AccountId: 011433970860
ContactId: a56a746e-95e1-4013-bd0c-4fb9783330bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 160289 ms
Total Talk Time (AGENT): 90918 ms
Total Talk Time (CUSTOMER): 60810 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/a56a746e-95e1-4013-bd0c-4fb9783330bd_20250210T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm with Woman's Hospital. I am calling to um verify patients benefits for outpatient surgery.
[AGENT][NEUTRAL] Sure, I could check those outpatient benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Is that the AH 0549224?
[AGENT][NEUTRAL] No, that is a bit too long to be one of our policy numbers. Um, typically they start with a impossible, we could, we could check that.
[CUSTOMER][NEUTRAL] OK, we start with the 216?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK 216-657-1.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. Yes, that was the correct policy number. OK, so the policy is active. Effective date was [PII]. And if you'll give me one moment, I will check that outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, now of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so their total outpatient benefit is $4800 per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, so this is like a limited plan.
[AGENT][NEUTRAL] This is a secondary medical plan, um, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so this is her secondary plan.
[AGENT][NEUTRAL] So more supplemental, yes.
[CUSTOMER][NEUTRAL] OK, OK, um, and do you know if we need any type of authorization or?
[AGENT][NEUTRAL] No authorization is required as long as major medical is willing to pay this policy can. If uh her major medical will not pay this policy can't.
[CUSTOMER][NEUTRAL] OK, OK, alright, and is there a reference number for the call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you at all?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] That's it I appreciate your help.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.