AccountId: 011433970860
ContactId: 33e68a3f-b5c3-4e0f-a506-793c60b88c88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256070 ms
Total Talk Time (AGENT): 114720 ms
Total Talk Time (CUSTOMER): 98130 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/33e68a3f-b5c3-4e0f-a506-793c60b88c88_20250613T13:43_UTC.wav
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[AGENT][NEUTRAL] ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Del Children's Medical Center here in [PII], and I'm trying to confirm coverage for a patient that was seen in our emergency department.
[AGENT][NEUTRAL] OK, let's take a look here. [PII], do you have their policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I hope so. I'm hoping that this is what the mom listed, but I'm not sure if it's accurate or not. I can give it to you though.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says 0026.
[CUSTOMER][NEUTRAL] 15803
[AGENT][NEUTRAL] Alright, let me pull that up and then for documentation [PII], do you have a good call back number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 269-491-6
[AGENT][NEUTRAL] Thank you. And then what's the patient name and date of birth?
[CUSTOMER][POSITIVE] Thank you. Mhm.
[CUSTOMER][NEUTRAL] The first name is [PII] The last name is [PII] and the date of birth that we have is [PII].
[AGENT][NEUTRAL] All right, thank you. So it looks like patient is active. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then you said the patient was seen in the emergency room?
[CUSTOMER][NEUTRAL] um
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Let me see what the benefit is for that here one second.
[CUSTOMER][NEUTRAL] it'll be
[CUSTOMER][NEUTRAL] Right through these.
[AGENT][NEUTRAL] Alright, so the member's plan is a limited benefit hospital indemnity plan. Were they ever admitted or is just emergency room?
[CUSTOMER][NEUTRAL] It doesn't show that the patient was admitted.
[AGENT][NEUTRAL] OK. So on here, the outpatient accident sickness treatment benefit for an emergency room is $50 per day and it's a maximum of uh 2 days per year. So what that means is the plan is gonna pay $50 towards that and nothing additional.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, and only 2 times a year.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so $50 per visit, that's it twice a year, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. And do you know, um, so the parent never provided an insurance, I mean, an insurance card when she was seen in the emergency department. So we don't have any kind of billing address for this insurance. Do you have that for us?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, I can give you the claims mailing address and also the payer ID if you'd like it.
[CUSTOMER][POSITIVE] OK, great. Thank you.
[AGENT][NEUTRAL] Yeah, so claims actually go to um it's attention IMA Inc so that's I as in India, M as in Mary, A as in apple incorporated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII]. Do you need me to spell [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, and then the zip code is [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] 645-556
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, is there a reference number for the phone call?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. My name is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much. I appreciate your time.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] OK, you too. Bye-bye.
[AGENT][NEUTRAL] Bye.