AccountId: 011433970860
ContactId: 9690d087-44e1-425e-869d-751587b34d3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308779 ms
Total Talk Time (AGENT): 135139 ms
Total Talk Time (CUSTOMER): 83887 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/9690d087-44e1-425e-869d-751587b34d3c_20250124T13:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Nicholas Children's Hospital. Um, I have a patient that has, uh, APO as a, uh, secondary insurance, insurance, and I would like to, uh, verify the eligibility and the plan, um, uh, coverage.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Mhm correct.
[AGENT][POSITIVE] Yes, I can help you with that and I'm so sorry. I did not understand your name the first time.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII] and your name is?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][NEUTRAL] Mhm, you're welcome and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] One moment to locate it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have that number as uh let me confirm it um one moment.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] So outpatient, OK, so that number will be 022 I'm sorry 0244.
[CUSTOMER][NEUTRAL] 3500 ML 8.
[AGENT][POSITIVE] OK, thank you, [PII]. Give me a couple of moments to get the member's information fully pulled up.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], uh, last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on this supplemental policy, and this supplemental policy, [PII] is active, effective [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this plan, the outpatient benefit max per calendar year per covered person for covered outpatient services is $6000.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] And just a couple of additional things for you, [PII], because this is a supplement to their primary insurance, we must also receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim, we also have a portal in which you should be able to check claim status and have access to our EOBs and our portal website is secured.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome. And if you need a reference number, [PII], for our call, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bear with me one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, thank you very much and just to verify, um, you said that they have a coverage, uh, a yearly of $6000. Has there anything, has there been anything applied to the to that amount as of yet?
[AGENT][NEUTRAL] For this calendar year?
[AGENT][NEUTRAL] Is this your, is this for a data service for [PII], you're needing to.
[CUSTOMER][NEUTRAL] No, for yes, sorry, yes, yes.
[AGENT][NEGATIVE] As of now, yes, as of now, there have not been any benefits used for this calendar year, as of this moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Uh-huh. And is there, you're welcome. And can I help you with anything else?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] No, that will be all thank you very much, do have a great rest of your day.
[AGENT][POSITIVE] I hope you do have a nice weekend and thank you again for calling UPL today, [PII]. Thank you.
[CUSTOMER][NEUTRAL] Likewise.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] Bye-bye.