AccountId: 011433970860
ContactId: 5d4e0fc7-033d-4e6c-9a92-0aabff96d32c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 137619 ms
Total Talk Time (AGENT): 74170 ms
Total Talk Time (CUSTOMER): 51974 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/5d4e0fc7-033d-4e6c-9a92-0aabff96d32c_20250130T20:48_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm a Baptist Medical Center on a recorded line. I was just calling to verify if a patient needs I need the effective date and if the patient needs an authorization for an observation stay.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's area code [PII].
[AGENT][NEUTRAL] OK. Thank you. And could I get the policy number, please?
[CUSTOMER][NEUTRAL] Um, I have it as 01588195 M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And the um date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Um, this one, they came to the ER and then they went to observation. They haven't been admitted or anything yet.
[AGENT][NEUTRAL] OK, for outpatient services, we cover up to 1000 per day, and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And if they're admitted um for inpatient, we cover up to 6000 per calendar year and that's again for the co-pay, the co-insurance, and the deductible. And there's no authorization required because this is secondary gap insurance and we go by the primary insurance guidelines.
[CUSTOMER][NEUTRAL] OK. That is what I needed to know. And um you said your name was [PII]?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, and is there any reference number for the call?
[AGENT][NEUTRAL] You can use my name and today's date for the reference number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That would be all. I do appreciate your help on this and you have a wonderful day. Thank you so much.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Alright.