AccountId: 011433970860
ContactId: 1ff0bca3-6537-40ea-b959-bee80683f28d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331299 ms
Total Talk Time (AGENT): 137516 ms
Total Talk Time (CUSTOMER): 87655 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/2025/01/23/1ff0bca3-6537-40ea-b959-bee80683f28d_20250123T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the Nicola Children's Hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, just I'm checking a patient eligibility and benefits.
[AGENT][POSITIVE] Sure, I can assist you with eligibility and benefits. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah one moment.
[CUSTOMER][NEUTRAL] The policy number it's 23061.
[AGENT][NEUTRAL] Um, is that all the numbers, Mister [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Actually, it's a group number I think.
[AGENT][NEUTRAL] OK, um, do you, do you see the policy certificate number? It should be on the bottom outpatient inpatient.
[CUSTOMER][NEUTRAL] Yeah, I, I got that. It's 018.
[CUSTOMER][NEUTRAL] 29319.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, and number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, so the member's first name is [PII], last name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so the date of birth is [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you said you need eligibility and benefits, and this is a hospital and is it gonna be for inpatient or outpatient service?
[CUSTOMER][NEUTRAL] This is for outpatient mental health.
[AGENT][NEUTRAL] A patient.
[AGENT][NEUTRAL] Outpatient mental health?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull the benefits. Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this is um effective date on the policy is [PII]. It is active at the moment and this is one of our secondary supplemental plans for the major medical.
[AGENT][NEUTRAL] And bear with me just a second, I'm still waiting on that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Irish
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And um Mr. [PII], let me give you the correct policy number. You have an old policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] OK, the correct policy number is 0197.
[AGENT][NEUTRAL] 8559.
[CUSTOMER][NEUTRAL] OK, that's it.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] 01978559 is the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, thank you for that.
[AGENT][NEUTRAL] You're welcome. OK, so this one has a benefit, uh, let's see, mental emotional disorder in the hospital. It is part of the outpatient maximum benefit, which is $7350 per covered person per calendar year.
[AGENT][NEUTRAL] And it is subject to 30 days of treatment.
[CUSTOMER][NEUTRAL] 7350.
[AGENT][NEUTRAL] 7350 per year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So this policy covered for $7350 per year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so it was a secondary insurance and uh
[CUSTOMER][NEUTRAL] The patient have another primary insurance, it will be covered, the primary co-pay and co-insurance and deductibles.
[AGENT][NEUTRAL] For this one, yes, we are the secondary, so we help with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][POSITIVE] Yeah, thank you for that information, ma'am.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And can you spell your name for me?
[AGENT][NEUTRAL] Sure, that's [PII] [PII].
[CUSTOMER][NEUTRAL] OK, and what is the call reference number for conversation?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, sir. Bye, have a wonderful day.
[AGENT][NEUTRAL] Is there anything else?
[AGENT][POSITIVE] You as well, Mr. [PII]. Thank you for calling ATM. Bye bye.
[CUSTOMER][NEUTRAL] No, no, no, that's it.
[CUSTOMER][NEUTRAL] Bye bye.