AccountId: 011433970860
ContactId: 1d594f23-46f0-47ac-b918-ca12902b782a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340290 ms
Total Talk Time (AGENT): 127687 ms
Total Talk Time (CUSTOMER): 79906 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/1d594f23-46f0-47ac-b918-ca12902b782a_20250106T21:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm calling on behalf of Homestead Hospital to verify member eligibility and benefits for an emergency room visit.
[AGENT][NEUTRAL] OK, yeah, I can look at uh eligibility and benefits for you. Um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII] and initial to my last name [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I have 016118.
[CUSTOMER][NEUTRAL] 36 M as in Michael, L as in Lima, and the number 8.
[AGENT][POSITIVE] OK thank you.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] A name is [PII].
[CUSTOMER][NEUTRAL] Uh, looks like [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy that it is designed to help with co-pay, deductible and coinsurance after major medical pays. And of course I will let you know verification of coverage is not a guarantee of payment for claims. Bear with me just a moment. And was this, um, I see outpatient hos uh emergency room?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK. Bear with me just a moment.
[AGENT][NEUTRAL] Alright, so the outpatient benefit is $1500 max per calendar year.
[AGENT][NEUTRAL] With it being so close, I don't imagine anything's been used, but I will still check just for good measure. Give me just a moment.
[AGENT][NEUTRAL] OK, no, none of that has been used so far this year.
[CUSTOMER][NEUTRAL] All righty, and what is the group name?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The group name on the policy, is there a group name?
[AGENT][NEUTRAL] Oh, give me just a moment, let me check.
[AGENT][NEUTRAL] Yes, it is City of [PII].
[CUSTOMER][NEUTRAL] Very well, and uh, would you have time to verify a second APL patient we have as well?
[AGENT][POSITIVE] Oh sure, yes, give me just a moment um I'll let you know when I'm ready for that one. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Appreciate your patience. Um, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] 025526666
[AGENT][NEUTRAL] And is this the same we're looking at uh emergency room benefit?
[AGENT][NEUTRAL] For outpatient? OK and uh what was the name and date of birth for this insured?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have that date of birth?
[CUSTOMER][NEUTRAL] And the date of birth I have is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, this policy is also active. Effective date was [PII]. Bear with me just a moment.
[AGENT][NEUTRAL] Alright, and again verification of coverage is not a guarantee of payment for claims. This outpatient benefit is $8000 max per calendar year.
[CUSTOMER][NEUTRAL] Alrighty, and what is the group name on this policy?
[AGENT][NEUTRAL] Group name is CarePoint that's one word CarePoint LLC.
[CUSTOMER][NEUTRAL] And is there a group number?
[AGENT][NEUTRAL] Yes, uh, 26,500.
[CUSTOMER][NEUTRAL] Did you say 26,500?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Uh, give me just, yes, 26,500.
[CUSTOMER][NEUTRAL] So that was 2650.
[AGENT][NEUTRAL] 20,026,500.
[CUSTOMER][POSITIVE] Alright, uh, let's see, I think I have everything I need and I thank you for your time today.
[AGENT][NEUTRAL] Of course. Was there anything else I can help you with [PII]?
[CUSTOMER][POSITIVE] Uh, no, ma'am, that'll be all, thank you.
[AGENT][POSITIVE] Alright yeah thanks for calling
[AGENT][POSITIVE] Hey I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you bye.