AccountId: 011433970860
ContactId: dd2e0f42-ea32-4a5c-b508-445a59c7fc59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542039 ms
Total Talk Time (AGENT): 195199 ms
Total Talk Time (CUSTOMER): 210418 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/dd2e0f42-ea32-4a5c-b508-445a59c7fc59_20250429T12:56_UTC.wav
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[AGENT][NEUTRAL] Call APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] and I need to verify a patient um to see if she's actually um eligible with you guys.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII] and that's the direct line.
[CUSTOMER][NEUTRAL] And then the policy number that we have.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, it's 02059580.
[AGENT][NEUTRAL] What is that member's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Uh, we have a different year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]. Let me see what's on her last.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, on her date of birth on her license, it says [PII].
[AGENT][NEUTRAL] Um, that's not what we have in the system.
[CUSTOMER][NEUTRAL] I can verify like her last 4 of her.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pull up the um application.
[CUSTOMER][NEUTRAL] I can verify her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] It's in her spouse's name, it looks like [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm. What's [PII]'s name and date of birth?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me get back to that.
[AGENT][NEUTRAL] Because it may be a typo in the system, but I just gotta pull up the application.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Plowing, um, let me see if I can find his because they do not have it right here.
[AGENT][NEGATIVE] Oh, your phone is breaking up. I could barely hear. I didn't hear anything that you said.
[CUSTOMER][NEUTRAL] I'm sorry, can you hear me now?
[AGENT][POSITIVE] Mhm. Yes, thank you. Yes, thank you.
[CUSTOMER][NEUTRAL] Is that better?
[CUSTOMER][NEUTRAL] OK, I'm sorry, his name is [PII], but I'm having to pull him up. They don't have his date of birth listed. Um, give me two seconds please.
[AGENT][POSITIVE] Sure take your time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Please verify their address.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] My goodness, come on.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] May I place you on a brief hold while I contact customer service to see if they can pull up the application to see if we made a typo in regards to [PII]'s date of birth.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hold one moment. Thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am. You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], how are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm great thanks for asking [PII]. I'm calling because I have a um I have a provider on the phone. She's calling to verify benefits for uh insured. However, she gave me the date of birth. The um year is incorrect. I was trying to pull up the application and on base, but it's, I'm not finding anything. Is it any way that you can pull it up to verify APL made a typo in her date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, what's that policy number?
[AGENT][NEUTRAL] It is 251-076-5.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, it's for [PII] though, the spouse.
[CUSTOMER][NEUTRAL] There. OK.
[AGENT][NEUTRAL] The provider gave
[CUSTOMER][NEUTRAL] It was electronically filed, so.
[AGENT][NEUTRAL] OK, the provider is [PII].
[CUSTOMER][NEUTRAL] But she had a policy before. Let me check it.
[AGENT][NEUTRAL] But we have 92.
[CUSTOMER][NEUTRAL] OK. Let me check the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check the older policy and see if there's an application on it.
[CUSTOMER][NEUTRAL] It was sent on our census status so there should be one on it. Hold on just a second.
[AGENT][POSITIVE] Mhm, take your time.
[CUSTOMER][NEUTRAL] Um number 02059580.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I wish they hadn't it so tiny.
[CUSTOMER][NEUTRAL] Ok and plowing.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I it.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] A one.
[CUSTOMER][NEUTRAL] OK, seems like they, they called two years ago to change it to 1991.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is that what this one's saying as well?
[AGENT][NEUTRAL] Yeah, that's what the um provider said it was 1991.
[CUSTOMER][POSITIVE] OK, I've got it fixed.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome. Have a good day.
[AGENT][NEUTRAL] So let me transfer you back you do the same. Goodbye.
[CUSTOMER][POSITIVE] All right, thank you. Goodbye.
[AGENT][NEUTRAL] Hello [PII], thank you for holding. I apologize for the inconvenience. So I got that date of birth updated for you, and you're calling to verify benefits eligibility. [PII]'s policy has been active since um mm, [PII] and it's currently active. And what is that place of service? Is it inpatient, outpatient, office visits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It looks like office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she has
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] She don't have all.
[CUSTOMER][NEUTRAL] Actually, you know what, I'm sorry. She was in the emergency room.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] It's an EKG that was in the hospital, in the emergency room. Place of service is 23, yes, so the emergency room.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she has outpatient benefits of $3000 per calendar year. However, she has an outpatient deductible of $2000 per year, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, so outpatient benefit.
[CUSTOMER][NEUTRAL] Of 3000 in an outpatient benefit deductible that she an outpatient deductible for $2000.
[AGENT][NEUTRAL] Deductible.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So, but she has been active for 7 months. OK, um, and can I verify.
[AGENT][NEUTRAL] Yes, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, got you. And can I, um, verify where we would need to send the claim?
[AGENT][NEUTRAL] So you can send it by um electronic payer ID.
[AGENT][NEUTRAL] Of 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 600.
[AGENT][NEUTRAL] Or you can send it by mail.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the mailing address will be addressed to APL claims department, [PII]. That's [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] And the address
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK. That's [PII]. 0, OK, the fax.
[AGENT][NEUTRAL] And we also have a fax number.
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, that is correct, [PII].
[CUSTOMER][NEUTRAL] OK. And can you spell your name for me?
[AGENT][NEUTRAL] Of course, [PII]. Today's date is a reference.
[CUSTOMER][NEUTRAL] And do you give a reference?
[CUSTOMER][NEUTRAL] OK, and the first letter of your last name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, and mine is [PII] in case you need that. So, and thank you so much for all your help.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome thanks for calling APL and you have a great day.
[CUSTOMER][POSITIVE] Yes ma'am you have a good day.
[CUSTOMER][NEUTRAL] OK, bye-bye.