AccountId: 011433970860
ContactId: 59569039-48d1-4f78-a27f-700ef273a668
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368489 ms
Total Talk Time (AGENT): 138629 ms
Total Talk Time (CUSTOMER): 118559 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/59569039-48d1-4f78-a27f-700ef273a668_20250403T19:57_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, yes, um, my name is [PII] calling from Saint Jude Orthopedics. We were just calling um to see if we could, uh, verify eligibility for a patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility. Could you repeat your name for me and then give me a good callback number?
[CUSTOMER][NEUTRAL] Of course. My name is [PII] spelled [PII]
[CUSTOMER][NEUTRAL] And my best callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do. It's uh D as in David 46401606.
[AGENT][NEUTRAL] OK, pulling that up. Give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what was the last name of the patient?
[CUSTOMER][NEUTRAL] Uh, [PII], spelled B [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name [PII]?
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] Yeah, she's got 2 policies here, so let me see which one.
[AGENT][NEUTRAL] What kind of services are these today?
[CUSTOMER][NEUTRAL] Uh, yes, so she's coming in for a consultation, um, with a specialty with the orthopedics department for her left knee.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] And what was her date of birth?
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, uh, looks like I've got an effective date of [PII]. She's currently active.
[CUSTOMER][NEUTRAL] Let me just write that down real quick, so that was [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, currently active, uh, does she have a specialty copay or co-insurance?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Let me pull up her policy. It's a, so this is a hospital indemnity plan. It's not a guarantee of payment, just a basic outline of the policy.
[AGENT][NEUTRAL] Looks like it is so loud. Hold on one moment.
[AGENT][NEUTRAL] So she has benefits for um
[AGENT][NEUTRAL] Surgery in a physician's office. I don't show an actual outpatient or an office visit.
[AGENT][NEUTRAL] She does have a group accident policy too though. Let me pull that up real quick and see if it offers any type of
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] She's got two plans. She's got hospital indemnity and a group accident, so let me, let me check on the group.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Now her knee, um, under the accident policy it would have to be obviously due to an accident that she's experiencing knee issues so.
[CUSTOMER][NEUTRAL] Mhm, yeah, that I'm not too sure um I believe she actually was already an existing patient of ours when she had her other insurance plan, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry because I realized afterwards, so yes, looks like she's following up on the need, but I'm not too sure if it was um accident related or not.
[AGENT][NEUTRAL] OK, let's see though and let me see if that just in case.
[AGENT][NEUTRAL] Depending on the diagnosis, of course, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh that one up.
[AGENT][NEUTRAL] Uh, that policy is effective on the same date, and again, not a guarantee of payment basic outline of the policy. Let's see what she's got.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one.
[AGENT][NEUTRAL] This one does have a physician's office visit. Um, it pays out a maximum of $50 and it has to be the initial treatment within 30 days of an accident.
[AGENT][NEUTRAL] So again not sure if this would apply or not but.
[CUSTOMER][NEUTRAL] Within 30, yeah, we're not too sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And we wouldn't probably know that until they bill everything, huh?
[AGENT][NEUTRAL] Right, and she, yeah, I mean, just based on the diagnosis code and then if she was seen for it prior, etc. so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and make a note of that here. And is there any way I can get um like a copy of her benefits faxed over or is there like a call reference number I can write down?
[AGENT][NEUTRAL] Um, our call reference number is, it just be my first name, [PII], first initial of my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] and [PII]
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Perfect and uh today's day uh day month today.
[CUSTOMER][NEUTRAL] Day then for the year? OK perfect so 44 3.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, 4325, yeah.
[CUSTOMER][POSITIVE] 2025. OK, perfect. Alright, thank you so much, [PII]. I really appreciate it.
[AGENT][POSITIVE] OK, thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] You too thank you OK bye bye.
[AGENT][NEUTRAL] Bye.