AccountId: 011433970860
ContactId: da0555b9-b50b-4f3c-91c7-e8d69112c49e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299119 ms
Total Talk Time (AGENT): 149416 ms
Total Talk Time (CUSTOMER): 73992 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/da0555b9-b50b-4f3c-91c7-e8d69112c49e_20250108T19:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking to? How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Memorial Stone Kettering. I was calling to verify a member's eligibility and what type of coverage the station has, has.
[AGENT][NEUTRAL] And what I'm sorry, eligibility and what type of what ma'am?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The type of coverage?
[AGENT][NEUTRAL] OK, the coverage. OK, well, I can assist you with that today [PII]. Verification of coverage does not guarantee the payment of a claim. What's a good call back number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information and what's the policy number you're calling regarding?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] 02405750
[AGENT][POSITIVE] Thank you for that information. And one moment while I get that pulled up, OK? Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for your patience. What's the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][POSITIVE] Thank you again for your patience.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, I wanna give you the uh correct policy number, the active policy number, should I say, because that policy number you gave me turned.
[AGENT][NEUTRAL] But the active policy number is 252.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1580, this policy has an effective date of [PII] and it's currently active, right, and what type of coverage? Well, this is a secondary gap insurance, OK? So this member has a primary insurance we do not know what that information is. You will have to check with the member if you don't have that and this policy will uh consider copay, co-insurance or deductible when.
[AGENT][NEUTRAL] A specific services covered under this, uh, medical gap insurance, OK? And you have to provide the primary explanation of benefits for review. So is there a specific type of service that you need to verify? Are you a physician's office?
[CUSTOMER][NEUTRAL] I'm calling from the facility, um, and the patient.
[AGENT][NEUTRAL] So you're
[AGENT][NEUTRAL] Is it an outpatient procedure that they're going to have or inpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient treatment and services it looks like the patient is on active.
[CUSTOMER][NEUTRAL] Cancer treatment. I'm just not exactly sure what type of treatments and services.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] I am showing that the member has an outpatient uh calendar year benefit of $2000. OK, that's the max, and I am showing that they have uh a uh cancer treatment writer, so you can submit those claims for review along with the primary explanation of benefits, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright, anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes, can I actually get, so you said the active ID number is 2,521,580. Can I get the claims address and the payer ID?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The electronic payer ID is 60801.
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, so the
[AGENT][NEUTRAL] Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] Um, you said the payer ID is 60801 claims address [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You got it. That's it. Anything else I can help you with, Mr. [PII]?
[CUSTOMER][NEUTRAL] Just, um, I'm sorry, your name again and a reference number?
[AGENT][POSITIVE] The reference for the call will be my name [PII] last initial [PII] and today's date that'll be your reference for the call. Thank you for calling [PII]. You have a great day and take care, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye