AccountId: 011433970860
ContactId: 8ee58bce-d92c-43a0-b0fb-dd84be9e6a00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334179 ms
Total Talk Time (AGENT): 143000 ms
Total Talk Time (CUSTOMER): 116037 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/8ee58bce-d92c-43a0-b0fb-dd84be9e6a00_20250519T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, yes, good evening. How are you doing?
[AGENT][POSITIVE] I'm doing well. How are you doing today?
[CUSTOMER][NEUTRAL] Hi, thank you. My name is [PII]. First initial, my last name is [PII] and [PII], I am calling from the facility, um, calling because they had a patient to come into the emergency room. Patient got admitted. The patient is still in house, and the patient indicated that this is his secondary insurance. I was calling to verify those benefits, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with the benefits. Ms. [PII], what is your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, my direct line is [PII].
[AGENT][NEUTRAL] OK, and what is the name of your facility?
[CUSTOMER][NEUTRAL] Aiken Regional Medical Center.
[AGENT][NEUTRAL] OK, and may I have the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] And this patient name is [PII]. His date of birth is [PII].
[CUSTOMER][NEUTRAL] And looks like the policy number is 02409018.
[CUSTOMER][NEUTRAL] Would you mind spelling your first name, please?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. OK, I have Mr. [PII] pulled up now. Um, he does have an active policy with us. The effective date of his policy is [PII].
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment. He does have a supplemental insurance policy that's billed secondary to the primary. This policy helps with deductible, co-pay, and co-insurance. He does have an inpatient calendar year benefit amount.
[AGENT][NEUTRAL] For hospital stays of 18 hours or more of $2000.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So if he's in there more than 18 hours.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What does that mean again?
[AGENT][NEUTRAL] If he's um in the hospital for more than 18 hours for accident or sickness, the policy will pay $2000 towards deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] Uh, he also has an outpatient benefit of
[AGENT][NEUTRAL] $1500 per occurrence.
[AGENT][NEUTRAL] To help with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So that's, so that's a loan with the $2000 that the plan we already pay, he also has a $1500 out of pocket.
[AGENT][NEUTRAL] No, the outpatient is a benefit of $1500 per occurrence.
[CUSTOMER][NEUTRAL] Oh, and
[CUSTOMER][NEUTRAL] That's for outpatient, but the inpatient is $2000 if he's hospitalized, um, 18 hours or more.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For sickness or accident. Give me just a moment. Let me put this and then uh.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And you said this is the secondary, am I correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] How much of the 2000 has he met already?
[AGENT][NEUTRAL] Let's look and see if he has used any of his benefits.
[AGENT][NEUTRAL] He has not used anything for the calendar year of [PII].
[CUSTOMER][NEUTRAL] OK, give me just a minute.
[CUSTOMER][NEUTRAL] Alright, and
[CUSTOMER][NEUTRAL] [PII], just let me verify where do we need to send these um claims to.
[AGENT][NEUTRAL] Yes, ma'am. Uh, we have a payer ID number. I can give that to you.
[AGENT][NEUTRAL] It is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we also have a claims mailing address and that would be APL Claims, and that is [PII], that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Alright then, [PII], and can I get the first initial of your last name please?
[AGENT][NEUTRAL] Yes, ma'am. It's A.
[CUSTOMER][NEUTRAL] And is there a reference number to our telephone call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Alright then, [PII], that's all I needed.
[AGENT][POSITIVE] OK, well Ms. [PII], I hope you have a wonderful week and we thank you for calling APL.
[CUSTOMER][POSITIVE] You too, thank you, sir. Do the same. Have a good day.
[AGENT][NEUTRAL] You too bye bye Miss [PII].
[CUSTOMER][NEUTRAL] Bye bye.