AccountId: 011433970860
ContactId: 43164fec-a365-4eb6-a914-dbc588dbd22c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275929 ms
Total Talk Time (AGENT): 129643 ms
Total Talk Time (CUSTOMER): 62600 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/43164fec-a365-4eb6-a914-dbc588dbd22c_20250225T17:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Nicholas Children's Hospital because I have a patient coming in and I need to make sure they're covered, um.
[AGENT][NEUTRAL] OK, so, all right, so you're, are you needing only eligibility or do you also need benefit information as well?
[CUSTOMER][NEUTRAL] With APL
[CUSTOMER][POSITIVE] Um, benefits too.
[AGENT][POSITIVE] Yes, ma'am, I can help you with both. And who am I speaking with?
[CUSTOMER][NEUTRAL] My.
[AGENT][NEUTRAL] I'm so sorry, your voice cut out. Could you say that again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sorry, one second.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um, insured playing and child.
[AGENT][NEUTRAL] Depending on the type of plan they have, [PII], it may have an in-hospital or an outpatient number.
[CUSTOMER][NEUTRAL] Yeah, that's what it has.
[AGENT][NEUTRAL] OK. Either one of those you can give me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, it's gonna be 0249.
[CUSTOMER][NEUTRAL] 483 5.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] M like Mike, L.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information [PII] that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that she is a dependent on this policy and this policy, the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] So she has an outpatient benefit maximum per calendar day for covered outpatient services of $750.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Got it. And has she accumulated anything yet?
[AGENT][NEUTRAL] Again, this is a per calendar day. So is this for a data service party? OK. And then too, because um this is a supplemental policy going in to the primary insurance when you all submit the claim to us for review, we will also have to have a copy of a primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] Got it. OK, got it, got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you all should be able to check claim status in by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] No, can I just have um reference number if there is one?
[AGENT][POSITIVE] Yes, ma'am, you would actually use my name along with today's date.
[CUSTOMER][POSITIVE] Got it. OK, thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a great afternoon, [PII].
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye bye.