AccountId: 011433970860
ContactId: 049e92cf-f9f5-4b4e-b808-6e2652d01851
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314540 ms
Total Talk Time (AGENT): 148554 ms
Total Talk Time (CUSTOMER): 94294 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/049e92cf-f9f5-4b4e-b808-6e2652d01851_20250616T18:11_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. We're calling from Thomas Jefferson University Hospital. I would like to know the patient's eligibility and benefits. Could you please help me with that?
[AGENT][NEUTRAL] I can help with eligibility and benefits. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 02294497.
[AGENT][NEUTRAL] Thank you. The patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][NEUTRAL] OK, thank you very much. It looks like the policy went into effect on October the.
[AGENT][NEUTRAL] Uh, 20, 0, excuse me, I'm sorry, [PII], that's [PII], it is active.
[AGENT][NEUTRAL] This is a hospital indemnity policy, [PII], and what it does is it pays a limited benefit.
[AGENT][NEUTRAL] For certain very specific services such as uh an initial hospital stay.
[AGENT][NEUTRAL] Or um there's also uh a first occurrence hospital confinement benefit. Is there anything in particular that I can tell you about the policy?
[CUSTOMER][NEUTRAL] Yeah. Uh, you said that the policy is effective from [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah. Uh, could you please take, uh, that this policy covers for inpatient admission?
[AGENT][NEUTRAL] Inpatient ER admission. I need to check.
[CUSTOMER][NEUTRAL] Like emergency
[CUSTOMER][NEUTRAL] Yeah, emergency room admission.
[AGENT][NEUTRAL] OK, so there is a daily hospital confinement benefit. There's also a first occurrence or initial hospital confinement.
[AGENT][NEUTRAL] So for the initial hospital confinement.
[AGENT][NEUTRAL] And that um is for a hospital stay of 24 hours or more.
[AGENT][NEUTRAL] The policy will pay a flat rate benefit of $500.
[AGENT][NEUTRAL] Each day after that, it will pay $50 for a hospital confinement.
[AGENT][NEUTRAL] And if he is in the um intensive care or coronary care unit, it's $200 a day.
[AGENT][NEUTRAL] Now this is just a verification of the benefits, not a guarantee of payment, but that is the type of policy that he has.
[CUSTOMER][NEUTRAL] If you don't mind, could you please repeat that, uh, benefit information once more again.
[AGENT][NEUTRAL] OK, certainly, um.
[AGENT][NEUTRAL] So for the um initial hospital confinement, and that's 24 hours or more, the initial hospital confinement.
[AGENT][NEUTRAL] We will pay
[AGENT][NEUTRAL] A flat rate benefit of $500.
[AGENT][NEUTRAL] For each day that he is in the hospital after that.
[AGENT][NEUTRAL] We will pay $50.
[AGENT][NEUTRAL] And that is just the verification of benefits.
[AGENT][NEUTRAL] It's not a guarantee of payment.
[AGENT][NEUTRAL] Now, is there anything else that I can tell you about the policy? We to submit your claims or anything else?
[CUSTOMER][NEUTRAL] Does this policy require a prior authorization for inpatient year admission?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, you said, um, this policy covers for inpatient ER benefits, right, uh.
[AGENT][NEUTRAL] It covers for inpatient hospital stays.
[CUSTOMER][NEUTRAL] So does this mean it is also
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, does that, um, does this mean?
[CUSTOMER][NEUTRAL] This policy required by authorization for inpatient year admission also, right? You said it is not required.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It is not required because this is a limited benefit policy. It's not major.
[CUSTOMER][NEUTRAL] Ma
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And is there any other active coverages I like uh other medical coverages for this patient?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Not that I'm aware of. This is the only one that I know about. Uh, um, he may very well have additional coverage but it's not something that we would know about.
[AGENT][NEUTRAL] Is there anything else I can help with?
[CUSTOMER][POSITIVE] Uh, it's OK. That's it for that. Thank you so much for the information. Finally, could you please spell out your name for documentation purpose?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And we'll use that today's date is over.
[CUSTOMER][NEUTRAL] And is there any card?
[AGENT][NEUTRAL] No, it's, it's my name.
[CUSTOMER][NEUTRAL] Your name and today's jet is to call reference, right?
[AGENT][POSITIVE] That is, that is correct, yes.
[CUSTOMER][NEUTRAL] Thank you, [PII]. Finally, just for the confirmation, uh, this patient's policy doesn't require a product for inpatient year admission.
[CUSTOMER][NEUTRAL] Uh, right.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much for the information. Have a great day.
[AGENT][POSITIVE] OK, thanks for contacting AP have a