AccountId: 011433970860
ContactId: 5d26d209-3800-4718-8ad4-03d1c131a6ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335869 ms
Total Talk Time (AGENT): 135785 ms
Total Talk Time (CUSTOMER): 112905 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5d26d209-3800-4718-8ad4-03d1c131a6ec_20250428T15:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from HCA Houston Healthcare Clear Lake. I'm trying to verify eligibility and benefits for a patient.
[AGENT][POSITIVE] Of course, I can help you with eligibility and benefits today. Do you have that policy number?
[CUSTOMER][NEUTRAL] I have 01653564, and I don't know what kind of policy it is because I don't have an insurance card to look at.
[AGENT][NEUTRAL] Oh, OK. I can tell you, see.
[AGENT][NEUTRAL] OK, [PII], what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Sure, my direct line is [PII].
[AGENT][NEUTRAL] OK, perfect. And then the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, so it looks like the policy is currently active. The effective date is [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And this is a meddling policy, so this is secondary to her primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now is it like a, a Medicare supplement policy or does it pay like a certain amount?
[AGENT][NEUTRAL] Yes, so it's a supplemental um insurance policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me what?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So is it a Medicare supplement or is it just like uh a hospital indemnity where it will, you know, pay a certain amount per day?
[AGENT][NEUTRAL] So, whatever her primary insurance doesn't cover, uh, this policy is made to cover the rest. So for like co-pays, um, office visits.
[AGENT][NEUTRAL] Let me look at her benefits. Um.
[CUSTOMER][NEUTRAL] OK, oh yeah, I guess.
[AGENT][NEUTRAL] Is this for an office visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's hospital inpatient.
[AGENT][NEUTRAL] OK, give me just one moment and I will look deeper into her policy to see.
[CUSTOMER][NEUTRAL] I didn't realize she didn't have Medicare.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That's why I was confused. I'm like, well, because it's a Blue Cross plan that she has a primary, and I thought it was a Medicare Advantage plan for whatever reason. I'm like, normally they don't have Medicare supplements, but OK, so it, it just covers anything that her primary does not.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh, yeah, no.
[AGENT][NEUTRAL] Yes, uh, it depends.
[CUSTOMER][NEUTRAL] So like you said, copays, deductibles.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, every policy is like different, um.
[AGENT][NEUTRAL] So it looks like for this policy, so this is not a guarantee payment, it's just a verification of coverage. So she does have a benefit of inhospital benefit max.
[AGENT][NEUTRAL] And that is 3500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so the plan only pays up to 3500 per year.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Again, I don't have a card or anything to look at, so it's just a supplemental policy, so there's no like network or anything like that, correct?
[AGENT][POSITIVE] No. Yeah, you are correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and how about prior authorization? I assume it's not required, but.
[AGENT][NEUTRAL] No, ma'am. It is a prior prior authorization is not required.
[CUSTOMER][NEUTRAL] OK, one last question. How about a claims mailing address?
[AGENT][NEUTRAL] Yes, I can provide that. Let's see.
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, perfect. [PII], what is the first initial to your last name and then is there a call reference?
[AGENT][NEUTRAL] Yes. So it is [PII]
[AGENT][NEUTRAL] And then the call reference number will be my first name, [PII], last initial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my gosh, I'm so sorry.
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] I thought it was, I thought you told me it was [PII]. I'm sorry.
[AGENT][NEUTRAL] Oh, no, no, it's OK.
[AGENT][NEUTRAL] So the reference number is just my first name, my last initial [PII], and then today's date.
[CUSTOMER][POSITIVE] Alright, perfect, thank you very much for your help. You have a great day.
[AGENT][POSITIVE] Yeah, of course, you too. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks bye bye.