AccountId: 011433970860
ContactId: 7229495f-39bd-478c-8826-68a8394e731f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 147399 ms
Total Talk Time (AGENT): 72188 ms
Total Talk Time (CUSTOMER): 41469 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/7229495f-39bd-478c-8826-68a8394e731f_20250421T12:22_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to the patient's eligibility and benefits.
[AGENT][NEUTRAL] Your name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what's the policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 15586
[AGENT][NEUTRAL] And a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And you said that you're calling for eligibility is this for service and benefits? Is this for service in an office?
[CUSTOMER][NEUTRAL] Uh, it's for an inpatient admission through the ER.
[AGENT][NEUTRAL] OK, so the policy effective date is [PII] currently active, and I have the inpatient benefit for you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The maximum inpatient benefit is up to $1500 that is per calendar year, and this information is verification and it's not a guarantee of payment and let me check history.
[AGENT][NEGATIVE] Yeah, I don't show anything paid out uh for [PII].
[CUSTOMER][NEUTRAL] Is the 1500 the patient's responsibility or what the insurance will pay for a year?
[AGENT][POSITIVE] That's the benefit.
[CUSTOMER][NEUTRAL] OK, so anything over that I guess would be the patient's responsibility for the cost.
[AGENT][NEUTRAL] Well, we don't determine patient's responsibility, but that's their maximum. So that would be for the hospital charge, the surgeon's charge if she has it, attending physician, um, surgery, any charge related to the inpatient visit, the max is 1500. So it's basically a matter who submits the claim first.
[CUSTOMER][NEUTRAL] OK, so that's her max is $500 with her insurance, um, OK.
[AGENT][NEUTRAL] Mhm. That is her benefit, correct.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You require an authorization.
[AGENT][NEUTRAL] My name in today's date, [PII] initial last is [PII].
[CUSTOMER][NEUTRAL] I know I said that you require an authorization, like a pre-authorization for the admission.
[AGENT][NEUTRAL] Oh, prior off or prior office is not required.
[CUSTOMER][POSITIVE] All right, thank you. Goodbye.