AccountId: 011433970860
ContactId: 1bb635a7-dd95-4e4d-8d7d-78ec615e1728
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300239 ms
Total Talk Time (AGENT): 126419 ms
Total Talk Time (CUSTOMER): 130797 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/1bb635a7-dd95-4e4d-8d7d-78ec615e1728_20250206T13:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, good morning. My name is [PII]. I'm calling from Star Cay Ranch ER and Hospital. We have a patient that came in our ER and I need to verify her eligibility and benefit please. I tried going in your website, but because we're a new user or something like that, it's we're not registered and try registering and it's not even letting me.
[AGENT][NEUTRAL] You can't verify eligibility online that's why can you spell your name for me?
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the policy number, um, [PII]?
[CUSTOMER][NEUTRAL] Um, it's 025099979.
[AGENT][POSITIVE] And a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's uh my number here is [PII].
[AGENT][NEUTRAL] Thank you and you said eligibility and benefits is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, emergency room hospital.
[AGENT][NEUTRAL] ER OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh the uh patient's name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII]. The policy effective date is [PII]. The policy is active at this time, and the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is it outpatient you said or ER benefit?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It's outpatient in general, not just specific to emergency room but outpatient. Mhm. Let's see.
[CUSTOMER][NEUTRAL] Oh, OK, got you, got you, mhm.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit is up to $5000 that is per covered person.
[AGENT][NEUTRAL] And this is a per calendar year benefit or per consignment per calendar year benefit. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Were any information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Checking to see if any has been used.
[AGENT][NEUTRAL] OK, I'm not showing any claims received for [PII] and let me check one more thing.
[CUSTOMER][NEUTRAL] Yeah, she was here [PII] at our ER so I'm not quite sure if our billing office has sent any.
[CUSTOMER][NEUTRAL] Um, bills yeah.
[AGENT][NEUTRAL] Yeah, we've not received a claim yet at this time. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so the maximum outpatient benefit is up to $5000 per covered person per calendar year. Um, did you have any other questions I could help out with today?
[CUSTOMER][NEUTRAL] Uh, yes, please. Uh, is there any co-pay, uh, co-insurance, deductible, all that?
[AGENT][NEUTRAL] So this policy is secondary, uh, to the major medical. Mhm.
[CUSTOMER][NEUTRAL] Oh, this is the 2nd there.
[AGENT][NEUTRAL] And so there's no.
[CUSTOMER][NEUTRAL] Do this.
[CUSTOMER][NEUTRAL] OK, uh, does it say anything about her primary insurance? Did she indicate?
[AGENT][NEUTRAL] As far as what?
[CUSTOMER][NEUTRAL] Uh, for her uh primary insurance. So you said this is a secondary.
[AGENT][NEUTRAL] Does it say anything as far as what? as far as her benefits?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, as a prime for the primary insurance cause you said I'm, I'm sorry, I'm a little confused because when you said this benefit that you just told me this is a secondary, correct?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] That just means that she has a major medical policy, and so the major medical would be primary, this policy would be secondary.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Oh, I see. So to get that information for the major medical, where can I get that?
[AGENT][NEUTRAL] From the major medical carrier.
[AGENT][NEUTRAL] You would have to contact that office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, hm I don't have that information. So it's, it's a totally separate company then or insurance carrier?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Major Medical is United Healthcare, Aetna. Those are, that's what I mean when I, when I say major medical. Give me a second. Let me see if I have that on record.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing UHC.
[AGENT][NEUTRAL] And then of course you wanna verify with your patient as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Of course. All right. uh I think um I can get that information from her. Thank you so much and can I have your name please?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call, [PII] First initial of my last name is [PII]. Anything else I can help out with today?
[CUSTOMER][POSITIVE] No, thank you so much for all your help you have a blessed day.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] OK thank you bye bye.