AccountId: 011433970860
ContactId: c6f64574-1bbb-46f3-b03b-2d6d631f7c65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499730 ms
Total Talk Time (AGENT): 117627 ms
Total Talk Time (CUSTOMER): 185816 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/c6f64574-1bbb-46f3-b03b-2d6d631f7c65_20250409T14:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. It's [PII] and the initial is [PII]. I'm calling from provider's office and my concern is regarding the eligibility and benefits for the patient.
[CUSTOMER][NEUTRAL] The authorization for this.
[AGENT][NEUTRAL] OK. OK, [PII], I can help you with benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have 0190932 and my ID number 8.
[CUSTOMER][NEUTRAL] service
[AGENT][NEUTRAL] OK. You said 0190932?
[CUSTOMER][NEUTRAL] I'm just
[CUSTOMER][NEUTRAL] Oh yeah, it's 0190932. M as in Mike, L as in Larry, number 8.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] the one that I have provided you 55899.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] OK, so I'm not showing a policy for 190932.
[CUSTOMER][NEUTRAL] So I'm not sure
[CUSTOMER][NEUTRAL] OK, just bear with me. Actually, I have their member ID card and it shows me a group number. So could you please check with the group number as well if you can?
[AGENT][NEUTRAL] Um, I cannot locate the group number without the policy number.
[CUSTOMER][NEUTRAL] Um, I cannot
[CUSTOMER][NEUTRAL] OK. Uh, on the card, it shows me an in-hospital benefit er number and it shows me an outpatient benefit cert number. So, could you please confirm me which number I can provide you?
[AGENT][NEUTRAL] Um, do you have the patient's first and last name? I can try to look them up that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the patient's first name is [PII]. It's spelled as [PII].
[CUSTOMER][NEUTRAL] And the last name is spelled as [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And can you spell that last name again? Is it [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Sorry, just one moment.
[CUSTOMER][POSITIVE] No problem, you can take your time.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and then patient's date of birth?
[CUSTOMER][NEUTRAL] Uh, the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] You are watching you in for.
[AGENT][NEUTRAL] OK, and then the benefits that you were needing, did you say outpatient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, what specialist office was it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], this is not a guarantee of payment. It's just a verification of coverage. So it looks like the patient has an outpatient benefit max per calendar year, and that amount is 1500.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] It is 1500 maximum amount. And could you please confirm me if is there any patient responsibility and because the patient has a primary as a Florida Blue. So, is the patient responsible for any uh patient responsibility, I mean, for the secondary insurance, is there any co-pay and deductible, or the insurance will cover that 100% with no patient responsibility.
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] We do not
[CUSTOMER][NEUTRAL] OK. So the patient is responsible, correct?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And you guys will cover up to 1500 or?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What was the 1500 amount? Actually, I don't get that.
[AGENT][NEUTRAL] Yes, that is the outpatient benefit max per calendar year.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So first patient needs to make that 1500. After that, the insurance will cover 100%, correct?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] This is so we will only pay 1500 per calendar year.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Oh, OK, OK. OK, I understand. OK, thank you so much.
[AGENT][NEUTRAL] We do not
[AGENT][NEUTRAL] Yes. Is there any further questions?
[CUSTOMER][NEUTRAL] Please go ahead.
[CUSTOMER][POSITIVE] Uh, no, it's all for today. Thank you so much. Could you please spell out your name for me?
[AGENT][NEUTRAL] Yes, it is [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last initial [PII], sorry.
[CUSTOMER][NEUTRAL] I may get an.
[CUSTOMER][NEUTRAL] OK. And could you please also confirm me the secondary plan effective date?
[AGENT][NEUTRAL] Yes, I can. Just one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the effective date is [PII] and the policy is currently active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Good afternoon
[CUSTOMER][POSITIVE] OK, thank you so much for assisting me. Have a great day. Thank you. Bye-bye.
[AGENT][POSITIVE] Yes, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm. All right. Goodbye.