AccountId: 011433970860
ContactId: 67e50a79-530e-4dc5-9224-6d602b65ba03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272760 ms
Total Talk Time (AGENT): 117801 ms
Total Talk Time (CUSTOMER): 91465 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/67e50a79-530e-4dc5-9224-6d602b65ba03_20250212T17:04_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from Nicholas Children's Hospital. How are you?
[AGENT][NEUTRAL] OK, thank you. How about you, Mr. [PII]?
[CUSTOMER][POSITIVE] Yeah, I'm doing so great. Thanks for asking. Actually, I wanna know about the patient's eligibility and benefits.
[AGENT][POSITIVE] Mm, OK, sure. I can assist you with eligibility and benefits. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, uh, that's a commission number, yeah, I have phone number of [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] Fishing policy number. What was that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I have policy number 165.
[CUSTOMER][NEUTRAL] 981 3.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII], [PII], I'm sorry, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And um, can you repeat the date of birth one more time?
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[AGENT][NEUTRAL] Or you said you need eligibility and benefits, correct? Yes, I'm so sorry. Yeah, I got it written down here. OK, so, uh, what type of service is being rendered.
[CUSTOMER][NEUTRAL] Uh, no, that's not for the claim. I need the benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's for specialist office visit and it's for neurology.
[AGENT][NEUTRAL] Neurology. OK. All right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is one of our secondary supplemental plan to the major medical. Um, let me pull and see if there's another policy. This one is terminated. Give me just a second, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we have an effective date of [PII].
[AGENT][NEUTRAL] And let me give you the correct policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Uh, I'm ready, go ahead.
[AGENT][NEUTRAL] 02496934.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, the policy is active at the moment and with this one, we cover office treatments, but we do not cover the office visit. So if there's any treatment or procedures in office that is subject to the outpatient maximum of 2500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm. OK. Uh, I do see the patient's primary insurance is A HMO that's on file and you are the secondary stated that. I just wanna confirm that, uh, you are currently active or inactive. Mm, that's more enough for me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. Yeah, it is. OK, yes.
[CUSTOMER][NEUTRAL] Uh, OK. So, can you please spell your name along with your last initial?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] May I know the reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][POSITIVE] Thank you so much, Ms. So, uh, that's it for today. Thanks for patiently assisting me. Bye, bye for now.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you for calling PR. Have a good day. Bye bye.
[CUSTOMER][POSITIVE] Yeah, yeah, have a wonderful day. bye.
[AGENT][NEUTRAL] Yes