an appointment set up scheduled for, for her.
[AGENT][POSITIVE] OK. I'm happy to check on benefits today. What's your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, I'm showing D as in Delta 46401216.
[AGENT][NEUTRAL] Alright, um, unfortunately, [PII], I can't pull him with that number. Do you have their name or their social? I can check by that.
[CUSTOMER][NEUTRAL] Yes, yes, indeed I can give you the social. Hold on one second, let me pull it up here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm wondering if I have the right uh ID number because the uh the card that she sent over is kinda, kinda fuzzy and that was the number that they put in uh for the social is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] OK, let's try that and see what we get here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the patient's first?
[CUSTOMER][NEUTRAL] She's the dependent.
[AGENT][NEUTRAL] Oh, is she?
[CUSTOMER][NEUTRAL] Uh, [PII], uh-huh.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And I see his name but I don't have his date of birth when she called in she just provided her information only, but I see on the card I see his name is.
[CUSTOMER][NEUTRAL] Subscriber.
[AGENT][NEUTRAL] Yeah, so it may not come up then if she's a dependent on it. Is the last name [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, mhm, and his first name is [PII].
[AGENT][NEUTRAL] What state do they live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then [PII], are we looking for dental or medical?
[AGENT][NEUTRAL] Coverage.
[CUSTOMER][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK, here we go. I found her.
[AGENT][NEUTRAL] All right. So, do you need this policy number to take down?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so the.
[CUSTOMER][POSITIVE] So this is really funny.
[AGENT][NEUTRAL] Policy number is gonna be 02.
[AGENT][NEUTRAL] 47.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 64.
[AGENT][NEUTRAL] 52.
[CUSTOMER][NEUTRAL] Let me repeat that back 02476452.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, that's totally different. So the employee, OK, because on here it says employee ID. OK, so let me make sure I have the correct address we, we do, uh, go by the payer ID. I see that, uh, is the pay ID 64556.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, yeah, all the claims for this plan go to IMA.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 45 OK and then uh that billing address is that the [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, just wanna make sure I got all of that right. Let me get that down and there's benefits in a card, right, benefits.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, and this is a limited, this is, is this a limited benefit plan?
[AGENT][NEUTRAL] Yes, ma'am. It is, yeah, so it's just gonna pay that set amount depending upon what they're being seen for. So for an office visit, let me see what they have here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We're a specialist office mhm we're a specialist office. I don't know if it's the same amount or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it looks like it has a physician's office and it looks like they're allowed to see under accident or sickness and the benefit amount for that is 125.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 125. OK, is there a certain amount of days that she has a year that's approved? Uh, how many days she has a year?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the plan looks like it only covers one visit a year.
[CUSTOMER][NEUTRAL] OK, 15.
[AGENT][NEUTRAL] Let me see if she's used one.
[CUSTOMER][NEUTRAL] Are you showing that she's already? OK.
[AGENT][NEUTRAL] Yeah, let's see. I don't show they've used any visits for the year, so.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] OK. Uh, what about like, um,
[CUSTOMER][NEUTRAL] Like we are a specialist office, but we also do like MRIs, uh, CAT scans, X-rays. Do you cover any of those, a certain amount or anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] So it looks like they are permitted diagnostic testing under the member plan up to 2 in a calendar year.
[AGENT][NEUTRAL] And it looks like the benefit amount on this is up to $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Up to $100 and and uh for 2 a year.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK, is that from the MRI CAT scan and X-rays?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, let me put that there. What about uh labs?
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] I don't see anything on here that speaks to any sort of lab work coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, no problem.
[CUSTOMER][NEUTRAL] And one more question, does the, uh, are there any surgery benefits, surgical benefits?
[AGENT][NEUTRAL] Um, so there is a, excuse me, a surgery in hospital or hospital outpatient facility, um, or surgery center. So the plan will cover, uh, looks like $500 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a maximum of one day per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One, OK.
[AGENT][NEUTRAL] If the surgery is in a physician's office, it does state that the benefit amount, it looks like is 125.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 125 and that, that would be once a year as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK, and then, uh, as far as the uh diagnostic, has she used any of those days by chance?
[AGENT][NEUTRAL] I don't show, yeah, no usage thus far for any of the benefits.
[CUSTOMER][NEUTRAL] I know there's 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK, alright, and I believe that is all I need do you, do you do call reference numbers?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference [PII] is gonna be my name with my last initials in today's date. My name again is [PII], which is [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. Alright, [PII], thank you so much for your help. 01 more thing and I'm out of your hair, are you showing us as in network? I know we, uh, we do accept multi plan as well. uh, by chance do you see that we're in network or anything, uh, with you all?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Um, I know with this particular plan the network's not required, so we unfortunately don't have a way to check that for you, [PII]. I remember, yeah, they can use it pretty much anywhere, but I hear, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. OK, no problem, mhm.
[CUSTOMER][POSITIVE] Got you OK alright thank you so much for your help and you have a wonderful Monday, OK? I appreciate you.
[AGENT][POSITIVE] You as well. Take care.
[CUSTOMER][POSITIVE] OK thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.