AccountId: 011433970860
ContactId: f7d23ef7-6281-43e3-b78c-54a3992b9d47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272269 ms
Total Talk Time (AGENT): 121855 ms
Total Talk Time (CUSTOMER): 99021 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/f7d23ef7-6281-43e3-b78c-54a3992b9d47_20250407T17:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to check on a, on an eligibility on the patient that's having a procedure if it's covered.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Alrighty, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01570123 M as in Mary, L as in Larry and number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this particular policy number um was active from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is an active.
[CUSTOMER][NEUTRAL] Oh so is is it still active or it's not active any longer?
[AGENT][NEUTRAL] That one is not, but there is an active policy. Um, let me give you that policy number.
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] OK, so it's 240.
[CUSTOMER][NEUTRAL] 240
[AGENT][NEUTRAL] 8806.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy, um,
[AGENT][NEUTRAL] has been active since [PII].
[CUSTOMER][NEUTRAL] So it's 2408806 compared to the other one?
[AGENT][NEUTRAL] Yes, the other one is terminated and this is the active policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me, no, I was, I was saying, um, because, um, the other one has, has so many more numbers than this one that's why.
[AGENT][NEUTRAL] Oh, the and the
[AGENT][NEUTRAL] And the MLA and all of that, that's just for the card. You don't have to um use that like when you call. That's that's probably why too.
[CUSTOMER][NEUTRAL] OK, but for billing purposes I do need it, right?
[AGENT][NEUTRAL] Mhm. You can just, that's just for the card to determine inpatient versus outpatient. The number is the same.
[CUSTOMER][NEUTRAL] OK, so it's 2408806.
[AGENT][NEUTRAL] Mhm. And that's their policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, now, um, obviously it's covered and, and you guys are are secondary to Asmet correct?
[AGENT][NEUTRAL] Let me double check for you. Hold on one second. I believe so, yes, ma'am. Well, hold on.
[AGENT][NEUTRAL] I just want to make sure it's switched over because I had went to the old one first. Hold on one second. Yes, ma'am, it's a man.
[CUSTOMER][NEUTRAL] OK, and, and you guys, um, um, pick up the deductible that has not been met with admin.
[CUSTOMER][NEUTRAL] So whatever I mean
[AGENT][NEUTRAL] Yes, so, so we pay towards the deductible, co-pay, and co-insurance of covered charges after primary up to $1000 per calendar year. Did you want me to see if they've used any of the 1000?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and she hasn't used any of uh any of her benefits for [PII] yet.
[CUSTOMER][NEUTRAL] She hasn't used anything? OK.
[CUSTOMER][NEUTRAL] Alright, so let me put here 80.
[CUSTOMER][NEUTRAL] 20 is and does she need an authorization?
[AGENT][NEUTRAL] Um, no, ma'am. Prior also pre-cert is not required.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] Uh to require, OK, and can I have a reference number for this call, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. Again, that's [PII].
[CUSTOMER][NEUTRAL] And today the [PII].
[CUSTOMER][POSITIVE] OK, perfect, thank you, [PII].
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.