AccountId: 011433970860
ContactId: d16ac7b3-4929-4541-8672-218afbd1e56c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364609 ms
Total Talk Time (AGENT): 164994 ms
Total Talk Time (CUSTOMER): 118144 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/d16ac7b3-4929-4541-8672-218afbd1e56c_20250107T17:49_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, I, I'm trying to see if a patient um have active coverage.
[AGENT][POSITIVE] Yeah, I'd love to look at eligibility for you my friend, and may I have your name and a good call back number please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's DOT callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much and the member's policy number?
[CUSTOMER][NEUTRAL] It is D as in David 43716262.
[AGENT][NEUTRAL] Alrighty, so that the number is gonna be for 90 degree benefits. Um, there should be like another number that's 6 to 8 digits.
[AGENT][NEUTRAL] Typically it starts with like a 0 on the card.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm, no, the only thing is on the card.
[AGENT][NEUTRAL] OK, um, I can try searching for your patient by their first and last name if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] [PII] Is that the first name, I'm sorry?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][NEUTRAL] I am really sorry. I am not showing anybody with that first name and last name in our system.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Yes, [PII] I'm sorry, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see that tight.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And you said you're looking for eligibility. Are we looking for a medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][POSITIVE] Medical. OK, perfect.
[AGENT][NEUTRAL] All righty. And your patient is current and active with an effective date of [PII]. Um, the plan they have with us is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then is there any other information I oh, I'm sorry.
[CUSTOMER][NEGATIVE] And it doesn't cover
[CUSTOMER][NEUTRAL] And you said um you said it's inactive, correct?
[AGENT][NEUTRAL] It is active.
[CUSTOMER][POSITIVE] Oh it is at. I'm sorry.
[AGENT][NEGATIVE] Mhm. No, don't be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause we have a claims and we submitted it out and we got sent back then they wasn't.
[CUSTOMER][POSITIVE] Active. They couldn't find the patient.
[AGENT][NEUTRAL] Um, and do you have that claim number? Maybe you can have look at it.
[CUSTOMER][NEUTRAL] We got, let me go back and look at it correspondence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, we don't have it just corresponding saying that they can find the patient.
[CUSTOMER][NEUTRAL] Could you tell me where like the medical claim is, OK, I know it's say indemnity. Do they cover um like physicians, um, office visits?
[CUSTOMER][NEUTRAL] Do her plan cover that?
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Yeah, let me pull up her benefits real quick for you. Hang tight.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I do wanna let you know any benefit information I give you over the phone is just a verification of coverage and never guarantee, um, so she does have, um, an outpatient sickness benefit. Um, it looks like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She can use that up to 3 times a year, or up to 4 times a year. I might need to pull up the full documents and then she also has a wellness and diagnostic benefit rider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And if anywhere possible you can tell me where the claim needs to be sent to be processed. Maybe I got we got the wrong um.
[AGENT][NEUTRAL] Yes, absolutely. So the payer ID is 64556, and they should be going to IMA at [PII].
[CUSTOMER][NEUTRAL] Here I'd be
[CUSTOMER][NEUTRAL] Could you repeat the um [PII] one more time for me?
[AGENT][NEUTRAL] Yeah, yeah, absolutely. So IMA is the name of the company you want to send it to, and it goes to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that payer ID is 64556, correct?
[AGENT][POSITIVE] Uh huh correct.
[CUSTOMER][NEUTRAL] OK, alright, yeah, we will send it to the wrong place.
[CUSTOMER][NEUTRAL] All right, I just need a reference number.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, it's just my name, [PII], first initial, last name, [PII], and today's date. And would you like me to give you the policy number I have on file for her as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] Yes, please, please.
[AGENT][NEUTRAL] OK, perfect. I have the policy number is 1967922.
[CUSTOMER][NEUTRAL] 1967922
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] My pleasure you too thank you.
[CUSTOMER][NEUTRAL] Alright bye bye.