AccountId: 011433970860
ContactId: f77d838f-d4f1-4cc7-8e74-80ab8d669ee3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380149 ms
Total Talk Time (AGENT): 189536 ms
Total Talk Time (CUSTOMER): 112504 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/f77d838f-d4f1-4cc7-8e74-80ab8d669ee3_20250328T15:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get benefits and eligibility on a patient please.
[AGENT][NEUTRAL] OK. You said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] And you're needing eligibility and benefits, is that also correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Uh yes ma'am, I can help you with those things and what is your call back number first off please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] 02507924 M like Mary L like Larry, number 8.
[AGENT][POSITIVE] OK, thank you so much. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mm, what is her first name?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK, that is not what we have.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Give me a second photo ID.
[AGENT][NEUTRAL] And what was the, yeah, what was the date of birth again?
[CUSTOMER][NEUTRAL] I have [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, so she is listed as [PII].
[AGENT][NEUTRAL] In our system.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] We don't even have [PII].
[CUSTOMER][NEUTRAL] Oh well
[CUSTOMER][NEUTRAL] Oh well, it looks like [PII] is her first name because that's what's on her license. I got [PII] from the license though. This is [PII].
[AGENT][NEUTRAL] OK, yes ma'am, they, uh, for her enrollment information that was submitted, she's listed as [PII].
[CUSTOMER][NEUTRAL] OK, because even the primary insurance has [PII], the AMed, that's what I'm looking at right now as well. So that's why I was like, let me just double check that before I went ahead and, but yeah, even the primary insurance is showing [PII], huh, that's weird.
[AGENT][NEUTRAL] Yeah, so we received.
[CUSTOMER][NEUTRAL] I will contact her about that.
[AGENT][NEUTRAL] Mhm. So yeah, we did receive her enrollment information strictly as [PII]. OK, so one moment please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'll make a note about that.
[AGENT][NEUTRAL] And you said it's [PII]?
[AGENT][NEUTRAL] 1 doll. I'm just gonna, I can't change it, but I'm gonna just make a note.
[CUSTOMER][NEUTRAL] Yes, that's what's on her license.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I'm gonna go ahead and I'll give her a call then as well just to let her know and she can update that herself as well.
[AGENT][NEUTRAL] OK, so we did, um, she is a subscriber on this list, excuse me, the supplemental policy, the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient please [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] I'm sorry, [PII]. I am so sorry about that. I don't know why I said, so sorry.
[AGENT][NEUTRAL] That's OK. You're fine. You're OK. You're OK. If you've had, if your week's been long like mine, that's quite all right. I've gotten several names.
[CUSTOMER][NEUTRAL] You think I'd remember it though only because my sister's name is [PII], so you think that would be, yeah, no.
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] Yeah, no.
[CUSTOMER][NEGATIVE] It should have been easier for me to remember.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Well, that's OK. That's OK. Oh.
[AGENT][NEUTRAL] OK, so she.
[CUSTOMER][NEUTRAL] It's Friday. I'm leaving Friday, OK?
[AGENT][POSITIVE] Amen. Amen. Um, so she has an outpatient benefit, Max.
[AGENT][NEUTRAL] Of $3500 per covered person per calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, with no outpatient deductible.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because
[CUSTOMER][NEUTRAL] And um [PII] has she met anything towards the 3500 as of yet?
[AGENT][POSITIVE] OK, sure, I can check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] And no, ma'am, as of now there have not been any benefits used.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Now, because this is a
[CUSTOMER][NEUTRAL] Alright, well, [PII], that is actually all I need.
[AGENT][NEUTRAL] OK, just a couple of additional things for you, [PII], because this is a supplement to the primary insurance. When a claim is filed with APL, we will also have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] For review as well and then once we've processed our claim we do have a portal in which you should be able to check claim status for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By going to secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Secured up by the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And again, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, that would actually be all thank you so much for your help though, [PII], have a wonderful day.
[AGENT][POSITIVE] Well, you, yes, ma'am, I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Goodbye.
[AGENT][NEUTRAL] All right, bye-bye, [PII].
[CUSTOMER][NEUTRAL] OK