AccountId: 011433970860
ContactId: f620914e-13fc-4b2e-8939-e6ef5c8dd307
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359040 ms
Total Talk Time (AGENT): 129353 ms
Total Talk Time (CUSTOMER): 150156 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/f620914e-13fc-4b2e-8939-e6ef5c8dd307_20250321T16:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from the primary care's office. Um, yesterday our patient came in with this secondary insurance that our EMR system was saying we should input. Um, I just wanted to clarify what does this insurance cover for the patients or yeah, if you could explain an eligibility to the effective dates if you have it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, sure, yes, I can assist you with the eligibility and benefits. So may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02425349.
[AGENT][NEUTRAL] Thank you. And may I have the member's um name and date of birth? [PII].
[CUSTOMER][NEUTRAL] So there's gonna be two members. Um, we can start with uh [PII]. He's the policy holder. His name is [PII], last name [PII].
[AGENT][NEUTRAL] OK, and what is his date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Um, let me check and see if there's a new policy because this one is terminated. It's just an old policy. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I do have, so [PII] was pulling in uh a different policy number.
[CUSTOMER][NEUTRAL] So should I just give you the one that they pulled in? This was the uh based on the card that the patient gave me, but I have another one.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So that one is going to be 01618422 ML 8.
[AGENT][NEUTRAL] Thank you. Yeah, that one is, is an older, it's an older policy. OK. Um, yeah, so yeah, so it looks like he doesn't have an active policy at this moment. Um, the last one I see here is the one that you provided. Mhm. Yeah, which is the 02455349. That one was effective from [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh God.
[CUSTOMER][NEUTRAL] That's so weird. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] terminated. OK, for the first one? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what about, can you check for his wife? Um, she may have a different number.
[CUSTOMER][NEUTRAL] Uh, and I can give you her, um, her date of birth and name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So her first name is [PII], same last name [PII]. I'll spell the first name. It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The last name is the same. It's [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me do a quick name search because she is under [PII] um so this one will be terminated. Let me see if there's any other out there that is not combined with [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One month.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, I don't see another policy for her, so she's under [PII]'s, um, policy, and that this one is terminated, so it's the same information.
[CUSTOMER][NEUTRAL] OK, that's weird. Our system's pulling this in, but, so I'll call him, um, and just see what's going on there because, yeah, if it's terminated back in [PII], then maybe, yeah, they should know. The patients, are they being outreached by you guys when there's like a termination or?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] It's a group termination, so usually the employer will let them know that they're either changing um a different company or um just let them know that they need to do open enrollment if they don't, you know, complete it during the time that it may be terminated, so they should know if it's an active policy or not or maybe they have a different company. I'm not sure. But yeah, um, right now we don't have a policy for them, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Yeah, I'll check in with the patient.
[CUSTOMER][POSITIVE] OK, OK, thank you so much for checking.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Um, no, that was all. Thank you so much. Mhm.
[AGENT][POSITIVE] Yeah, you're welcome. Thank you for calling APL. Have a good weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.