AccountId: 011433970860
ContactId: 503c77d0-7fd8-43eb-ad26-42ad6717be0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300839 ms
Total Talk Time (AGENT): 138707 ms
Total Talk Time (CUSTOMER): 131495 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/503c77d0-7fd8-43eb-ad26-42ad6717be0e_20250214T13:53_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 [PII], how are you? I'm calling from Nicola Children's Hospital. It's in regards benefits and eligibility verification on one of your members.
[AGENT][NEUTRAL] OK, you're needing benefit and eligibility information, is that correct?
[CUSTOMER][POSITIVE] Correct, correct.
[AGENT][POSITIVE] Yes ma'am. I can, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] This is [PII]. The first initial of my last name is [PII].
[AGENT][NEUTRAL] OK, and the first initial to my last name is [PII]. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It is um 02449587 ML 8.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment please.
[CUSTOMER][POSITIVE] Sure, not a problem.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I guess.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] I'm sorry, what is the first name again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Please, no problem.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I do show that this member is covered under the supplemental policy and the policy is active. The policy has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what kind of benefits?
[CUSTOMER][NEUTRAL] And it's still active?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Yeah, it's our X-ray in outpatient hospital.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, so on the supplemental policy, [PII], the outpatient benefit max per calendar day per covered person for covered outpatient services is $750 and there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Because this is a supplemental policy to the primary insurance, we will also need for you to send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] From
[AGENT][NEUTRAL] And then once we have, go ahead.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, so you cover, you say you cover 75 um 75,750 per calendar day or per calendar year?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am for covered outpatient services.
[CUSTOMER][NEUTRAL] For our patient services, OK.
[AGENT][NEUTRAL] Covered services.
[CUSTOMER][NEUTRAL] For OK per service, OK, uh, the patient is active.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so go ahead because you were explaining something, yeah, yeah, yeah.
[AGENT][NEUTRAL] And then once
[AGENT][NEUTRAL] Yes, ma'am. And so I explained that you would also need to send us their primary insurance company's explanation of benefits along with the claim for review and then once APL has processed our claim, you may go to our portal at secured.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you should be able to again check claim status and have access to our explanation of benefits.
[CUSTOMER][NEUTRAL] OK perfect perfect [PII], is there any reference number for this call?
[AGENT][NEUTRAL] OK, and.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Could you please spell out your first name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You are very welcome. So, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, no, I'm OK thank you [PII] bye bye.
[AGENT][NEUTRAL] OK. Well, you're welcome and have a