AccountId: 011433970860
ContactId: cf9614b7-a6cf-49e1-b120-6ceae564ae36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238690 ms
Total Talk Time (AGENT): 88863 ms
Total Talk Time (CUSTOMER): 77821 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/cf9614b7-a6cf-49e1-b120-6ceae564ae36_20250512T18:44_UTC.wav
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[AGENT][POSITIVE] Thanks for calling AL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, this is [PII] I'm calling from a provider's office and I need assistance on getting um more information about the benefits for a member.
[AGENT][NEUTRAL] OK. Do you have the policy number for that patient, [PII]?
[CUSTOMER][NEUTRAL] Uh, I do not. I asked the mom, but, uh, she said she had the group number, but for some reason she didn't have that. Uh, I was confused. I have the patient's name and date of birth, uh, but also the policy holder's information as well.
[AGENT][NEUTRAL] OK, uh, do you have the group number? What is it?
[CUSTOMER][NEUTRAL] Uh, let's see, it's 22843.
[AGENT][NEUTRAL] And patient's first or the insured's first and last name?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK. And who is the patient and their date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, let me give you that policy number. It's um 218.
[AGENT][NEUTRAL] 7702.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, is this like a medical insurance?
[AGENT][NEUTRAL] It's like a secondary gap policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let
[AGENT][NEUTRAL] And then do you need the benefits? Is it for outpatient or?
[CUSTOMER][NEUTRAL] Yeah, uh, it was just an X-ray. Um, it was performed. So I don't know, um, do you guys cover that?
[AGENT][NEUTRAL] Uh, was that in the hospital or the doctor's office?
[CUSTOMER][NEUTRAL] It's in office, yeah, doctor's office. Mhm.
[AGENT][NEUTRAL] OK. Um, let me double check.
[AGENT][NEUTRAL] Not a guarantee of payment. It's a basic outline of the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so they have a $3000 calendar year maximum, uh, payable. So after primary insurance processes the claim, any treatments or procedures performed in office will pay up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how do we bill you guys? Do we have to attach the primary as well? or what is the address? Do we have a form that I need to fill out?
[AGENT][NEUTRAL] Uh, no, there's no form. Just submit the claim along with the primary explanation of benefits. Um, I've got, we have a mailing address, a payer ID, and a fax number.
[CUSTOMER][NEUTRAL] OK, uh, can I get the mailing address and the fax number as well?
[AGENT][NEUTRAL] Yes, mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And fax number [PII].
[CUSTOMER][NEUTRAL] OK, great. uh, can I get a call reference number?
[AGENT][NEUTRAL] Uh, call reference number is my name, [PII], first initial to last name [PII] as in [PII], and today's date. And anything else I can help with, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, I guess that will be all. Thank you for your help.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.