AccountId: 011433970860
ContactId: ff7b053d-42ec-41bd-ba7b-2c4c4443929b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398440 ms
Total Talk Time (AGENT): 105699 ms
Total Talk Time (CUSTOMER): 182225 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/ff7b053d-42ec-41bd-ba7b-2c4c4443929b_20250122T20:37_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the provider's office. Just wanna check eligibility of the patient if patient's plan is still active with y'all.
[AGENT][NEUTRAL] OK. How do you spell your name?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]. Can you please spell your name as well so that I can document it correctly into my account?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That will be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number that I have for the patient is.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So I have the member ID card um which is in hospital benefit that number OK so this is for outpatient facility service so it will be 10154.
[AGENT][NEUTRAL] Yes, ma'am, that number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8508 M. like Mike L like Lima 8.
[CUSTOMER][NEUTRAL] And [PII], can you please help me with the initial of your last name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] You're welcome. And what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you are needing benefits?
[CUSTOMER][NEUTRAL] Just needing the eligibility.
[CUSTOMER][NEUTRAL] And also is this patient's plan if patient is eligible yet, uh, can you please tell me what kind of plan is this? Is this an employee group plan or is this?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy is active. This is a secondary policy coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] OK. And this is a mega plan, right?
[AGENT][NEUTRAL] Yes, it's an APL, American Public Line.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and just a moment.
[CUSTOMER][NEUTRAL] So maybe like, uh, is this.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so it covers basically the remaining of the primary, is that correct?
[AGENT][NEUTRAL] It only picks up what the, what is applied to their deductible co-pay or co-insurance for up to certain amounts depending on what type of services for.
[CUSTOMER][POSITIVE] OK, thank you very much for this and can you please uh help me with.
[CUSTOMER][NEUTRAL] The service called dialysis, is that covered in the patient's plan?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Hold on just a moment, let me check.
[CUSTOMER][NEUTRAL] I got another.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, that
[AGENT][NEUTRAL] Hold on one moment, I'm checking for you.
[CUSTOMER][NEUTRAL] Mm, no problem. Just as just checking, you said the effective date is [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII], yes.
[CUSTOMER][NEUTRAL] OK, [PII] and.
[CUSTOMER][NEUTRAL] And it's not termed in between at any point in time, right? I mean, is there a gap in the policy?
[AGENT][NEUTRAL] No, ma'am. No, ma'am.
[AGENT][NEUTRAL] And any benefits given over the phone is not a guarantee of payment.
[CUSTOMER][POSITIVE] Well, thank you very much.
[CUSTOMER][NEUTRAL] Sure, yes, I understand.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, it's an outpatient facility, right?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] If major medical covers, we normally cover it. If they do not cover it, we do not cover it. And if it's for outpatient, we only pick up deductible co-pays or co-insurance up to
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $1500 per calendar year for outpatients.
[CUSTOMER][NEUTRAL] Alright. And do you by any chance have any other insurance on file for the patient?
[AGENT][NEUTRAL] They would have to have a major medical to have this insurance.
[CUSTOMER][NEUTRAL] A patient has an employer group health plan. So, uh, I, what I wanted to ask is, do you have any, uh, Medicare?
[AGENT][NEUTRAL] I do not know that information.
[CUSTOMER][NEUTRAL] For the patient available on file.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Right, thank you very much for this information. Can you help me with the call reference number now?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Alright, thank you very much, [PII], for all that information today, and I think that should be it. You should have a great day ahead.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day as well.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.