AccountId: 011433970860
ContactId: fc2257d0-81e3-4c04-a987-9c6407228cd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356230 ms
Total Talk Time (AGENT): 127656 ms
Total Talk Time (CUSTOMER): 146712 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/fc2257d0-81e3-4c04-a987-9c6407228cd7_20250113T14:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I need your help with um eligibility for a mutual patient.
[AGENT][NEUTRAL] OK, I can help you spell your first name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, and what's the policy number, [PII] and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Good. Um, my direct line is [PII], and I'm a bit confused on the on the patient's policy number because he gave me two of them. Um, I think it's this one, it's 02556496ML8. I have two of them, one that ends with a 7 and one that ends with an 8. I'm not really too sure which one to give you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Yeah, one is outpatient inpatient, but the number before the letter M should be the same for both.
[AGENT][NEUTRAL] So whenever you call us just give us the number before the the numbers before the elm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Gotcha. OK, good to know, good to know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me one moment to pull up the policy information and I'll be able to assist.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][NEUTRAL] OK dokey.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have one I think it's his last name is pronounced [PII], uh, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thanks for, thanks for that, [PII] and you're just needing the effective date of the policy is currently active?
[CUSTOMER][POSITIVE] Absolutely
[CUSTOMER][NEUTRAL] Right, so he, I just got off the phone with him and he told me that he has you guys as a secondary, I'm assuming, and um I wanted to know if he was currently active, what his effective date is, and if you guys require prior off he's coming in for a kidney ultrasound as outpatient here at our facility, which is a hospital.
[AGENT][NEUTRAL] OK, so I have that information for you. I'm showing an effective date of [PII]. Uh, the policy is currently active at this time. Pre-cert is not required.
[AGENT][NEUTRAL] Did you need the outpatient benefit?
[CUSTOMER][NEUTRAL] Um, sure, why not? I don't know if you guys cover anything, so I'm not really familiar with you guys.
[AGENT][NEUTRAL] Uh, so this is a supplemental, it's a, it's a Metlink, uh, policy, which is secondary to the patient's major medical coverage.
[AGENT][NEUTRAL] Um, this policy will reimburse, um, amounts applied towards the major medical deductible, co-insurance and or co-pay amounts, and that's covered charges up to 8000.
[AGENT][NEUTRAL] $700.
[AGENT][NEUTRAL] That's per calendar year.
[CUSTOMER][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Alright, so you guys are called Medin Select you said?
[AGENT][NEUTRAL] Nothing
[AGENT][NEUTRAL] Yes, whatever is on his card, I think it's on his identification card. I think it's metling select.
[CUSTOMER][NEUTRAL] OK, and you guys reimburse the deductible co-insurance and co-pays up to $8700 per calendar year?
[AGENT][NEUTRAL] For any outpatient service correct, any covered outpatient service.
[CUSTOMER][NEUTRAL] Covered outpatient service.
[AGENT][NEUTRAL] And that's an ultrasound.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The cell.
[CUSTOMER][NEUTRAL] Alrighty. Yes, it's an ultrasound. I have the procedure code if you need it for your records, um.
[AGENT][NEUTRAL] Mm, that's OK.
[CUSTOMER][NEUTRAL] I had another question regarding claims um where do we send that to?
[AGENT][NEUTRAL] So American Public Life.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 248
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Uh-huh.
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Say that one more time [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Thank you. And do they have a group number?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] They do, let's see, let me get that for you.
[AGENT][NEUTRAL] That group number should be on the ID card if you have it. It's 80094.
[CUSTOMER][NEUTRAL] 80.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 94.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] 94, got it. OK dokey. I think I got everything I needed. Do you mind, Ms. [PII], just your name is spelled [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh [PII], first initial last name is [PII]. Use my name and today's date as reference for today's call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK. Thank you. I appreciate all your help today. You take care and be well.
[AGENT][POSITIVE] You're welcome and thanks for calling APL Astrid. Have a good day as well.
[CUSTOMER][NEUTRAL] You too bye bye.