AccountId: 011433970860
ContactId: d292756e-d370-471c-844d-32442760d0a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288750 ms
Total Talk Time (AGENT): 113324 ms
Total Talk Time (CUSTOMER): 80768 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/d292756e-d370-471c-844d-32442760d0a7_20250321T15:04_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]. This is [PII] calling from Apia Healthcare to check eligibility and benefits on a recorded line.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Number, yes.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] Yes. 021 00295.
[CUSTOMER][NEUTRAL] Mary 18.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that 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].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It is a secondary insurance to the patient, right?
[AGENT][NEUTRAL] Correct. This is the secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the, the benefits?
[AGENT][NEUTRAL] So what type of benefits did you want to go over today, outpatient?
[CUSTOMER][POSITIVE] Uh, it's a durable medical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Equipment
[AGENT][NEUTRAL] So durable medical equipment would be under the outpatient benefit. Um, it's, it's an additional rider, however, this policy does not have it, so they wouldn't be eligible for durable medical equipment on this policy.
[AGENT][NEUTRAL] Let me make sure
[CUSTOMER][NEGATIVE] Uh, I didn't get your point. Mhm.
[AGENT][NEUTRAL] OK, hold on one moment. I don't see it on one screen, but I see it on the other. So let me just make sure if they do have durable medical equipment coverage or not, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is the, yeah.
[AGENT][NEUTRAL] Yeah, they have it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So after I double checked, yes, the policy does have the durable medical equipment rider. So the policy um would pay up to $7350 per calendar year towards the outpatient expenses. Did you want me to see if any have been used?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, uh, I need, uh, in-network status and also the co-insurance percentage.
[AGENT][NEUTRAL] So this is a secondary insurance, so that would apply to primary.
[CUSTOMER][NEUTRAL] OK, fine. OK, fine, fine, got it. And what about the network status?
[AGENT][NEUTRAL] There is no network because we're secondary.
[CUSTOMER][NEUTRAL] Oh, OK. OK, fine. May I have the group ID number?
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] The group number is 23632.
[CUSTOMER][POSITIVE] Mhm. Thank you so much, [PII], for today, uh, for your assistance. May I have the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. Have a nice day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye.