AccountId: 011433970860
ContactId: b9a0a842-bb3d-4a50-82da-fa51c5b54675
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 864659 ms
Total Talk Time (AGENT): 217566 ms
Total Talk Time (CUSTOMER): 349863 ms
Interruptions: 5
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/b9a0a842-bb3d-4a50-82da-fa51c5b54675_20250122T18:16_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? I'm calling from Nicola Children Hospital. I'm doing good. I'm calling from Nicola Children Hospital. It's in regards uh to no eligibility and benefits on one of your members, please.
[AGENT][POSITIVE] I'm great, thanks [PII]. How are you?
[AGENT][POSITIVE] Sure, I can assist you with that. I didn't catch your name. Can I have it again and the callback number for you?
[CUSTOMER][NEUTRAL] Yeah, uh my name is uh [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Can I have the policy number of the member?
[CUSTOMER][NEUTRAL] Your name, oh yes, yes, it is, uh, it's for hospital outpatient X-ray. It is uh 02507924 ML8.
[AGENT][NEUTRAL] Thank you and what is the member's name and date of birth that you're requesting benefits for today?
[CUSTOMER][NEUTRAL] It is uh first name is [PII].
[CUSTOMER][NEUTRAL] Uh, the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] What is her date of birth?
[CUSTOMER][NEUTRAL] It is I have uh [PII].
[AGENT][NEUTRAL] I'm not showing that date of birth. Do you have a policyholder's name and date of birth, because that's a different date of birth that we have for [PII].
[CUSTOMER][NEUTRAL] Oh yes it is it is hold on one second. Well, I have, uh, let me check, hold on one second.
[CUSTOMER][NEUTRAL] [PII], first name [PII], the last name.
[CUSTOMER][NEUTRAL] It's the mother I believe [PII] [PII].
[AGENT][NEUTRAL] You might want to reach out to the policyholder to verify [PII]'s date of birth because we have something completely different in the system. You said her birthday was [PII].
[CUSTOMER][NEUTRAL] OK, hold on one second, let me, let me look for it. Give me one minute.
[CUSTOMER][NEUTRAL] Uh yes, it's [PII]. The the the first name is [PII]. The last name is [PII].
[AGENT][NEUTRAL] Right, so her name matches, but the date of birth doesn't.
[CUSTOMER][NEUTRAL] The date of birth that I have.
[CUSTOMER][NEUTRAL] In the system it is [PII].
[AGENT][NEUTRAL] No, we don't have [PII] as the year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You don't have [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, not as the year in the system.
[AGENT][NEUTRAL] And I can't give you what we do have because it doesn't match what you're verifying.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, but the.
[AGENT][NEUTRAL] Let me pull up the application to see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bear with me, I'm looking up to see what was submitted under the policy itself.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I place you on a brief hold?
[CUSTOMER][POSITIVE] Sure, absolutely.
[AGENT][POSITIVE] Thank you. Be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Now transferring.
[CUSTOMER][NEUTRAL] Thank you for calling the APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], how are you doing?
[CUSTOMER][NEUTRAL] I'm fine how are you?
[AGENT][POSITIVE] I'm great thanks for asking [PII]. This is [PII] in claims um.
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][NEUTRAL] How you been doing, Miss [PII]?
[CUSTOMER][POSITIVE] I'm good, Ms. [PII]. It's good to hear your voice, honey.
[AGENT][NEUTRAL] Same here. This is [PII]. I call. Could you look at a policy with me?
[CUSTOMER][NEUTRAL] I can help you.
[CUSTOMER][NEUTRAL] I can.
[AGENT][NEUTRAL] The policy number, let me know when you're ready for it.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It is 2507924.
[CUSTOMER][NEUTRAL] I've not talked with you in a while.
[AGENT][NEUTRAL] It's been a minute.
[CUSTOMER][NEUTRAL] Yes, it has.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes, um, so I have a provider on the phone. She's calling about [PII], but when she got ready to verify the date of birth, she said it was [PII], and I was trying to pull up the, the, um, application to the policy, but when I get in on base I'm not able to see anything to verify if there was a typo or something.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] I bet it was
[CUSTOMER][NEUTRAL] Uh, this was issued through enrollment services probably off of a file fee or something so let we'd have to, I will have, I can, uh, la la la la la. Oh, let me think, let me think how I put the wrong number all together.
[CUSTOMER][NEUTRAL] Um, let me look 17021 let's try that again.
[CUSTOMER][NEUTRAL] Yeah, let me see if I can go in and find anything.
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] My impatient decisions.
[AGENT][NEUTRAL] And I'm normally able to go on the APR applications and put in the policy number.
[AGENT][NEGATIVE] But it's, it, it didn't pull up anything for me when I did that.
[CUSTOMER][NEUTRAL] Yeah, because it was issued off of a file.
[CUSTOMER][NEUTRAL] So it, it's just it's not gonna be under the policy number South Miami inpatient physicians.
[CUSTOMER][NEUTRAL] Let's say this was issued 2024.
[CUSTOMER][NEUTRAL] We're just gonna see if we can find anything.
[CUSTOMER][POSITIVE] Fingers crossed. So I do see a sense of so let hopefully she's on here.
[CUSTOMER][NEUTRAL] Oh wow, but down I got down all the time. I look on it.
[CUSTOMER][NEUTRAL] It's not an ABC order. Let's see if I can find.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So Miss [PII], they got 2024 on here on this file.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] They sure do. They've got 2024 on the file that we received from the group.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let me, let me check it, um, hold on, let's see who can I ask where's.
[CUSTOMER][NEUTRAL] Where's [PII].
[CUSTOMER][NEUTRAL] And the, the providers saying it should be [PII], she's at lunch.
[CUSTOMER][NEUTRAL] Let's see if this [PII] is available. [PII]'s, nope, she's not at lunch.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Let's try [PII].
[CUSTOMER][NEUTRAL] They sure have 2024 on here. They come on they have [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the providers and it should be [PII].
[AGENT][NEUTRAL] If we
[AGENT][NEUTRAL] That's what I was calling to see was it on the application, but because in the system it says [PII], but she's giving me [PII].
[CUSTOMER][POSITIVE] Yeah, I'm gonna go ahead and update it so you can.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And I told her to advise just for the policyholder like she verified the policyholder's name and date of birth, but just not [PII], that's who she's calling about.
[CUSTOMER][NEUTRAL] OK, I am
[AGENT][NEUTRAL] I told her to advise [PII] to give us a call to verify [PII]'s date of birth.
[CUSTOMER][NEUTRAL] Yeah, I think we need to do that, but I went ahead and updated it, but I think the, the, the mother, the insured should give us a call, um, updated part two.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They the date of.
[CUSTOMER][NEUTRAL] Date of birth from.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Per
[CUSTOMER][POSITIVE] OK, Ms. [PII], go ahead. We're gonna go ahead and do it. If it's wrong, we'll just have to fix it later. But I, I'm hoping, I'm hoping it's, it is the providers probably sitting there with the mom and everybody, you know, hopefully it's right.
[AGENT][POSITIVE] Alright, thank you Miss [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am. Well, thank you, Ms. [PII].
[CUSTOMER][POSITIVE] You're welcome, dear. Have a good day, [PII]. That's right, that's right.
[AGENT][POSITIVE] And hopefully I'll see you next week.
[AGENT][POSITIVE] Well, thank you. You have a good one as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You too, sweetie. Bye-bye.
[AGENT][NEUTRAL] Hello, [PII]?
[CUSTOMER][NEUTRAL] Hi, yes, yes.
[AGENT][POSITIVE] Thank you for holding. So, um, I'm gonna give you the benefits, however, if you would be.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Would you be able to reach out to [PII], the mom to call ATL to verify [PII]'s date of birth because the one that you provided is not mentioned in the system.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I'm gonna write it all, yeah.
[CUSTOMER][NEUTRAL] OK, uh, what are the benefits?
[AGENT][NEUTRAL] So this policy has been active since [PII] and it's currently active and you're calling about outpatient benefits. The member has outpatient benefits of $3500 per calendar year for outpatient services and this is not a guaranteed benefits, just a disclaimer of the policies policies. This is a mm, $3500 per calendar year and this is not a guarantee of benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The patient has uh or the uh has utilized something or the 3 no.
[AGENT][NEUTRAL] No, the member's benefit starts over in January, January the first until December, and she has no history on file, nor has she utilized any of her benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So no accumulation.
[AGENT][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] No a commodation, OK, uh, your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and what is the first letter of your last name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], [PII]. What is the first initial of your last name?
[CUSTOMER][NEUTRAL] [PII]. So I'm gonna write a note and then count it that the mother has to call the.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Insurance to uh update the date of birth.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, [PII] for your patience. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, no, no, I'm, I'm OK, [PII]. thank you very much for your help bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.