AccountId: 011433970860
ContactId: 650db540-096b-486b-9807-afc3a6d16857
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235050 ms
Total Talk Time (AGENT): 128087 ms
Total Talk Time (CUSTOMER): 68323 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/650db540-096b-486b-9807-afc3a6d16857_20250228T19:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from Holy Cross Hospital. I'm calling because I need to check eligibility on a patient that is scheduled to come in for a procedure Monday.
[AGENT][NEUTRAL] OK, and did you say that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh, [PII]. OK, thank you. I'm so sorry about that. And you're needing to just check eligibility. You do not need benefits. Is that correct?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, well, uh, if the plan is active and you know, just.
[CUSTOMER][NEUTRAL] At um and what it will cover, so eligibility and benefits sorry.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with both, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 1381893.
[AGENT][NEUTRAL] Thank you, one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So I do show that he is the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] No outpatient.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So on this supplemental policy, the outpatient benefit maximum per calendar day for covered outpatient services is $1000 and there is no outpatient deductible per calendar day for covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, [PII], thank you very much uh huh, go ahead.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes ma'am, you're welcome and just a couple of additional thingselma when the claim is submitted to us for review, you will also need to include a copy of their prime of his primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] And then we do have our portal that once we process the claim here you should be able to check claim status and have access to our EOB and our portal website for that is secured. Ampublic.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, thank you very much, [PII]. Could I.
[AGENT][POSITIVE] All right. Well, you are certainly very welcome.
[CUSTOMER][NEUTRAL] Could I have the initial of your last name?
[AGENT][NEUTRAL] [PII] and my name in today's date will be your call reference number.
[CUSTOMER][POSITIVE] Thank you very much. You have a good weekend.
[AGENT][POSITIVE] For you, yes ma'am, you too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK then, take care.
[AGENT][NEUTRAL] Um, you too. Bye-bye.
[CUSTOMER][NEUTRAL] Look at that