AccountId: 011433970860
ContactId: 3cd6e973-4fa7-4250-bf37-eec260c5040b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187160 ms
Total Talk Time (AGENT): 97430 ms
Total Talk Time (CUSTOMER): 67679 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3cd6e973-4fa7-4250-bf37-eec260c5040b_20250127T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, [PII], this is [PII] calling from Nicholas Children's Hospital. I need to check the patient eligibility and benefits. Could you please help me that?
[AGENT][POSITIVE] Yeah, I can check benefits and eligibility for you [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is 021.
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] All right, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. The patient first name is [PII], the last name is [PII]. Can I spell the last name?
[AGENT][NEUTRAL] Oh, that's fine. Um, do you have the date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, thank you for verifying all of that then. uh, so the policy is active. Effective date was [PII], and we're we need to look at, uh, outpatient benefits?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, of course this is a secondary medical policy, so it is designed to help with co-pay, deductible and coinsurance after major medical pays, and a verification of coverage is not a guarantee of payment for claims. So the outpatient benefit is $2000 per calendar year and if you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, $2000.
[AGENT][NEUTRAL] Yes, and none has been used so far this year.
[CUSTOMER][NEUTRAL] OK. Uh, this $2000 means it's out of pocket, out, out of pocket, or?
[AGENT][NEUTRAL] That's that's their benefit amount that's the maximum we would pay per calendar year.
[CUSTOMER][NEUTRAL] Oh OK. OK, got it. OK, got it. Uh, could you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, [PII], uh, the patient have any, that insurance have any group name or group number?
[AGENT][NEUTRAL] Yes, OK, so that group number is 25037.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and the group name, um, I'm going to spell the first word for you. It's O R I E N T E.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then Latin America Inc.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] On America
[AGENT][NEUTRAL] It's Oriente Latin America Inc.
[CUSTOMER][NEUTRAL] Oh, OK, got it. Uh, that's all, uh, could you please provide the reference number for this call?
[AGENT][NEUTRAL] Uh, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII], was there anything else I could help you with then?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's why I the only one patient. Thank you so much for assisting me a wonderful day. Bye bye.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thank you so much.