AccountId: 011433970860
ContactId: 17a71615-cc98-450c-a17e-e98f574aadb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 178809 ms
Total Talk Time (AGENT): 78114 ms
Total Talk Time (CUSTOMER): 82216 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/17a71615-cc98-450c-a17e-e98f574aadb3_20250313T12:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling on behalf of Jackson Memorial Hospital. How are you?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm glad I'm doing great as well. I'm trying to check the eligibility for this patient and would it, would it cover, um, this plan.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What do you need the member ID or?
[AGENT][NEUTRAL] Uh, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the policy number?
[CUSTOMER][NEUTRAL] Wow, this is for the outpatient service um let me see I have here.
[CUSTOMER][NEUTRAL] 024 96 46 2 M. like Mary L like Larry A.
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And for
[CUSTOMER][NEUTRAL] Yeah, [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. You said this is for outpatient services?
[CUSTOMER][NEUTRAL] Yes, it's for an ultrasound.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] You're like the secondary. Mhm.
[AGENT][NEUTRAL] So for outpatient, the policy would pay up to $750 per calendar day.
[CUSTOMER][NEUTRAL] OK, 7:50. Let me ask you a question because I have here.
[CUSTOMER][NEUTRAL] Ultrasound, the patient, uh, the first insurance have to make the co-payment of $300 so you guys will cover that, uh, that co-payment for the first insurance just to make sure.
[AGENT][NEUTRAL] Right, we pay towards the copay, the deductible and co-insurance after primary. Um, so if they're required to pay that upfront once we receive the claim on the back end, they could be reimbursed and if there's something still owed to the provider that can be paid out as well up to the $750 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome, may I ask your name?
[AGENT][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][POSITIVE] Thank you very much for your help. Let me see, I have a claim number, yeah, have a wonderful day, OK.
[AGENT][POSITIVE] You also you there, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, I totally forgot you said 750 and what is the coin insurance?
[CUSTOMER][NEUTRAL] 80? What is it you mentioned, 80?
[AGENT][NEUTRAL] No, no, no, no, there's no, uh, so we pay up to $750 a day. We pay towards the copay, deductible and co-insurance.
[CUSTOMER][POSITIVE] Got it. Understood. Thank you. Have a wonderful day, OK?
[AGENT][POSITIVE] You're welcome. You also. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.