AccountId: 011433970860
ContactId: 86b05b1e-33ae-4a0b-9374-54fb4d9ad455
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450809 ms
Total Talk Time (AGENT): 205613 ms
Total Talk Time (CUSTOMER): 103218 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/86b05b1e-33ae-4a0b-9374-54fb4d9ad455_20250616T18:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm with Mother Francis Hospital. I need to verify eligibility and benefits for a patient.
[AGENT][POSITIVE] I can help you with eligibility and benefits, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number with you?
[CUSTOMER][NEUTRAL] D 43,730,780
[AGENT][NEUTRAL] All right. Do you have their card, uh,
[AGENT][NEUTRAL] With you.
[CUSTOMER][NEUTRAL] Uh, let me check one moment.
[CUSTOMER][NEUTRAL] Uh, yes, I do.
[AGENT][NEUTRAL] Do you see anything that might say policy certificate number or um
[AGENT][NEUTRAL] It might say member ID, but it'll usually start with a 01 or 02.
[AGENT][NEUTRAL] Or inpatient outpatient benefit number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, well, first of all, the employee ID on the card is the one that I just gave you, uh.
[CUSTOMER][NEUTRAL] And as far as the.
[CUSTOMER][NEUTRAL] Number to call this is the one that it gave me it's on the back of the card.
[CUSTOMER][NEUTRAL] The one that I called to reach you.
[AGENT][NEUTRAL] OK, and it doesn't have like a policy certificate number, any other number on it?
[AGENT][NEUTRAL] Policy number not not phone number.
[CUSTOMER][NEUTRAL] Uh, just as
[CUSTOMER][NEUTRAL] Oh, no, I mean, uh, it just has the employee ID group number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, do you have their social and I can try and look it up that way?
[CUSTOMER][NEUTRAL] Let's
[CUSTOMER][NEUTRAL] OK, I have [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And what's the first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify his date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And let's see, I am showing several policies with us, so let me see. Um, what are you calling in regards to?
[CUSTOMER][NEUTRAL] Uh, eligibility and then benefits for hospital inpatient.
[AGENT][NEUTRAL] OK, OK, I just wanted to make sure that I pulled up the right policy, um, so I didn't give you something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That didn't really matter to you.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Alright, I can give you his policy number for his hospital indemnity policy if you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's 02487793.
[AGENT][NEUTRAL] And that is for hospital indemnity.
[CUSTOMER][NEUTRAL] OK, so what is the.
[AGENT][NEUTRAL] Oh, uh-huh.
[CUSTOMER][NEUTRAL] Oh, wait, what is the one that I gave you that starts with a D since it's on the card that he gave.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It's for 90 degree benefits typically so whenever you're filing a claim for um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For hospital indemnity claims you'll send it to IMA and so that's the number that IMA has but we don't have that number um it goes through the claims will go through them and I have their information for you as well if you need that for a claim.
[CUSTOMER][NEUTRAL] Oh, OK, alright.
[CUSTOMER][NEUTRAL] Um, oh yeah, I, I'll go ahead and take that just in case you need it.
[AGENT][NEUTRAL] OK, um, so it's for IMA.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] In [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And their payer ID is 64556.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's for their hospital indemnity policy, so let me see, and then you wanted benefits, correct?
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me pull that up.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] O
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] And this is just a verification of benefits, not a guarantee of payment. It looks like they have a hospital admission benefit of $1000 per day.
[AGENT][NEUTRAL] With a maximum of one day per calendar year.
[AGENT][NEUTRAL] They have a hospital confinement benefit of $100 per day with a maximum of 30 days per calendar year.
[AGENT][NEUTRAL] They have an accident or illness surgery benefit as well. Um, if it's surgery in a hospital, hospital outpatient facility or a free-standing surgery center, they have a maximum of up to $500 per day with a maximum of 1 day per calendar year.
[AGENT][NEUTRAL] And surgery in a physician's office, which is $125 per day with one day per calendar year. They also have diagnostic testing benefits. Um, is, is that something you need as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No thank you, um, OK, so this is a limited plan um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so it pays $1000 for uh admission like for day one and then it's gonna pay $100 per day, is that correct?
[AGENT][POSITIVE] Correct for confinement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh, is an authorization required for the admission?
[AGENT][NEUTRAL] Uh, no, ma'am, we don't, we don't, uh, do pre-authorization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could I get your last name initial, and a call reference number?
[AGENT][NEUTRAL] So we don't have a call reference number, but you can use my name and last initial in today's date so it will be [PII] and today's date.
[CUSTOMER][POSITIVE] Alright thank you [PII].
[AGENT][POSITIVE] Great thank you so much for calling APL. If there's nothing else, I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][NEUTRAL] Alright bye.