AccountId: 011433970860
ContactId: 5589456a-d0de-4f19-b32f-6af014a9b288
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236750 ms
Total Talk Time (AGENT): 109805 ms
Total Talk Time (CUSTOMER): 97059 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/5589456a-d0de-4f19-b32f-6af014a9b288_20250625T17:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, I'm Will calling from Nicholas Children's Hospital to check on eligibility benefits for the patient.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility and benefits for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Can I have your name?
[AGENT][NEUTRAL] It's [PII] A. Would you mind spelling your name for me?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[AGENT][POSITIVE] Got it thank you and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure, that is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, sure, I can definitely help you with that.
[CUSTOMER][NEUTRAL] Just give me a moment. The policy number.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] For the subscriber patient is 02575005.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] OK, uh, do you want the subscriber's name or patient's name?
[AGENT][NEUTRAL] Uh, the patient, please.
[CUSTOMER][NEUTRAL] OK, the first name is [PII], last name is [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Thank you and then do you have her date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of birth of the patient is uh [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you so much for verifying all of that. Well, so this policy is active, that effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And were we needing to look at uh outpatient benefits for this number or inpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can I, can I have the plan name for this patient? It's the PPO plan?
[AGENT][NEUTRAL] Uh, it's
[AGENT][NEUTRAL] It's a Medlink, it's a supplemental, so secondary medical uh supplemental policy, the plan name, yes, it is uh Medlink, so M E D L I N K.
[CUSTOMER][NEUTRAL] Oh, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Medlink, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, I think, uh, that, uh, I got the information that is required. So it supports the primary plan right for co-pay coinci instance and deductible.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So, uh, if the patient has this plan, so they are 100% covered for the primary plan, right?
[AGENT][NEUTRAL] Um, up to a specific dollar amount per calendar year, um, again, was this, uh, for outpatient services?
[CUSTOMER][NEUTRAL] Mhm. Yeah, it's, it's a specialty office visit, doctor visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it, so I will let you know of course that um verification of coverage is not a guarantee of payment for claims, so their outpatient benefit um is $5500 max per calendar year, so it will pay up to that dollar amount per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that, uh, [PII]. Can I have the call reference number for this?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] A. last initial is A. Was there anything else I could help you with?
[CUSTOMER][POSITIVE] OK. No, I think I got it all covered. Thank you so much for your time.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah, you too, bye for now.
[AGENT][NEUTRAL] Bye bye.