AccountId: 011433970860
ContactId: 51ebd571-4998-4829-b1fc-e6ee25907b02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214130 ms
Total Talk Time (AGENT): 85078 ms
Total Talk Time (CUSTOMER): 80070 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/51ebd571-4998-4829-b1fc-e6ee25907b02_20250211T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII], how can I help today?
[CUSTOMER][NEUTRAL] Yeah, I need uh eligibility and benefits for the patient and uh the member ID is 01446132.
[AGENT][POSITIVE] All right, thank you for that one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] All right. Thank you so much. One moment.
[AGENT][NEUTRAL] Right, so the member does have an active plan with us. It is a different policy number. Would you like to take that down?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] The active policy is 02.
[AGENT][NEUTRAL] 54.
[AGENT][NEUTRAL] 9559.
[AGENT][NEUTRAL] The effective date on this policy is [PII], members still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the benefits for diagnostic X-ray on-campus outpatient hospital?
[AGENT][NEUTRAL] Looks like the outpatient benefit max for this patient's plan is 27,000. We are the secondary insurance, so this covers deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So the maximum amount is $27,000 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what will be the met amount? Is there any amount met?
[AGENT][NEUTRAL] Uh, let me see if the patient has used anything. One moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient has the full amount to date.
[CUSTOMER][NEUTRAL] So nothing has been met, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And what is the group name and group number?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Group name is COD supplies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Group number is 15832.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 15832. OK, got that. And uh yeah, thank you so much for this information. Can you please spell your name with an issue?
[AGENT][NEUTRAL] My name is spelled [PII]. My last [PII] is [PII].
[CUSTOMER][NEUTRAL] OK. May I get your call number?
[AGENT][NEUTRAL] Call references my name with my last initial and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Have a great day. Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah.