AccountId: 011433970860
ContactId: a350b444-85d2-487a-86cc-d5e1165a81cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231000 ms
Total Talk Time (AGENT): 92176 ms
Total Talk Time (CUSTOMER): 134480 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/a350b444-85d2-487a-86cc-d5e1165a81cb_20250616T13:16_UTC.wav
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[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Memorial Hospital West. Just need to verify eligibility on application, please.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 01891650.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] birthday is [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active and you said this was for outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct, outpatient procedure, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said 11 I'm sorry [PII]? OK, sorry.
[AGENT][NEUTRAL] OK. Actually, there's no outpatient.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII] [PII], OK, thank you.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, no problem. And the policy is still active, but I'm not showing any coverage for outpatient. I'm only showing inpatient coverage.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so no inpatient or out wait no outpatient.
[CUSTOMER][NEUTRAL] OK, and she's coming for an outpatient surgery tomorrow.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, I'm only showing inpatient and for inpatient, um, we cover up to 2500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] Did you go to?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] It looks like they called.
[CUSTOMER][NEGATIVE] They called and spoke to somebody there on the [PII] that was April. Did it change because I guess in April um that she didn't need authorization they never mentioned that she didn't have the coverage for that.
[AGENT][NEUTRAL] OK, one moment, let me.
[AGENT][POSITIVE] Thank.
[CUSTOMER][NEUTRAL] They verified that she was active but nothing was mentioned, not needed with APL supplement patient active perksa.
[AGENT][NEUTRAL] Uh, yeah, I'm showing the policy was active, but I'm not showing no outpatient coverage.
[CUSTOMER][NEUTRAL] Same phone number.
[CUSTOMER][NEUTRAL] Hm, OK, so she'll be responsible for her her.
[CUSTOMER][NEGATIVE] You guys won't pick up anything second.
[CUSTOMER][NEUTRAL] 20% or anything? OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am, not unless she's admitted. Yeah.
[CUSTOMER][NEUTRAL] No outpatient.
[CUSTOMER][NEUTRAL] OK, no all patient benefits.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and what was your name?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, do you have a reference number?
[AGENT][NEUTRAL] You can use my name and today's date for the reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's EVI you said right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, I appreciate it thank you so much.
[AGENT][POSITIVE] OK, thank you, [PII] for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too, my dear bye bye.
[AGENT][POSITIVE] Thank you.