AccountId: 011433970860
ContactId: ea64335d-4278-4201-b49e-adb88ea07de5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 693460 ms
Total Talk Time (AGENT): 276869 ms
Total Talk Time (CUSTOMER): 389017 ms
Interruptions: 10
Overall Sentiment: AGENT=1.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/ea64335d-4278-4201-b49e-adb88ea07de5_20250423T15:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. We're the provider. Can you please help me, um, with eligibility for 2 patients?
[AGENT][NEUTRAL] Yeah, I can check eligibility for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][POSITIVE] Yeah, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, I'm sorry, I said it wrong, eligibility and benefits for 2 patients.
[AGENT][POSITIVE] Yeah, I could check out 30 on benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[AGENT][NEUTRAL] Thank you. OK, and what did the, I know you said 2 members, were they two different policies?
[CUSTOMER][NEUTRAL] Uh yes, uh-huh.
[AGENT][NEUTRAL] OK. OK, yeah, if you wouldn't mind, go ahead and give me that, uh, first policy number, please.
[CUSTOMER][NEUTRAL] OK, the first one is gonna be.
[CUSTOMER][NEUTRAL] 02491469 ML 8.
[AGENT][NEUTRAL] Thank you and then uh what was the name and date of birth for this member please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we we needing to check inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] She does have outpatient urgent care coverage.
[AGENT][NEUTRAL] Yes, OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so this outpatient benefit is on a per calendar day basis, so it pays up to $250 max per calendar day.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] OK, good, so she does have that outpatient uh urgent care coverage.
[AGENT][NEUTRAL] So it pays $250. Again, that goes towards co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Thank you. OK, um, any, um, group name or group number?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, let me get that for you so that group number, sure that group number is 25921.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, and the group name?
[AGENT][NEUTRAL] Mhm, that is M as in Mike D as in Delta, M as in Mike Hotel Group.
[CUSTOMER][NEUTRAL] Oh, MDM Hotel Group?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, alright, perfect.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] MD and hotel group alright perfect and then let me add your name in today's date and then I will go on to the next one.
[AGENT][NEUTRAL] Sure, uh, give me just a moment. I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] OK, yeah, I need a second too because I need to add a note for a second.
[AGENT][NEUTRAL] Yeah, same
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's like, yeah, hold on.
[AGENT][NEGATIVE] I am not the fastest typer.
[CUSTOMER][NEUTRAL] And she
[CUSTOMER][NEUTRAL] And she's the and she's the subscriber right?
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][POSITIVE] Thank you. OK.
[AGENT][POSITIVE] All right. I am ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] Oh OK hold on now you're faster than me, [PII].
[AGENT][NEUTRAL] No, no, no, you're fine, you're fine, just whenever you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] People put the wrong billing address for things, so it's like if you put the wrong billing address, it gets billed wrong.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] I was just making a note for.
[CUSTOMER][NEUTRAL] Mhm updated billing address for you and this is for United Healthcare. Imagine you said submit the bill and it goes to the wrong place. Can you like, no, uh.
[AGENT][NEGATIVE] Yeah, creates all kinds of problems.
[CUSTOMER][NEUTRAL] denial, right?
[AGENT][NEUTRAL] All kinds of confusion, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, for HCX.
[CUSTOMER][MIXED] OK and so, but people don't care, you know.
[AGENT][NEUTRAL] Oh yeah, that's usually somebody else's problem kind of thing.
[CUSTOMER][POSITIVE] I try to go every day above and beyond.
[AGENT][POSITIVE] Yeah, make it streamlined as possible easier on everybody.
[CUSTOMER][NEUTRAL] But people don't do that.
[AGENT][NEGATIVE] No, unfortunately.
[CUSTOMER][NEUTRAL] And verify.
[CUSTOMER][NEUTRAL] [PII] OK alright.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, the next one.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let me pull up her name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] How's your day going so far today? Good?
[AGENT][POSITIVE] So far so good, yeah, how about yours?
[CUSTOMER][POSITIVE] Good, it's it's almost lunch time here in [PII], so we're, I'm almost ready for almost ready for lunch.
[AGENT][NEUTRAL] There you go.
[AGENT][POSITIVE] Even better.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm running off of my kale smoothie it's like, oh, almost time to eat.
[AGENT][NEUTRAL] I'm just running off of my coffee on, um, honestly.
[CUSTOMER][NEGATIVE] Oh, I don't like coffee. I, I just, I can't drink it. Oh, nope.
[AGENT][NEUTRAL] It's a bad addiction. It's a good thing you don't.
[CUSTOMER][NEGATIVE] I just don't like the way it tastes.
[AGENT][POSITIVE] Understandable and again that's probably for the best.
[CUSTOMER][NEUTRAL] And it's a
[CUSTOMER][NEUTRAL] And I say oh as you get older you like coffee I'm like no I just I just.
[CUSTOMER][NEGATIVE] No, you know, I just, no.
[AGENT][POSITIVE] I understand. I absolutely understand.
[CUSTOMER][NEUTRAL] OK perfect so let me go ahead and check something for a second, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's let me just double check something they because they have signs I'm just double checking something. OK, is that the correct address? You should see all my notes I have. I have like notes for everything.
[AGENT][NEUTRAL] Yeah, you're fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She laughs but it's true.
[AGENT][POSITIVE] I know, I get it and that's good.
[CUSTOMER][NEUTRAL] OK, 188.
[CUSTOMER][POSITIVE] Based off like the policy number I know like where it's supposed to go, OK, perfect.
[AGENT][NEUTRAL] There you go, yeah.
[CUSTOMER][NEUTRAL] Uh, OK, I, I think that's try going above and beyond.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Um, OK, so let's see. Um, OK, so her policy number is 02545505.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for this member?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Awesome, thank you for that, [PII]. Uh, so this policy is active, uh, effective date was [PII] and the same thing, it is a secondary medical, so designed to help with co-pay, deductible and co-insurance after major medical pays, and we were still checking this was for, um, this was still outpatient urgent care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Outpatient, yeah.
[AGENT][NEUTRAL] Yes, OK, so this outpatient benefit is also on a per calendar day basis. Uh, this one pays $500 max per calendar day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK perfect and she's subscriber she's the subscriber for this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, perfect, [PII]. Alright, so then let me go ahead and add your address add your name [PII] and today's date. This one is flying by already.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Good, that's awesome. Yeah, I feel like it is too. It's, it's been a pretty good day.
[CUSTOMER][NEGATIVE] I can't believe it.
[CUSTOMER][POSITIVE] I don't know. This whole month is flying by. It's so funny. My friend and I were talking on the phone, and next month, May, it's my one year anniversary at this at this job, and it's like, oh she's like, can you believe it? I'm like, thank you. She's like, we have to celebrate. I'm like, I'm like, OK, but I'm like, I don't know where to go eat, you know.
[AGENT][POSITIVE] Oh, congratulations! Yeah, that's awesome.
[AGENT][POSITIVE] Definitely.
[AGENT][NEUTRAL] So I, I know what you mean.
[AGENT][NEUTRAL] Flip a coin.
[CUSTOMER][NEUTRAL] Oh, you don't, is it?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I know, oh, have you, are you, have you hit your one year too?
[AGENT][NEUTRAL] Not yet um mine is going to be in June, but I'm the same as you. I feel like I can't believe I've been here this long already.
[CUSTOMER][POSITIVE] Right, and how do you feel? Do you feel like you being where you are has changed your life? I don't know, I feel like where I, where I've been has changed my life.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yeah, oh, no question. This, this job was an absolute life changer, game changer, all of it. I mean, I may not stay in this position, but I'm definitely staying with this company. It's been fantastic.
[CUSTOMER][NEUTRAL] Oh really? Oh, you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, same thing with me. I there's there's a lot of growth and have a career, and every year has just been so like, you know, there's, it's a good work environment. Everybody's respectful. You have a question, it's not a problem, you know, and it's like, like you get the other day with my manager, I said we were talking and I said, oh thank you so much for following up. I truly appreciate it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm like, uh, see, I'm like I work we work from home, but that makes me melt, you know, I'm like, oh, that's so nice.
[AGENT][POSITIVE] Yes. Yeah, I know what you mean. Um, everyone here is just like they genuinely care and wanna help you, and I'm not used to that. Like everywhere else that I've worked in the past has not been like this, not by a long shot.
[CUSTOMER][NEUTRAL] Care
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Yes, no, no, you know, and I, I have a friend who works for the company I used to work for, right, and you're on the clock, right? So if she didn't work this amount of hours they're on her. What are you doing? Ah, you're not working hard enough, you know, it's just very.
[AGENT][NEUTRAL] Oh, the micromanaging yes.
[CUSTOMER][NEGATIVE] You know, you worked for, what do you, and I was just like, no, I don't wanna, I don't wanna hear it. I'm gonna work 50 hours, so I don't have to hear him say, you know, and it's just like, oh my goodness, or people inserting themselves into into emails when they shouldn't be, or it's just.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah, like, where'd you come from?
[CUSTOMER][NEGATIVE] Hello. I, yeah, so then it's like when I started here last year with the this company, I'm like, what is this real? Like what? Are you, are you lying to me? Are you, are you?
[AGENT][POSITIVE] Yeah, oh, I, I know exactly what you mean. Like, oh wow, work environments really do exist like this.
[CUSTOMER][NEGATIVE] I'm like, what? Are you, like, this is a joke.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Like, are you just pretending?
[AGENT][NEUTRAL] Yeah, I know what you mean.
[CUSTOMER][NEGATIVE] Because no one's ever kind of work, yeah, it's just that's crazy. So you're genuine and you know everybody's just looking to backstab you.
[AGENT][NEUTRAL] Mhm, or genuine, and yeah.
[AGENT][NEUTRAL] Yes, right. Yeah, I know what you mean. I've been there too, but yeah.
[CUSTOMER][NEUTRAL] I work.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][POSITIVE] Yeah, so that's so funny. Oh my, so when you have your one year car, you gotta go celebrate.
[AGENT][POSITIVE] I'm sure glad that you found somebody.
[AGENT][POSITIVE] Yeah, I'm so glad you found a place like that [PII].
[CUSTOMER][NEUTRAL] Oh, you too.
[AGENT][NEUTRAL] All right. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] So my, my friend's like gotta get.
[CUSTOMER][POSITIVE] Um, no, thank you, [PII]. I really appreciate everything and almost congratulations to you too.
[AGENT][POSITIVE] All right, yeah, it's been a pleasure.
[AGENT][POSITIVE] Thank you you too have fun.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Have a great rest of your day.
[CUSTOMER][POSITIVE] Alright, thanks [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] All right, bye-bye.