AccountId: 011433970860
ContactId: 838e2e91-8001-4a5f-8843-b7970c4310b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345820 ms
Total Talk Time (AGENT): 154446 ms
Total Talk Time (CUSTOMER): 94246 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/838e2e91-8001-4a5f-8843-b7970c4310b7_20250529T17:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with Covenant Children's Hospital in [PII], and I have a question regarding a patient of ours trying to verify coverage and a couple other pieces.
[AGENT][NEUTRAL] OK, well, I can help you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, um, my number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02552172.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Calling regarding [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um so the policy is active, it's been effective since [PII]. And what kind of questions did you have?
[CUSTOMER][NEUTRAL] Well, I'm curious, does the patient have hospital coverage inpatient coverage on this account or on this coverage?
[AGENT][NEUTRAL] Hold on one moment. Let's see.
[AGENT][NEUTRAL] Hospital coverage. So, yes, it is a hospital indemnity policy. So the policy has um admission benefits and confinement benefits, um.
[AGENT][NEUTRAL] For admission, it's $2500 per day, with a max of 4 days per calendar year.
[AGENT][NEUTRAL] And then for confinement, it would, the policy would pay.
[CUSTOMER][NEUTRAL] Sorry, say that.
[CUSTOMER][NEUTRAL] Say that one more time.
[AGENT][NEUTRAL] For the hospital admission, the policy will pay up to $2500 per day, with a max of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for hospital confinement, um, any time over 18 consecutive hours, the policy will pay up to $50 per day with a max of 5 days per calendar year.
[CUSTOMER][NEUTRAL] OK, and then um I would take it that you guys would be secondary to any commercial insurance. Are you showing the patient has commercial Blue Cross by chance?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, not on this policy. We, we can't see it, um, but they could possibly have other insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you tell me if the claim is on file?
[AGENT][NEUTRAL] Mhm, uh, what's the data service for the client?
[CUSTOMER][NEUTRAL] Or do I need to talk to somebody else?
[CUSTOMER][NEUTRAL] Would be [PII].
[CUSTOMER][NEUTRAL] Total charge is $1,029,552.65.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, so, what's the name of your facility? I'm pretty sure this is it.
[CUSTOMER][NEUTRAL] This is for uh Covenant Children's Hospital.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Cover it, yep, OK, yes, um, there's a claim on file for your dates of service.
[AGENT][NEUTRAL] Did you need the claim status?
[CUSTOMER][NEUTRAL] What is the current?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 5970.
[AGENT][NEUTRAL] And we paid a total of $2750.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, hold on one moment.
[AGENT][NEUTRAL] I think.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] So this is actually paid to the insured.
[CUSTOMER][NEUTRAL] OK, paid to the patient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And when, when did that payment go out?
[AGENT][NEUTRAL] Um, we finished processing on [PII]. So I actually, I wish I would have noticed that. I'm sorry, I should not have given you that information, so I do apologize, but that, that is the information on file. I just noticed.
[CUSTOMER][POSITIVE] OK, not a problem, um.
[CUSTOMER][NEUTRAL] Yeah, we're showing the patient has commercial coverage so we're gonna go ahead and build them primary.
[CUSTOMER][POSITIVE] But thank you I appreciate the information. Is there a reference number?
[AGENT][NEUTRAL] You're welcome. So there's no call reference number, but you can use my name in today's date.
[AGENT][NEUTRAL] And again, that's [PII] to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] All right, thank you and I appreciate it. Have a good day.
[AGENT][POSITIVE] You're welcome [PII]. Thanks for calling APL. You're welcome bye.