AccountId: 011433970860
ContactId: 1f871525-5278-403c-bd53-555430ebec89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337239 ms
Total Talk Time (AGENT): 114878 ms
Total Talk Time (CUSTOMER): 165361 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/1f871525-5278-403c-bd53-555430ebec89_20250620T19:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII] with Baptist Hospital. How are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm good, thank you, my love. I'm calling to see if you can help me with the member's benefits to see if he has um what he has available to use.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] It's area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] The policy number is going to be 01611807 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's first name is [PII]
[CUSTOMER][NEUTRAL] The last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's gonna be outpatient benefits.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to 1500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim and actually she's used the full 1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. OK, so she has nothing available to use.
[AGENT][NEUTRAL] Not for um outpatient services, no, ma'am.
[CUSTOMER][NEUTRAL] OK, give me one second, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me just, I'm just writing, I'm just getting all this information. Hold on.
[CUSTOMER][NEUTRAL] Copy paste, APL APL.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. 1500. She's already used it, no none. No office is required.
[CUSTOMER][NEUTRAL] OK, perfect. So I got that and oh my goodness, I put it for the wrong patient.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] I'm sorry, hold on. Yeah. Hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] While you were looking up the information I was, I was putting in other stuff, OK.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] All right. So go back here. No uh.
[CUSTOMER][NEUTRAL] No. OK. And so, OK, at, and then I have another per another patient as well to see if you can help me. Um, let me ask you, I'm so sorry. Can you tell me your, your name?
[AGENT][NEUTRAL] Um yes, my name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. OK. And then, um, so that I have that done. And then I have another patient, hold on. uh [PII] that I had to go to, but there's another one. I wanna see if you can help me with this one. OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. The member does have APL and, but hers doesn't have an M and MNL it's just numbers. Um, let me know when you're ready so I can give you that.
[AGENT][NEUTRAL] OK. Well, I'm ready. What's that number?
[CUSTOMER][NEUTRAL] It's 02570591.
[AGENT][NEUTRAL] OK, and please verify her name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and then it's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, I found her in our system and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. Um, is this also for outpatient?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK. For outpatient under this policy, we cover up to 3000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary, and the full 3000 is available. She hasn't used any benefits this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, 3000.
[CUSTOMER][NEUTRAL] OK. And may I have a reference number?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, thank you so much for your help, my love. I appreciate it.
[AGENT][POSITIVE] No problem, [PII]. Thank you for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][POSITIVE] You too take care bye.
[AGENT][POSITIVE] Mm thanks.