AccountId: 011433970860
ContactId: 9abb39cb-eebe-4e1d-b903-2e91e985a1df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263739 ms
Total Talk Time (AGENT): 137129 ms
Total Talk Time (CUSTOMER): 54040 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/9abb39cb-eebe-4e1d-b903-2e91e985a1df_20250304T13:05_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning [PII]. My name is [PII]. I'm calling from Nicholas Children's Hospital. I need to see if a um member is active.
[AGENT][NEUTRAL] OK, [PII], you're only needing to verify eligibility not benefit information, is that correct?
[CUSTOMER][POSITIVE] Well, both would be nice.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with both and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] The member's telephone number.
[AGENT][NEUTRAL] No, policy, policy, policy.
[CUSTOMER][NEUTRAL] I had all policy I had to.
[CUSTOMER][NEUTRAL] The policy number that I have is 2481566.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And I will send in the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. Give me just one moment for the information to get finish loading.
[CUSTOMER][POSITIVE] Of course, no worries.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] How's your morning been so far?
[AGENT][POSITIVE] I just started, so we'll see. So far so good.
[AGENT][NEUTRAL] And again any information [PII] provided will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so I do say she is a dependent on the supplemental policy. This supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services per person is $3000.
[AGENT][NEUTRAL] With no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, do you know if [PII] has met anything towards the 3000?
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] And as of now there have not been any benefits used.
[AGENT][NEUTRAL] For this calendar year now because this is a supplemental policy, [PII] to their primary insurance when the claim is submitted to APL we will also have to have a copy of our primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK perfect all right thank you so much, [PII] can I get your first initial to your last name and do you guys give out reference numbers?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name in today's date will be your call reference number and the first initial to my last name is [PII].
[AGENT][NEUTRAL] And is there anything else else that I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all. I hope you have a very nice day, OK?
[AGENT][POSITIVE] Oh, I hope you do too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][POSITIVE] All right. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.