AccountId: 011433970860
ContactId: fe837525-9b86-40d4-a954-69964184e5cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414510 ms
Total Talk Time (AGENT): 102175 ms
Total Talk Time (CUSTOMER): 166797 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/fe837525-9b86-40d4-a954-69964184e5cc_20250610T13:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] No, I think she's getting.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with South Atlanta Pediatrics. I'm calling on behalf of a patient, um, to see if we are in network, um, as well as what the benefits are for their plan.
[AGENT][POSITIVE] OK, I can help you with eligibility and benefits. Um, can you spell your name for me please?
[CUSTOMER][NEUTRAL] [PII] last initial [PII]
[AGENT][POSITIVE] Thank you and [PII], can I get a good uh callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Um, give me one second, I just had it.
[CUSTOMER][NEUTRAL] D as in dog, 43733598.
[CUSTOMER][NEUTRAL] I told her that much though.
[AGENT][NEUTRAL] Alright, give me just a moment.
[CUSTOMER][POSITIVE] Thank you OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Money yeah.
[CUSTOMER][POSITIVE] OK, OK, thank you, bye.
[CUSTOMER][NEUTRAL] Hi, [PII]
[AGENT][NEUTRAL] What is the last name?
[CUSTOMER][NEUTRAL] Last name is [PII], first name [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK give me just one moment.
[CUSTOMER][NEUTRAL] And he didn't mention anything about follow up um in 2 weeks 2 weeks.
[CUSTOMER][NEUTRAL] Like medications
[AGENT][NEUTRAL] What did you say the date of birth was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Oh, there's a restroom right here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, 2 weeks of the [PII], um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So that [PII].
[AGENT][NEUTRAL] OK, it looks like this policy is active with an effective date of [PII]. The number that you gave me isn't the policy number, so would you like me to give you the policy number?
[CUSTOMER][NEUTRAL] Yes, what is the policy number?
[AGENT][NEUTRAL] 02633640.
[CUSTOMER][NEUTRAL] Oh dear, you're all set.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Could you repeat that for me?
[AGENT][NEUTRAL] Sure, it's 02.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 63
[AGENT][NEUTRAL] 3640.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And would you like a fax back of their benefits?
[CUSTOMER][NEUTRAL] OK, because on the card it says medical ID.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, what are the benefits for an, uh, well, first I need to know for a network.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm gonna work but I have that [PII].
[AGENT][NEUTRAL] So we aren't in and out of network. We do participate in the Carrington PPO network, but it's not required. So as long as the services are covered under their policy, we'll pay the benefits.
[CUSTOMER][NEUTRAL] OK, um, so for a 6 office visit, what is the benefit for a PCP office?
[AGENT][NEUTRAL] Do you know what the code would be?
[CUSTOMER][NEUTRAL] I don't. It would just be a general office visit.
[CUSTOMER][NEUTRAL] Hey there
[CUSTOMER][NEUTRAL] How's that tay case?
[CUSTOMER][POSITIVE] It's all right
[CUSTOMER][POSITIVE] like it's fun though.
[AGENT][NEUTRAL] OK, it looks like that would be in preventative. So that would be at 100% allowable.
[CUSTOMER][NEUTRAL] Like they wanted to follow up with the dermatologist.
[CUSTOMER][NEUTRAL] Mm, so this is, this wouldn't be considered preventative.
[CUSTOMER][NEUTRAL] Preventative would be like a checkup. I'm asking about a sick visit or an office visit.
[AGENT][NEUTRAL] Oh, are you a medical? I thought you were a dental provider. I'm sorry.
[CUSTOMER][NEUTRAL] No, I'm medical.
[AGENT][NEUTRAL] OK, this is their dental policy. Give me just one moment.
[CUSTOMER][NEUTRAL] Oh, this is a dental policy. OK, now that makes sense. So the remember I decided what it be.
[AGENT][NEUTRAL] They,
[AGENT][NEUTRAL] I'm sorry, yeah, I wasn't able to pull them up by that member ID, um.
[CUSTOMER][NEUTRAL] Um, what about this number 02.
[AGENT][NEUTRAL] And you're just
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02633637.
[AGENT][NEUTRAL] OK, that's the one I was looking at. That is a hospital indemnity policy, so I don't think it will cover office visits, um, but I can double check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The MRN number
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 779
[CUSTOMER][NEUTRAL] Uh hey, how are you?
[CUSTOMER][NEUTRAL] I notated that for
[CUSTOMER][NEUTRAL] Um, and then we'll see her back, oh, in about 2 weeks so she's already scheduled for the [PII] at [PII] if you try to.
[CUSTOMER][POSITIVE] You're welcome. I'll go one day in a couple weeks.
[CUSTOMER][NEUTRAL] 6 months
[AGENT][NEUTRAL] All right, let me check.
[AGENT][NEUTRAL] Yeah, this is just a hospital indemnity policy. They don't have uh their major medical through us.
[CUSTOMER][POSITIVE] OK, well, thank you so much. I appreciate it.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great day, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][NEUTRAL] Bye.