AccountId: 011433970860
ContactId: c4ab9171-a702-4503-9d06-452427b867be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220479 ms
Total Talk Time (AGENT): 78122 ms
Total Talk Time (CUSTOMER): 85769 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/c4ab9171-a702-4503-9d06-452427b867be_20250521T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good, uh, morning. My name is [PII] and I'm calling to check the member's eligibility and benefits.
[AGENT][POSITIVE] OK, [PII]. I'm happy to check eligibility and benefits. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number here is D as in David 43733452.
[AGENT][NEUTRAL] Unfortunately, I can't pull the member with that number. Do you have their card? Do you see a certificate number, or do you have their name or date uh social?
[CUSTOMER][NEUTRAL] Mm, can you try this one that is [PII]?
[AGENT][NEUTRAL] Let me try that.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So, patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Is there any group number or group name?
[AGENT][NEUTRAL] Looks like the group number is 70056.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The group name is Man analysis and utilization.
[CUSTOMER][POSITIVE] OK, thank you so much. So can you be able to provide me the.
[CUSTOMER][NEUTRAL] uh eligibility for the durable medical equipment, so I need the co-insurance deductible in the out of pocket.
[AGENT][NEUTRAL] This is not a major medical, it's a limited benefit plan. So it's only gonna pay a set amount towards services rendered. There is no deductible co-pay or co-insurance on it. Let me see if medical equipment's covered under the plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK sure thank you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't show that medical equipment is listed under the patient plan, so it would not be a covered benefit.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So you mean that this patient?
[CUSTOMER][NEUTRAL] Durable medical equipment if the CPAP supplies will not cover.
[AGENT][NEGATIVE] There's no coverage for that on the patient plan.
[CUSTOMER][POSITIVE] OK, so if the techies, thank you so much, [PII], and I'll go ahead and call the patient to uh.
[CUSTOMER][NEUTRAL] Inform them that uh.
[CUSTOMER][NEUTRAL] He's not uh covered for this insurance for the medical supplies. But, uh, is there any reference number for this call?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] References my name with my last initial and today's date. My name again is [PII], that's [PII] [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. So thank you so much, [PII], for your assistance. It's highly appreciated. Bye for now and you have a good day.
[AGENT][NEUTRAL] You too. Bye bye.