AccountId: 011433970860
ContactId: d1b8065b-d83f-42ea-8456-d98fe1853b30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443160 ms
Total Talk Time (AGENT): 194637 ms
Total Talk Time (CUSTOMER): 155318 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/d1b8065b-d83f-42ea-8456-d98fe1853b30_20250403T15:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the University of Chicago Hospital. I'm calling to verify the patient insurance plan if it is a major medical plan.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I just had a whole conversation on mute. I am so sorry, Ms. [PII]. Um, I can definitely assist you with the member's medical policy. Um, may I have a good contact number in case we disconnected? I'm sorry.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] option one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] 02399302.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] And date of birth [PII].
[AGENT][NEUTRAL] Alrighty, and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active, it's been effective since [PII]. Um, let me see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is the secondary insurance, so we pay towards the copay, deductible and co-insurance after Aetna.
[CUSTOMER][NEUTRAL] OK, so Aetna is no longer active.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, let me see what he had previously, uh, uh.
[CUSTOMER][NEUTRAL] Yeah, looks like the Aetna is no longer active.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] See, I don't know how that would work because this policy is second only to Aetna, it's through his employer.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And our policy is second only to Aetna.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So if Aetna is no longer active,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That means they're not gonna be applying, which means we, I'm gonna send this over to claims and see what they say, but if Aetna, the policy with APL is active and if Aetna is not active, we haven't been notified of that, but I'm gonna pass this over to, um, I'm gonna show this to my team to see how that would be handled moving forward, um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] But their policy with APL is active.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just know that if Aetna is, if we're second to Aetna and and Aetna doesn't apply because they're not active, then he can't use the second either.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Are you sure, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] How, when did, do you know the termination date for Aetna or did the members say Aetna was no longer active?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me check it again because Aetna was not the last primary insurance we had on file for the patients.
[AGENT][NEUTRAL] Now, I also
[CUSTOMER][NEUTRAL] Well, let me
[AGENT][NEUTRAL] Do you know if there's like a, is there a, no, this is an individual policy. I was thinking maybe it was a spouse that has another insurance too because sometimes they have more.
[AGENT][NEUTRAL] Then one major.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] But I don't see a spouse on here.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? I'm getting ready to.
[CUSTOMER][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] See how that works. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let me wait for you first to see if um like are you using Aetna's portal to see?
[CUSTOMER][NEUTRAL] The Aetna.
[AGENT][NEUTRAL] OK, I'll wait for you because they're gonna ask me, so I'll wait.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, the Aetna is no longer active. Looks like the Aetna ended [PII].
[AGENT][NEUTRAL] [PII], there's another plan somewhere.
[AGENT][NEUTRAL] Because this policy didn't become effective until [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He had a UMR insurance.
[CUSTOMER][NEUTRAL] Prior, I mean, after the Aetna looks like, but that is not active either.
[AGENT][NEUTRAL] And what was the 2nd Aetna date?
[CUSTOMER][NEUTRAL] No, the UMR.
[AGENT][NEUTRAL] I'm just
[CUSTOMER][NEUTRAL] UMR was uh through United.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, hold on one moment for me, OK. And what was the termination date for you and R?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] last year.
[AGENT][NEUTRAL] OK, so if you like, I can either place you on hold and um figure this out on my end, or I can give you a call back once I get everything and have an update. It's up to you if you don't mind holding, that's fine, whatever you prefer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] You know, I will give you a call back. I mean, I'll give you a callback number, but I'm leaving early today, so.
[CUSTOMER][NEGATIVE] Uh, you may not get me.
[AGENT][NEUTRAL] Oh, I'm getting ready. It'll probably be in the next 10 minutes, maybe 15.
[CUSTOMER][NEUTRAL] But the callback number.
[CUSTOMER][NEUTRAL] Mhm. OK, so that.
[AGENT][NEUTRAL] You still gonna be gone?
[CUSTOMER][NEUTRAL] No, I'm leaving.
[CUSTOMER][NEUTRAL] In about 40 minutes and 11.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The callback number.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so the call back number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 5836.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alrighty, so let me go ahead and look into this and I will give you a call back. I'm getting ready to talk to my team. I'll give you a call back or supervisor. I'll give you a call back in 15 minutes, uh, as soon as I get an update, OK? But I'm pushing for before you leave.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII], was there anything else I could assist you with? You're welcome.
[CUSTOMER][POSITIVE] All right. Thanks, [PII].
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I'll talk to you shortly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.