AccountId: 011433970860
ContactId: 693827ac-fc0a-4c31-a8c5-8ca0209b00b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374220 ms
Total Talk Time (AGENT): 110906 ms
Total Talk Time (CUSTOMER): 85410 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/693827ac-fc0a-4c31-a8c5-8ca0209b00b0_20250514T18:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the Nicholas Children's Hospital. I'm checking a patient eligibility and benefits.
[AGENT][NEUTRAL] You said your name is [PII]?
[CUSTOMER][POSITIVE] Yep, that's correct.
[AGENT][NEUTRAL] And I'm sorry, you're calling from where?
[CUSTOMER][NEUTRAL] That's Nicholas Children's Hospital.
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, it's [PII].
[AGENT][NEUTRAL] And I'm sorry, one more time, [PII].
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01972388 M as in Mike L as in Lima.
[CUSTOMER][NEUTRAL] The number 8
[AGENT][NEUTRAL] OK, one moment while I look that up for you.
[CUSTOMER][NEUTRAL] Yep, sure.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, first patient first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Um, the date of birth is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm showing that this policy is it has an effective date of [PII].
[AGENT][NEUTRAL] It is active.
[AGENT][NEUTRAL] And it is a Medlink policy, which is a secondary gap policy, meaning that the major medical will have to pay um part of it first and then we come in second.
[CUSTOMER][NEUTRAL] Mm, yes. So this plan is covered.
[AGENT][NEUTRAL] And we pay towards co-insurance and
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, yeah, I need to know this plan covered uh mental health benefits.
[AGENT][NEUTRAL] You said mental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I'm showing an in-hospital treatment for a mental or emotional disorder.
[AGENT][NEUTRAL] This has a maximum of 30 days per treatment, per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Now this is a secondary gap policy. So in order for this to be um
[AGENT][NEUTRAL] Paid, the primary insurance will need to pay first, and when you submit the claim, we will need the primary EOB as well.
[AGENT][NEUTRAL] And I do want to mention that this is a verification of benefits and not necessarily a guarantee of payment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] But it does allow for up to 30 days. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So only 30 days will be covered for mental health right.
[AGENT][NEUTRAL] Correct. And that's if the primary um covers it first. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I can understand that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That's one. Can you please spell your name for me?
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] My last name starts with the letter [PII].
[AGENT][NEUTRAL] Which you can use as a call reference number along with today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for providing us information. Have a wonderful day. Stay safe and bye-bye.
[AGENT][POSITIVE] OK, thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.