AccountId: 011433970860
ContactId: 2cafe465-9809-475d-bd72-bdc482530b66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367660 ms
Total Talk Time (AGENT): 157892 ms
Total Talk Time (CUSTOMER): 108063 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/2cafe465-9809-475d-bd72-bdc482530b66_20250121T20:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the Nicola Children's Hospital. I am checking eligibility and benefits for the patients.
[AGENT][NEUTRAL] OK, [PII], you have one patient that you're needing eligibility and benefits on, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I have 2 patients to check.
[AGENT][POSITIVE] OK, yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, my callback number.
[CUSTOMER][NEUTRAL] Sorry, it's [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you and the number, the first, OK, so first off, [PII], you will use my name along with today's date as the call reference number for each one.
[AGENT][NEUTRAL] And then any information that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, what is the first patient's policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's 014803777 M as in Mike, L as in Lima, the number 7.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] And what is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient first name is [PII] and last name is [PII]. Uh, the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So I did say, she is a dependent on this policy and this supplemental policy is active with an effective date of [PII]. And what type of benefit information are you needing inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, for outpatient offices, sir?
[AGENT][NEUTRAL] OK, office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mm thank you for that. Can I go for the next patient?
[AGENT][NEUTRAL] OK, just one moment. And also on this, should you all end up submitting a claim to APL [PII], we will also have to have a copy of the primary insurance company's explanation of benefits for any claim overdue.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then also once we've reviewed our claim we do have a portal that you can check claim status in and also have access to our explanation of benefits and that portal website is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, is your next patient on a, under a different policy number?
[CUSTOMER][NEUTRAL] Yes, the different policy number.
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And what is that next patient's policy number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure. It's 02042058 M as in Mike, L as in Lima and number 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And with your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Our patient name is [PII]. Her date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So I do show that she is a dependent also on this supplemental policy and it is active, effective [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Yeah, it's outpatient office is it.
[AGENT][NEUTRAL] OK, so an office visit is not covered under this policy either. However, if
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If there's any treatment rendered within the office, then under this policy we could review the treatment under her outpatient benefit maximum.
[AGENT][NEUTRAL] Which is $1500 per calendar year for covered outpatient services and no outpatient deductible, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] Well, you're very welcome. And yes, sir. Is there anything else that I could help you with, [PII]?
[CUSTOMER][NEUTRAL] With the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Uh, no, crazy, that's it. I'm done with.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.