AccountId: 011433970860
ContactId: 54cf9d6a-9e59-4976-b404-5167a06fde0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295480 ms
Total Talk Time (AGENT): 145411 ms
Total Talk Time (CUSTOMER): 73229 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/54cf9d6a-9e59-4976-b404-5167a06fde0e_20250522T15:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Palm Bay Hospital registration in [PII]. I am just trying to verify a patient's um insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're with Palm Bay Hospital, is that correct?
[CUSTOMER][NEUTRAL] Yes, in [PII].
[AGENT][NEUTRAL] Yes, ma'am. OK, and you're needing to verify eligibility?
[AGENT][NEUTRAL] Or benefits, I'm sorry. Which one, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Both eligibility and benefits.
[AGENT][NEUTRAL] Both, OK. Yes, well, I can help you with both. And what is the members, uh, well, first off, what's your callback number?
[CUSTOMER][NEUTRAL] It is [PII]. I had to think about it for a second.
[AGENT][NEUTRAL] I understand that. And then what is the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] It is 01861698 M as in Michael L as in Larry 7.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sierra
[AGENT][NEUTRAL] OK, so any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, her name is [PII].
[CUSTOMER][NEUTRAL] And her birthday is [PII].
[AGENT][NEUTRAL] Thank you. So I do show that she is the subscriber on the supplemental policy, and this supplemental policy is active, effective [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, ER visit, so inpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She's been admitted as an inpatient or she's in the emergency room?
[CUSTOMER][NEUTRAL] No, she was in the emergency room.
[AGENT][NEUTRAL] OK, so her outpatient benefit.
[CUSTOMER][NEUTRAL] She was never admitted.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar year for covered outpatient services is $5000.
[AGENT][NEUTRAL] And give me just one moment um to verify her if there's any deductible.
[AGENT][NEUTRAL] On an ER visit. I don't believe there is, but I want to double check something.
[AGENT][NEUTRAL] OK, and then, so her outpatient benefit max as I stated per calendar year for covered outpatient services is $5000 and there is no deductible.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Her ER occurrence.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, because this is a supplement to the primary insurance, [PII], when it's, the claim is submitted to us for review, we will have to have a copy of her primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once the claim has been processed here at APL we do have a portal.
[AGENT][NEUTRAL] In which you should be able to check claim status and that website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then what was your name again?
[AGENT][NEUTRAL] Again, my name is [PII], and my name will be your call in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] patient Route 16 trio project.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you very much for your help. I appreciate it. That was all I needed to know.
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] OK, well if that is all I can help you with [PII], then thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye.