AccountId: 011433970860
ContactId: f0a5f48b-33ee-4a8d-afcf-faa3a98be5b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357940 ms
Total Talk Time (AGENT): 167171 ms
Total Talk Time (CUSTOMER): 136295 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f0a5f48b-33ee-4a8d-afcf-faa3a98be5b0_20250107T19:31_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, uh, good afternoon. My name is [PII]. That is spelled [PII] Last initial is [PII]. I'm calling from Deech Solutions at the request of the doctor and on behalf of the patient, our line will be recorded for quality and training purposes. I'm sorry, are you with provider services?
[AGENT][NEUTRAL] This is the claims department.
[CUSTOMER][NEUTRAL] Good, I am so sorry. I must have been misdirected. Um, can I please have you transferred to the, uh, uh, provider services department?
[AGENT][NEUTRAL] When you say provider services department, elaborate.
[CUSTOMER][NEUTRAL] Uh, this is for, uh, benefits and eligibility determination.
[AGENT][NEUTRAL] So you want benefits. This is the like this is the the department where we verify claim status and benefits because when you say provider services as in thinking that you want to verify credentials to send in a W-9 in regards to the provider services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Alright, most, yeah, most, uh, bigger corporations tend to have that just all grouped into one quote unquote provider services. Sorry about that my mistake.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So would you like benefits? Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Of course, yes, uh, callback number is [PII] and there's no extension.
[AGENT][NEUTRAL] Thank you, and the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is D for Delta 43510931.
[AGENT][NEUTRAL] I do apologize but that's not a policy number here at American Public Life. Do you have the member's social?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I don't have this. Let me see here. Let me try one more thing. Uh, give me one second. I do believe there is one I have.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] This one policy number let's try 02576376.
[AGENT][NEUTRAL] What is this member's name that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] Uh patient's name is [PII]. Uh date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] So the policy number of the 2576381 is the policy number. That's the policy number when you call to verify benefits, that's the policy number when you submit a claim.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] 258 uh can you repeat that number one more time sorry about that.
[AGENT][NEUTRAL] Of course, 257-6381.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][POSITIVE] 381. All right, perfect thank you so much.
[AGENT][NEUTRAL] You're calling to verify benefits eligibility. This member's policy has a maximum benefit amount of $500 per calendar year with a $50 deductible per insured up to $150 per family, which does not apply to us preventative services, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[AGENT][NEUTRAL] [PII], this policy became effective [PII] and is currently active. The policy only covers preventative services and basic. Unfortunately, it does not cover major endopperoprosthesis or surgery, crowns, bridges, ortho perioendo, and I can definitely send you a face back if you would like because I know there was a lot of information all at once.
[CUSTOMER][NEUTRAL] OK, so sounds like, well, you mentioned a lot of sounds like, uh, maybe dental-ish kind of stuff, uh, and you said preventative mostly let's see here, so it's probably not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it only covers like simple extractions of 7140, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Exams, trophies.
[AGENT][NEUTRAL] X-rays.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So alright, understood, thank you so much. Just wanted to double check that's OK, will not probably cover anything that the patient will need. OK, great. Uh, let's see, uh, this is like an indemnity kind of plan, right?
[AGENT][NEUTRAL] This is a dental plan, a dental policy? You called to verify dental benefits, correct?
[CUSTOMER][NEUTRAL] Oh, dental.
[CUSTOMER][NEUTRAL] OK, it isn't
[CUSTOMER][NEUTRAL] Uh, actually it's for medical. Do we have medical coverage?
[AGENT][NEUTRAL] This is the dental cue, so you need to verify medical benefits.
[CUSTOMER][NEUTRAL] Gosh
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let me transfer you to the correct queue.
[CUSTOMER][NEUTRAL] No wonder.
[CUSTOMER][POSITIVE] Yeah, sorry about that. My apologies, um, and if I can just get your name one more time, yeah, for my.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Go thank you [PII].
[AGENT][NEUTRAL] Hold one moment.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], how are you doing?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][POSITIVE] I'm great, thanks for asking [PII]. I have a provider on the phone by the name of [PII]. He's calling to verify benefits.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] It's 257-6376. It's 257-6376 for [PII].
[CUSTOMER][NEUTRAL] OK, and I just need to verify benefits.
[AGENT][NEUTRAL] Mhm, he's verified all of her information and the callback number is [PII]. His name is [PII].
[CUSTOMER][NEUTRAL] OK. You can send it to me.
[AGENT][POSITIVE] Thank you. Alright, let me transfer him over.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Hello [PII], I'm gonna transfer you to [PII] so she can better assist you with the medical benefits. Thanks for calling APL and have a great day. Goodbye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]