AccountId: 011433970860
ContactId: fcc43eab-034b-4250-9883-6f8fac2a553e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286809 ms
Total Talk Time (AGENT): 111636 ms
Total Talk Time (CUSTOMER): 98625 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/fcc43eab-034b-4250-9883-6f8fac2a553e_20250103T17:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and I am calling from United Health Group coordination of benefits department, and the purpose of my call is to verify members' eligibility and for quality assurance purposes this call may be monitored or recorded.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility, [PII]. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01640969
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth of uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Is there also a pharmacy coverage?
[AGENT][NEUTRAL] Um, let me take a look at the benefits. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm not showing any um outpatient or any um pharmacy or prescription coverage on this secondary policy.
[CUSTOMER][NEUTRAL] Or a pharmacy vendor like Express, CVS Caremark.
[AGENT][NEUTRAL] I mean, I can double check if you'd like, but I'm looking at the benefits and there's no um prescription benefits on here. It's just for inpatient facilities, outpatient facilities, and they have the office treatment writer for treatment in the office.
[CUSTOMER][NEUTRAL] Mhm. And uh can you provide me also the group number and the group name for billing purposes?
[AGENT][NEUTRAL] Sure, the group number is 13333.
[AGENT][NEUTRAL] And the group name is Hospital Authority.
[AGENT][NEUTRAL] Of Wilkes, W I L K as in kite, ES County.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] Hospital Authority of Wilkes.
[AGENT][NEUTRAL] County.
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Mhm. County.
[CUSTOMER][NEUTRAL] County.
[CUSTOMER][NEUTRAL] Is it uh he is the subscriber here in the plan?
[AGENT][NEUTRAL] Yes, the member is the policyholder, [PII].
[CUSTOMER][NEUTRAL] And is there also a dependent child named [PII] and [PII]?
[AGENT][NEUTRAL] Let's see. Um, no, this is an individual policy. It's only the policyholder.
[CUSTOMER][NEUTRAL] And may I know if this is through active employment through exchange or through self pay?
[AGENT][NEUTRAL] Um, active employment.
[CUSTOMER][NEUTRAL] And this is a commercial plan, right?
[AGENT][NEUTRAL] No, what do you mean by commercial? like Aetna, Blue Cross Blue Shield?
[CUSTOMER][NEUTRAL] Um, uh, yes, um, or a medical plan.
[AGENT][NEUTRAL] No, we're not, we're not major.
[CUSTOMER][NEUTRAL] Or other insurance.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No, we're not commercial. We're not a major medical insurance company. We we offer secondary insurance or limited medical benefits.
[AGENT][NEUTRAL] For medical.
[CUSTOMER][NEUTRAL] Can I have now the call reference number with your last name initial please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much and have a good one. Bye for now.
[AGENT][POSITIVE] You also done, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Um, there's none. This is all that I need and thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too bye.