AccountId: 011433970860
ContactId: 37dda265-fb75-4f01-ab63-6e56687a55c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316709 ms
Total Talk Time (AGENT): 150726 ms
Total Talk Time (CUSTOMER): 66435 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/37dda265-fb75-4f01-ab63-6e56687a55c8_20250106T18:30_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], I'm calling from Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] Um, I was calling to verify benefits for a patient, please.
[AGENT][NEUTRAL] OK, you're needing to verify benefit information for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] Od it [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Is that all? and your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 1, wait a minute, I'm sorry 147.
[CUSTOMER][NEUTRAL] 5081.
[CUSTOMER][NEUTRAL] ML
[CUSTOMER][NEUTRAL] But I have a feeling this insurance card that they gave is very old.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] OK, and any information that I provide for you today would be a verification of benefits Dallas and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, so yes, ma'am, this policy is no longer active. It was active from [PII].
[AGENT][NEUTRAL] The policy that is currently active.
[AGENT][NEUTRAL] What um
[AGENT][NEUTRAL] This policy number is 01933929 and it went into effect [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's still active.
[AGENT][NEUTRAL] OK give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, give me her date of birth one more time, please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, no, no hospitals inpatient.
[AGENT][NEUTRAL] Inpatient
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on this uh currently active policy at Daly the inpatient benefit max.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, I'm so sorry. I thought I was ready to give that information to you. I thought I was.
[CUSTOMER][NEUTRAL] It's OK darn.
[AGENT][NEGATIVE] But I was, I was not, not as great as I thought.
[AGENT][NEUTRAL] OK, so the inpatient benefit maximum is $7900 per covered person per calendar year, and there is no inpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] And of course on this policy because it is a supplement we do also have to have a copy of the primary insurance company's explanation of benefits for review as well and then we do have our portal which you probably already have our website for but it's [PII] and that's where you can have access to the claim status and EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bills, are they sent to the PO box in [PII]?
[AGENT][NEUTRAL] Yes, ma'am. They are 2 the 248,950.
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][POSITIVE] Right, and I got it perfect. OK, thank you, [PII]. I hope you feel better.
[AGENT][POSITIVE] Uh-huh. You are, uh, thank you very much. I do too. I was hoping I already would. This has been going on for a minute, so, but it's, it's just lingering terribly. So, but thank you so much. Yes, I appreciate it. Yes, ma'am. You too, [PII]. Nice talking to you.
[CUSTOMER][POSITIVE] I know. Oh my goodness.
[CUSTOMER][NEUTRAL] I know, and lingering.
[CUSTOMER][POSITIVE] No, of course. Have a nice day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you you too bye bye.