AccountId: 011433970860
ContactId: e1aee45d-f6b5-413c-b758-6a801c20cb2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304320 ms
Total Talk Time (AGENT): 157453 ms
Total Talk Time (CUSTOMER): 113288 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/e1aee45d-f6b5-413c-b758-6a801c20cb2c_20250124T18:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Dolphin Pediatrics. I need to verify eligibility and benefits.
[CUSTOMER][NEUTRAL] And I need to know if this one covers copay.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility and benefits. And this is considered an office or a hospital?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] Office. OK. And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, uh, [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure it's 60801 from what I see here.
[AGENT][NEUTRAL] OK, that's gonna be the payer ID. Do you see the numbers in the bottom where it says inpatient, outpatient cert? I'm gonna need the outpatient cert.
[CUSTOMER][NEUTRAL] No, because the patient hasn't come here. That's what the mom gave me. It's a newborn.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. Um, so you don't have the card?
[CUSTOMER][NEUTRAL] I could give you mom's information.
[CUSTOMER][NEUTRAL] No, no, because she hasn't come here. She comes here on Monday, so we have to verify before Monday and that's all she gave me 60801 and then her name is [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh, got you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] OK. How do you spell the last name?
[CUSTOMER][NEUTRAL] [PII] and then the other one is [PII]
[AGENT][POSITIVE] OK, thank you. Let me see if I can find.
[CUSTOMER][NEUTRAL] Her date of uh yeah, first name is [PII] and the date of birth is uh [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] She also gave me a group number. I don't know if you need that.
[AGENT][NEUTRAL] If I can find it like this, then I can use that.
[CUSTOMER][NEUTRAL] Uh, group number is 17816. I don't know if that makes any.
[AGENT][NEUTRAL] Bear with me. I, I'm gonna try the name first if I cannot find it with the name, I can try the group.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, you said the date of birth was [PII]. OK, I found her. All right. And so you said you're looking for a co-payment uh for a dependent or a baby.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Usually you guys cover it it will be like hospital coverage, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, Ms. [PII], this particular policy um doesn't cover the co-payment for the office visit. We only cover procedures done in the office as long as it's for sickness or injury, no preventative. Um, we do cover the office treatment or the lab work, um, and that is subject to the outpatient maximum which is 4000 per covered person per calendar year.
[AGENT][NEUTRAL] And let me give you the effective date of the policy. Um, the effective date of the policy is [PII] and it is active at the moment. And let me know when you're ready for the policy number.
[CUSTOMER][NEUTRAL] OK, so do you guys only cover the procedures and if there's an injury?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It, it will be for sickness or injury. So it will not cover any preventative. We do not cover preventative. Um, it will be like any procedures done in the office like injections or treatments or uh X-rays, ultrasounds, anything like that will be considered under the benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No copay, right, and no deductible.
[AGENT][NEGATIVE] No co-payment for the office. They said we do not cover the co-payment for the office basically.
[CUSTOMER][NEUTRAL] OK, can I please get the policy number?
[AGENT][NEUTRAL] Sure, the policy number is 0231.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2664.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02312664
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] OK, thank you, and then the medical claims, uh, is PO Box 248,950 Oklahoma.
[AGENT][POSITIVE] Yes, that is correct, Miss [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then can I please get a reference number of the call and that will be it.
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] Yes please mhm.
[AGENT][NEUTRAL] OK, that's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with? Thank you.