AccountId: 011433970860
ContactId: da84cd17-1644-4340-92db-814e3fde6c8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 203169 ms
Total Talk Time (AGENT): 101429 ms
Total Talk Time (CUSTOMER): 86681 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/da84cd17-1644-4340-92db-814e3fde6c8c_20250129T20:12_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] Reality.
[CUSTOMER][NEUTRAL] Hi, I'm calling for a patient and to check over um verification.
[AGENT][POSITIVE] Oh, I'd love to help you with that today.
[CUSTOMER][NEUTRAL] To see if you guys
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I wanted to know um do you need the member ID for the patient?
[AGENT][POSITIVE] And I'm sorry.
[AGENT][POSITIVE] Yes, I'd love that, please.
[CUSTOMER][NEUTRAL] Uh, OK, let's see, payer ID.
[CUSTOMER][NEUTRAL] Is is it is it 80066?
[AGENT][NEUTRAL] Um, let me check. I'm not sure. That sounds like maybe it's a group number and not a policy number.
[CUSTOMER][NEUTRAL] Yeah, because this is my first time calling this type of insurance to verify, so let me see, is it the one that says payer ID?
[AGENT][NEUTRAL] It might say like member ID or policy certificate or inpatient outpatient number.
[CUSTOMER][NEUTRAL] It says in hospital benefit center number and then it says outpatient benefit number.
[AGENT][POSITIVE] OK, either one of those numbers will get me exactly where I've got to go.
[CUSTOMER][NEUTRAL] OK, so 02500284ML8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much. And while I'm getting that policy pulled up, do you mind if I snag your name and a good callback number real quick as well?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII] and the callback will be [PII].
[AGENT][POSITIVE] Perfect. And
[AGENT][NEUTRAL] Would you be able to verify for me, please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The the patient's date of birth and last name?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] His last name [PII] His date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. I do see [PII] here. He's current and active since um [PII]. And then as far, were you just looking to confirm eligibility, were you needing benefit information?
[CUSTOMER][NEUTRAL] No, like I need like two questions. It's just um if you guys cover a 2D, a 2D echo?
[CUSTOMER][NEUTRAL] And if you guys cover a CT scan.
[AGENT][NEUTRAL] OK, so I can't, um, I can't verify like individual procedures over the phone. I can give you inpatient or outpatient benefits, but everything else, because we're secondary to his primary, it really depends on how his primary pays for things, so we need to see the claim form to know how we cover.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So we would have to call the primary first?
[AGENT][NEUTRAL] Um, so we, we won't be able to tell you any coverage over the phone. We can't, um, we can't process over the phone based off codes. We have to have that claim on file.
[CUSTOMER][NEUTRAL] Oh, like we would have to.
[CUSTOMER][NEUTRAL] So we have to like um in person or like the primary has to clean um um send you guys like a bill and then you guys will see if you cover it.
[AGENT][NEUTRAL] So what would have to happen is you would process the claim with primary they'd send you back the EOB and then you'd send us the claim with the primary EOB.
[CUSTOMER][NEUTRAL] Oh, OK. Can I have a reference number for the call?
[AGENT][NEUTRAL] Yes, absolutely. The reference number is in my name, [PII] like [PII].
[CUSTOMER][NEUTRAL] A L L I E B.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][POSITIVE] OK thank you I appreciate it.
[AGENT][POSITIVE] Oh, it's my pleasure, Ms. [PII]. I hope you have such a wonderful week.
[CUSTOMER][POSITIVE] You too. Hope you have a great day.
[AGENT][POSITIVE] Thank you.