AccountId: 011433970860
ContactId: 90d0a6fc-232c-4de9-b2e9-f718472c1f8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239399 ms
Total Talk Time (AGENT): 105915 ms
Total Talk Time (CUSTOMER): 105497 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/90d0a6fc-232c-4de9-b2e9-f718472c1f8b_20250130T20:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, it's [PII] at Kettering Health Green Memorial. I was just wanting to try to verify a patient's coverage.
[AGENT][NEUTRAL] I'm sure, darling.
[CUSTOMER][NEUTRAL] And your menu selection kind of has me confused because the patient was here seen in the emergency room yesterday, but it to me it's not looking like it's an accident or anything so I don't know if he has just medical coverage for illness.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Yes, ma'am. I can assist you with this benefits. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] They have D as in David.
[CUSTOMER][NEUTRAL] 47694166
[AGENT][NEUTRAL] OK, that's not the policy number. Um, do you have the member's social?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Uh, Yang said there's no card. All I can give you is the info that the patient provided.
[CUSTOMER][NEUTRAL] Um, let's see, yep, I have a social. I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found him in our system. Please verify the name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you. And would you like his policy number?
[CUSTOMER][NEUTRAL] And this is gonna be uh what I file on my claim, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] It is 025.
[AGENT][NEUTRAL] 83369.
[CUSTOMER][NEUTRAL] OK, that's a big difference in what he gave us, huh?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Unfortunately.
[CUSTOMER][NEUTRAL] Is there a group number or anything that I need to use?
[AGENT][NEUTRAL] Um, yes, ma'am. The group number is 70084.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. No problem. And just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on the policy was [PII] and the policy is still active.
[AGENT][NEUTRAL] And you said this is for an emergency room visit?
[CUSTOMER][NEUTRAL] Yeah, it was looks like it occurred yesterday so.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] He's already been treated and gone so the benefits are really um not an issue it's gonna be what it's gonna be.
[CUSTOMER][NEUTRAL] Um, he gave us a claims address of [PII]. Is that correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII]. It's [PII].
[CUSTOMER][NEUTRAL] What's the zip?
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, I'll fix that then too.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh um.
[AGENT][NEUTRAL] And yes, ma'am, for benefits under his plan, this is a limited hospital indemnity plan. Um, we do have some outpatient benefits and I'm showing that for ER visits, he gets 2 visits per calendar year, and we cover up to $50 per visit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A maximum of $50 OK?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Alright, I'll make that note. Do you guys give reference numbers or do I just use your name?
[AGENT][NEUTRAL] Yeah, you'll just use my name and today's date. My name is [PII]. Um, it's spelled [PII] Last initial is [PII], and today's date for the reference number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, that's that's it thank you so much.
[AGENT][POSITIVE] OK, thank you again, [PII], for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you.