AccountId: 011433970860
ContactId: b9c55a08-4555-46b4-8324-7663880f26d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215509 ms
Total Talk Time (AGENT): 103901 ms
Total Talk Time (CUSTOMER): 133857 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/b9c55a08-4555-46b4-8324-7663880f26d9_20250102T19:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII], uh, from Doctor [PII]'s office. I need to verify benefits on a patient. She has regular Aetna insurance and she says her American public life pays the co-pay.
[AGENT][POSITIVE] OK, well, I can definitely help you with the um benefits and her coverage. And can you repeat your name for me please and a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Sorry about that
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII] or not I'm sorry [PII]. I was trying to give you my dang fax number.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It's OK. Sometimes I get the cell phone numbers till they catch their cell.
[AGENT][NEUTRAL] And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am, it is 025160445.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Is that the same insurance card that she's always had?
[CUSTOMER][NEUTRAL] Well, double check it because in here it's showing you have a deductible.
[AGENT][NEUTRAL] And I have the number here. I just need you to verify the date of birth and the first and last name.
[CUSTOMER][NEUTRAL] And I've always paid $30 and it's gonna be my annual. OK, the, um, hang on just a second, the date of birth is [PII] and her first name is [PII] I think that's [PII].
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the last name is [PII]
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII]. And yes, ma'am, we are her secondary insurance, so we pay towards the copays, deductible and co-insurance after primary. If there is a co-pay that's required, um, she'll have to take care of that upfront and then once we receive the claim, she could be reimbursed or you all can be paid or, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On a
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] your
[CUSTOMER][NEUTRAL] So usually I always double check before I get the call.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's showing a $35 copay on her Aetna, so she needs to pay that and then after we file the claims and everything, you guys will more than likely reimburse her.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, um, are you all considered outpatient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well we are her PCP and we're in network.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] But if that's what you call outpatient, yeah I guess so.
[AGENT][NEUTRAL] Uh, hold on one second.
[CUSTOMER][NEUTRAL] But we're her, we're her PCP and.
[CUSTOMER][NEUTRAL] They're not in any facility when they see us, so.
[AGENT][NEUTRAL] Oh, no, it's OK. They, she has physician office coverage on this policy too. I just want to make sure, but for outpatient, the um max per year is $3000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but she still goes ahead and pays this copay and then and then goes from there, right?
[AGENT][NEUTRAL] Yes, ma'am. However you all handle it, if you can be billed, we'll handle it on the back end if she needs to pay for a service, then she'll have to pay upfront.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright then, thank you ma'am bye bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] No ma'am, what was your name?
[AGENT][NEUTRAL] All right. My name is [PII].
[CUSTOMER][NEUTRAL] Do you have a um.
[CUSTOMER][NEUTRAL] A lot like a reference or a call number, reference number?
[AGENT][NEUTRAL] I don't have a call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, all right, thank you very much I appreciate it, [PII].
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL and happy [PII] Year, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Uh, same to you bye bye.