AccountId: 011433970860
ContactId: 4bb40b73-2de9-4151-9ab3-46c2d7112686
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244020 ms
Total Talk Time (AGENT): 89838 ms
Total Talk Time (CUSTOMER): 116268 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/4bb40b73-2de9-4151-9ab3-46c2d7112686_20250207T21:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. Good afternoon. My name is [PII], and I am calling from our Houston Methodist Sugar Land, uh, Hospital Insurance verification department. And I was calling to verify coverage on one of your members that admitted here to our Houston Methodist Sugar Land Hospital on yesterday came in through the emergency room and is currently still in-house, and I was trying to obtain eligibility and benefits, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you, [PII], do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, let me see where is it? Uh, we have in our system.
[CUSTOMER][NEUTRAL] 01194612.
[AGENT][NEUTRAL] OK, what's the, uh, what's a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, I have a callback number with area code [PII], which is the direct line?
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] Date of birth, we have [PII].
[AGENT][NEUTRAL] OK, so we're checking eligibility and then inpatient benefits, right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so the policy effective date is [PII]. Policy is active at this time?
[AGENT][POSITIVE] And let me pull up the benefits and I can assist with that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, go right ahead, thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] I'm showing that the maximum in hospital benefit is up to $3000 per covered person per consignment.
[AGENT][NEUTRAL] And information provided is verification, not a guarantee of payment, and I'll check to see if any use this year, you know, that benefit is available at this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so he hasn't used any of it at this time. Alright, and, and what about authorization now we have this as like a secondary insurance. he has other insurance as well as Medicare as well.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Correct. So there, he should have a major medical policy. So this policy, did you say he does have Medicare?
[CUSTOMER][NEUTRAL] He does have Medicare, right? Uh-huh. He has, like I said, he has a commercial UnitedHealthcare plan and he also has Medicare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so this is a supplemental Metlink policy, um, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if we, we would bill Medicare before we would build this in this particular plan, is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, got you, alrighty, OK, that think that answers all my questions.
[AGENT][NEUTRAL] But is United Healthcare, is it, is this Medicare through UHC?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Or, or does he have a major medical and a Medicare plan?
[CUSTOMER][NEUTRAL] He has, uh, he has a commercial which is like the Medicare plan UnitedHealthcare is his primary and then the United the, and then he has the Medicare and then he has his policy, right. Uh-huh. So everything is primary over this particular plan, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got it. OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alrighty, OK, and how are you spelling your name?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Um, [PII] and you'll use my name and today's date is reference for today's call [PII]. Mhm. Did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, as a reference, OK, got you, alright, no ma'am, that's everything I need. I thank you so much for your time you have a great day and enjoy your weekend.
[AGENT][POSITIVE] You too, [PII], thanks for calling APL. Have a great day as well bye bye.
[CUSTOMER][POSITIVE] Thank you, uh huh bye bye.