AccountId: 011433970860
ContactId: bcd9b189-2cae-464b-89d7-3b3c516cee11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353250 ms
Total Talk Time (AGENT): 183148 ms
Total Talk Time (CUSTOMER): 111225 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/bcd9b189-2cae-464b-89d7-3b3c516cee11_20250505T19:07_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. First initial to my last name is [PII]. I'm so sorry, I wasn't able to hear your name.
[AGENT][NEUTRAL] Yes ma'am. My name is [PII] [PII], that's [PII]
[CUSTOMER][NEUTRAL] All right, thank you so much for that, [PII]. So I am calling in reference to a patient. I just wanna see what their eligibility and benefits are.
[AGENT][POSITIVE] OK, [PII], I'll be glad to help you. Go ahead, give me a good policy number, please.
[CUSTOMER][POSITIVE] Yes, of course. Let me pull it up here.
[CUSTOMER][NEUTRAL] Policy number is going to be the number 60801.
[AGENT][NEUTRAL] That is our electronic payer ID number. What I'm needing, [PII], is that certificate number, like an eight digit number starts with 01 or 02.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me see if they provided it with.
[CUSTOMER][NEUTRAL] Cause some, that's what the patient herself provided. So let me see if I can find.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Take your time, [PII].
[CUSTOMER][NEUTRAL] Give me
[CUSTOMER][NEUTRAL] So there seems to be a new policy. I, I don't have the policy number. I have only that number provided. I have the patient information. I don't know if that's a way to.
[AGENT][NEUTRAL] What do you
[AGENT][NEUTRAL] Well, I can. Do you have the insured on this policy Social Security number by chance?
[CUSTOMER][NEUTRAL] Let's find out if she, I gave it.
[CUSTOMER][NEUTRAL] So she refused to give it.
[AGENT][NEUTRAL] OK, let's see. The only other way I can look it up is hopefully we can find it by the name. So what is the patient's uh last name?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Her name is [PII], so it's going to be [PII], and then the letters [PII].
[AGENT][NEUTRAL] [PII] is the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, OK. And first name please, ma'am [PII]?
[CUSTOMER][NEUTRAL] That's gonna be [PII]
[AGENT][NEUTRAL] [PII] OK, let me just put that in. Let's just see if we can find her.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, I see somebody. What, what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yep. Her date of birth is going to be [PII].
[AGENT][NEUTRAL] Yeah, I see it. She's a dependent. uh, OK, first off, [PII], I'm gonna give you the correct policy number. This will be the number that you need to send in to APL on any claims that you send in to APL and that policy number is going to be 02.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] 61.
[AGENT][NEUTRAL] 6798.
[CUSTOMER][POSITIVE] All right perfect thank you so much for that.
[AGENT][NEUTRAL] Yes, ma'am. All right, [PII], let's see. Now, you did say you want benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, this would be outpatient.
[AGENT][NEUTRAL] OK, OK, is that what she haven't done outpatient, you know what she's having done outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, she's having an ultrasound breast.
[AGENT][NEUTRAL] OK, alright, let me get back over there. OK, now I do show the original effective date on this medical supplemental plan.
[AGENT][NEUTRAL] Um, [PII], she is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim. But now what we all of course is just her medical supplemental plan. So the only thing that we will pick up and pay on is anything for sickness and injury. No routine here is covered no matter what that is applied towards your deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] And her benefit for outpatient here is a zero deductible, no pre-cert, and she has $1000 payable per calendar year under this benefit, and she has not met any claims as of today.
[CUSTOMER][NEUTRAL] OK, so just to make sure she has $1000 per year and remaining, she has $1000. You also mentioned you guys cover only illness and sickness. So for example, a routine.
[AGENT][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] A routine visit co-pay, she wouldn't be covered?
[AGENT][NEUTRAL] No, not for, uh, she don't have office visits, period. But if it's for a routine mammogram, no, ma'am. There's nothing routine covered at all. It would have to have a medical uh diagnosis on it. Nothing routines covered here, no matter what the primary insurance carrier does.
[CUSTOMER][NEUTRAL] OK. All righty, perfect. OK, yeah. So then she wouldn't be covered for this exam. It's just.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, well that.
[CUSTOMER][POSITIVE] All right, perfect. All I would need to
[CUSTOMER][NEUTRAL] All I would need now is just a reference number if you guys provide them.
[AGENT][NEUTRAL] Well, is that all that I can help answer for you today, [PII]?
[CUSTOMER][POSITIVE] Yep, that was all. Thank you so much.
[AGENT][NEUTRAL] Alright, well, we do not give reference numbers, [PII], but you can use my name in today's date if you need to do so, OK?
[CUSTOMER][POSITIVE] All right, thank you so much for that. [PII]. Have a great day. Enjoy your week.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. You as well, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.