AccountId: 011433970860
ContactId: d554ad5e-6784-40f1-bd2f-097f8cbf21d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550570 ms
Total Talk Time (AGENT): 123870 ms
Total Talk Time (CUSTOMER): 94207 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/d554ad5e-6784-40f1-bd2f-097f8cbf21d1_20250401T18:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm trying to see if a patient has active coverage.
[AGENT][NEUTRAL] OK, I can help you with the eligibility and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] I don't have that. They, they didn't bring that in. I have their name, date of birth, and social.
[AGENT][NEUTRAL] OK, I can use the full social.
[CUSTOMER][NEUTRAL] OK, social is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm just waiting for the policies to populate here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment. Do you mind if I place you on just a brief hold? It looks like our system just went down, but I'm hoping that's not what happened. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes for sure thank you.
[AGENT][NEUTRAL] OK, you're welcome hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, I hope not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Our systems did go down, um, but it just came back up. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, for sure, thank you so much, bear with me one second now I'm gonna have to go back to that account.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Uh, [PII], 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. Um, so the active policy number is 186.
[AGENT][NEUTRAL] 886 8.
[AGENT][NEUTRAL] And the policy has been active since [PII]?
[CUSTOMER][NEUTRAL] And so the benefit for emergency room would be?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Uh, and does it show is it a PPO plan?
[AGENT][NEUTRAL] Um, hold on one moment because I actually just pulled up the first one that came up for her. Let me go to the active one.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So it's the 2nd
[AGENT][NEUTRAL] So it's a secondary insurance.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So, so we pay towards the copay, the deductible, and the co-insurance after primary?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so let me see for emergency room.
[CUSTOMER][NEUTRAL] Oh my [PII]
[AGENT][NEUTRAL] So it's up to $2550 per calendar year. Did you want me to see if he's used any for the year?
[CUSTOMER][NEUTRAL] Yes please per calendar year.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] All right, and they haven't used any for the year, so they still have that full balance.
[CUSTOMER][NEUTRAL] OK, and then the member ID was 18688668?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and is it a PPO plan?
[AGENT][NEUTRAL] Um, this is a secondary policy, so there's no PPO or HMO that would be for their primary.
[CUSTOMER][NEUTRAL] OK, and what's the claims address and that would be [PII], [PII].
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you [PII]. I think that's everything. Do you have a reference number or is it just your name?
[AGENT][NEUTRAL] There's no call reference number. It will be um just my name and today's date and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] For