AccountId: 011433970860
ContactId: ed1cd4de-2402-472c-ac6a-8861b55f645b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 746539 ms
Total Talk Time (AGENT): 263339 ms
Total Talk Time (CUSTOMER): 251208 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ed1cd4de-2402-472c-ac6a-8861b55f645b_20250314T14:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. Uh, I have a question. I'm calling on benefit and eligibility, but mostly benefit. Do you cover, um, I know you were secondary, and I know you mostly cover for like hospital, the doctor and stuff like that. Do you have plans also to cover like medical, like doctor's visit, co-pay and stuff, or no?
[AGENT][NEUTRAL] OK, [PII], I can actually help you with the eligibility if it's for a patient. Can you please give me um your callback number, ma'am just in case our call gets disconnected and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. My number is [PII]. And I'm calling from Pediatric Associates.
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] I have a few, that's why, but I believe you don't cover any, but let's check. I have like 3 patients, that's why.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my first patient is 025.
[CUSTOMER][NEUTRAL] 86068.
[AGENT][NEUTRAL] OK, let me look that up real quick because some of our policies do cover the office visits, so we'll have to look at each individual policy.
[CUSTOMER][NEUTRAL] Oh, so some of you, I thought none of them, OK. I have never in so.
[AGENT][NEUTRAL] OK, so yeah, yeah.
[AGENT][NEUTRAL] And then if it's, then if it's this, um, secondary insurance, and, uh, it does help with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] Um, what's the patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have [PII], birth date is [PII]. Give me a second. I think I have more than one patient actually. Oh no, on the [PII] for this plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looking at this policy for [PII].
[AGENT][NEUTRAL] The policy is no longer active. The policy lapsed on [PII]. Well, yeah, [PII], so.
[AGENT][NEUTRAL] The policy is terminated.
[CUSTOMER][NEUTRAL] OK, but back when it was active because I have charges from [PII] actually.
[AGENT][NEUTRAL] Oh, OK, OK, let me look.
[AGENT][NEUTRAL] Let me pull this in real quick.
[AGENT][NEUTRAL] OK, so on this policy, and this is just to verify benefits, it's not a guarantee of payment. She had an inpatient calendar year benefit amount of $6000 to help with deductible co-pay or coinsurance and then she also had an outpatient per calendar day benefit of $350. Let me pull up the policy certificate so we can see if office visits were on this one.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] It's gonna be just a second because the computer needs to load it.
[CUSTOMER][POSITIVE] No problem. Thank you. I'm sorry, what is your name again? Oh my [PII], I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Sorry. I know you said that. I just didn't write it down.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right, let's look.
[AGENT][NEUTRAL] It's hard to look when they're laps because you can't pull in the benefits the way you need to because everything is gone on it.
[CUSTOMER][NEUTRAL] Oh wow, and you said terminated on [PII], right?
[AGENT][NEUTRAL] OK, let's see if.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, update that.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, on this policy um they had outpatient treatment but not visit.
[CUSTOMER][NEUTRAL] No, that's it. OK.
[CUSTOMER][NEUTRAL] So it's a no for [PII].
[AGENT][NEUTRAL] And let me look real quick.
[AGENT][NEUTRAL] OK. And what's the next patient?
[CUSTOMER][NEUTRAL] Oh, hold on a 2nd, 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No linear because I have green.
[CUSTOMER][NEUTRAL] Uh, the next one is.
[CUSTOMER][NEUTRAL] ID number 024.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you have letters ML and the number 8.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and [PII] is no longer covered under this policy?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Actually, he is. It just needs to be updated.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] The effective date for [PII] is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this policy again, um, helps with deductible, co-pay or co-insurance and this is just to verify benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] He had an inpatient calendar year benefit amount of $5000.
[AGENT][NEUTRAL] And an outpatient calendar year benefit amount of $2500.
[AGENT][NEUTRAL] And let me see if office visits were covered.
[AGENT][NEUTRAL] And office visits are not covered under this policy.
[CUSTOMER][NEGATIVE] Oh, it's a no no for this one also.
[CUSTOMER][NEUTRAL] I know, I think most of your plans that did not cover.
[AGENT][NEUTRAL] Yeah, most of them don't, yeah.
[CUSTOMER][NEUTRAL] OK, allow me a minute, let me put my notes here.
[CUSTOMER][NEUTRAL] Um, PC do do do.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You just let me know when you're ready for the next one.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But this one is also like hospital.
[AGENT][NEUTRAL] It's what?
[CUSTOMER][NEUTRAL] An outpatient.
[AGENT][NEUTRAL] Outpatient also? OK.
[CUSTOMER][NEUTRAL] This one is only like hospital and outpatient.
[AGENT][NEUTRAL] Right, for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, give me one more second. I have to put it here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And get this one.
[CUSTOMER][NEUTRAL] OK, let me go and get my 3rd patient.
[CUSTOMER][NEUTRAL] OK, I did [PII], I did [PII]ave Charlotte. ID number is 01826184ML and the number 8.
[AGENT][NEUTRAL] OK, and you said the name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And this one I have the whole family.
[CUSTOMER][NEUTRAL] Like 34 different person on this policy, but it should be the same thing for all of them.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right. And let me look and see.
[AGENT][NEUTRAL] OK, this policy is active. Um, [PII]'s effective date is [PII].
[AGENT][NEUTRAL] Um, you said you have the whole family?
[CUSTOMER][NEUTRAL] Yeah, but it should be the same benefit for all of them. Uh, [PII]
[AGENT][POSITIVE] Yeah, same benefits that they have.
[AGENT][NEUTRAL] But they have different effective dates.
[CUSTOMER][NEUTRAL] That's fine. I just need.
[CUSTOMER][NEUTRAL] It's fine, but all of them in [PII] or no?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, um, [PII] and [PII] are [PII].
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] [PII] [PII] is [PII] and then [PII] is [PII].
[CUSTOMER][NEUTRAL] Yeah, I guess, um.
[CUSTOMER][NEUTRAL] Cause they, they have different birthday too.
[AGENT][NEUTRAL] Yeah, OK, and then, um, so on this one, the outpatient, you said it was for outpatient, is that correct?
[CUSTOMER][NEUTRAL] No, it's for a visit. It's, well, yeah, I, I mean, it's office visit, basically, that's what I'm looking for. We are just doctor's office.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Right, they have a calendar year outpatient benefit amount of $1500.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] And I'm sorry, um, do you provide reference? Am I by any chance, sorry?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much and have a good day.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Not at this moment. Hopefully I don't have to call you back because I have more patience to check on this report. If anything, we talk later.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] Yes, we'll talk later and if not you have a wonderful weekend.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you, same. Have a beautiful weekend. Bye bye-bye. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye, Ms. [PII].