AccountId: 011433970860
ContactId: 9854ea12-1f13-4ce7-b745-98a7325b8228
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333970 ms
Total Talk Time (AGENT): 81399 ms
Total Talk Time (CUSTOMER): 121805 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/2025/03/17/9854ea12-1f13-4ce7-b745-98a7325b8228_20250317T18:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. This is [PII]. I'm calling from provider Office Jackson Memorial Hospital looking on a patient eligibility.
[AGENT][POSITIVE] I'd be happy to assist with eligibility today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] So that number is gonna be [PII]. It would be a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, just a moment. The policy number, it starts with 01611565 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. Now, are you calling for medical or dental?
[CUSTOMER][NEUTRAL] Uh, medical.
[AGENT][NEUTRAL] OK, and are you calling for inpatient or outpatient?
[CUSTOMER][NEUTRAL] Uh, it's for an outpatient.
[AGENT][NEUTRAL] I'm showing the outpatient calendar year maximum is $1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what is the policy effective date?
[AGENT][NEUTRAL] Policy effective [PII] and it's currently active.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Uh, hectic.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] I need eligibility for one more patient.
[AGENT][NEUTRAL] Under the same policy or a different policy?
[CUSTOMER][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] Oh, the policy looks like the same, but patient is different.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth would be [PII].
[AGENT][NEUTRAL] OK. So the same goes for her. The policy is active?
[CUSTOMER][POSITIVE] Thank you very much. Just a second. I do have one more patient. Let me check it comes under the same.
[CUSTOMER][NEUTRAL] Or not?
[CUSTOMER][NEUTRAL] Uh, yeah, it's for a different patient. Uh, shall I provide you the member ID?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] ID number it starts with 01749237 ML8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[AGENT][NEUTRAL] OK, I do show the policy is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] Uh, actually, uh, can you able to check the claim status for this patient?
[AGENT][NEUTRAL] Data service please.
[CUSTOMER][NEUTRAL] [PII] with the total charge amount of $818 even.
[AGENT][NEGATIVE] I'm showing the claim denied because the benefits were maxed out.
[CUSTOMER][NEUTRAL] When it was received on the night?
[AGENT][NEUTRAL] Claim received on [PII], claim denied on [PII].
[CUSTOMER][NEUTRAL] So what is the general reason? Could you please repeat it one more time for me?
[AGENT][NEUTRAL] Their outpatient benefits were maxed out when we received the claim.
[CUSTOMER][NEUTRAL] So how much it can be uh
[CUSTOMER][NEUTRAL] Loud and
[AGENT][NEUTRAL] They get a 6, they have $6000 per calendar year for outpatient services and that had been maxed out back in [PII] to a different provider.
[CUSTOMER][NEUTRAL] [PII], am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Can I, can I get the claim number?
[AGENT][NEUTRAL] Your claim number is 356-417-0.
[CUSTOMER][NEUTRAL] So we can bill it to the patient for the charges, right?
[AGENT][NEUTRAL] If you'd like to, yes.
[CUSTOMER][POSITIVE] Thank you very much, [PII] for providing me all the information. That's it for today. Yes, you can, uh, go ahead with the call reference number, then we'll wind up.
[AGENT][NEUTRAL] Reference it's just my name and today's date and time.
[CUSTOMER][POSITIVE] Got it. Thank you very much for assisting me very patiently, [PII]. Have a wonderful rest of your day. Take care. Bye bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] I