AccountId: 011433970860
ContactId: 67de42c8-7067-45d0-b28b-129d485727a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190990 ms
Total Talk Time (AGENT): 73911 ms
Total Talk Time (CUSTOMER): 68311 ms
Interruptions: 1
Overall Sentiment: AGENT=2.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/67de42c8-7067-45d0-b28b-129d485727a8_20250114T20:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII], uh, I'm [PII] calling from Nicola Children's Hospital. I'm looking for eligibility and benefits. Could you just spell your name for me?
[AGENT][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, may I also have your name, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII], and the last name first is gonna be [PII].
[AGENT][POSITIVE] Thank you, [PII], and can I have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure, the callback number is gonna be uh it is [PII].
[AGENT][NEUTRAL] Thank you. And what's the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the member ID just give me a minute. I can provide you that.
[AGENT][POSITIVE] Oh take your time no worries.
[CUSTOMER][NEUTRAL] It's gonna be the member ID, yeah, the member ID is gonna be 01843877 M as in Mary, L as in Lima, number 7.
[AGENT][POSITIVE] Thank you, give me a moment to get that pulled on up for you.
[AGENT][NEUTRAL] And would you be able to go ahead and verify for me please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure, the member's name is gonna be uh [PII], and the date was gonna be [PII].
[AGENT][POSITIVE] Perfect, and give me just one second.
[AGENT][NEUTRAL] I do see [PII] here. It looks like he is current and active with an effective date of [PII].
[AGENT][NEUTRAL] And you said you're looking for benefits as well as eligibility. Are you looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] It's for outpatient diagnostic X-ray.
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] I do wanna let you know that any benefit information I give you over the phone is just gonna be a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, I just want to know, uh, this is the secondary, uh, plan for the member and the primary, uh, SBCPS and the crossover will be paid by APL, right?
[AGENT][NEUTRAL] So we don't do crossover. You'll have to submit a claim to us once you receive the explanation of benefits from primary insurance, um, but yes, we are their secondary and your patient has an outpatient calendar year maximum of $5000.
[CUSTOMER][NEUTRAL] Yeah, yeah, sorry, yeah. Sure. Sure, got it, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, got it.
[AGENT][POSITIVE] Perfect. And then is there any other information I can do for you today, my friend?
[CUSTOMER][NEUTRAL] Just give me a minute.
[CUSTOMER][NEUTRAL] Uh, can I have a call reference number? I think that's it for this.
[AGENT][NEUTRAL] Yeah, you bet your call reference number is my name [PII], and today's date.
[CUSTOMER][POSITIVE] Yeah, thank you [PII]. Have a great day. Take care bye for now.
[AGENT][POSITIVE] My pleasure thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.