AccountId: 011433970860
ContactId: d02cad4f-a367-44fd-9b3f-0fbe7ba9ace2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316519 ms
Total Talk Time (AGENT): 193500 ms
Total Talk Time (CUSTOMER): 87283 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/d02cad4f-a367-44fd-9b3f-0fbe7ba9ace2_20250213T21:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] with MD now urgent Care in [PII]. I'm trying to get an eligibility on a patient trying to be seen here today.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], oh, I'm so sorry. I totally misheard that. I apologize. I'm so sorry.
[CUSTOMER][POSITIVE] No, you're fine. You're totally fine.
[AGENT][NEUTRAL] OK, and you're needing to verify just eligibility, not benefits, is that correct, [PII]?
[CUSTOMER][POSITIVE] Yeah, benefits as well.
[AGENT][POSITIVE] Yes ma'am, I can help you with both and what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] D as in dog 41203456
[AGENT][NEUTRAL] OK, now, [PII], that is not a policy number for APL. That is a 90 degree benefit number. Some of these numbers also have dual policy. Do you know if the number also has coverage with APL?
[CUSTOMER][NEUTRAL] I'm not sure. I just called the number on the back of the card.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Number? OK. Now, I can, before I transfer you over to IMA if you would like for me to check to see if their number also has a policy with us, I can do that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Um, do you happen to have the full social of the page of the member, the subscriber?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just one moment then.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. [PII], and I'm just gonna repeat that. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] I don't know how to pronounce the last name, so I'm gonna spell it for you. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. 0, I'm sorry.
[AGENT][NEUTRAL] Uh, that's fine. I need the date of birth, yes. OK, thank you. So give me a moment, please. I did locate a policy in our system for this number also. So just one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] So the plan that he has with our company, it's a limited benefit plan, Phoebe. It is not major medical insurance. The policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, what type of benefit information were you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't, I'm not sure what urgent care is considered as.
[AGENT][NEUTRAL] OK, so just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so he for a visit, an outpatient visit.
[AGENT][NEUTRAL] The maximum benefit per visit is $75.
[AGENT][NEUTRAL] And a max number of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the address, the PO box for claims should be on his ID card.
[CUSTOMER][NEUTRAL] Yes, I see that here.
[AGENT][NEUTRAL] OK, and then once the claims have been processed by by APL, we also have a portal, Phoebe, that you all should be able to check claim status in and have access to the explanation of benefits for APL, and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me give you this policy number for APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 254.
[AGENT][NEUTRAL] 9747.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, what was the policy number again?
[AGENT][NEUTRAL] 2549747
[CUSTOMER][NEUTRAL] So is that like a number I can call or is that just a regular policy number?
[AGENT][NEUTRAL] That's his policy number with our company. Mhm.
[CUSTOMER][POSITIVE] OK, no problem, thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. So is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that, uh, do you have a reference number?
[AGENT][NEUTRAL] You would just use my name, [PII], along with today's date.
[CUSTOMER][NEUTRAL] You said hey?
[AGENT][NEUTRAL] [PII] I said, we both got each other's names wrong.
[CUSTOMER][POSITIVE] Oh, [PII], sorry about that.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] OK. You're welcome, [PII], and thank you again for calling APL. I hope you have a great evening.
[CUSTOMER][POSITIVE] No problem have a nice one.
[AGENT][POSITIVE] You too, thank you. Bye bye.