AccountId: 011433970860
ContactId: aa57d85e-6132-4438-b0a1-0292b541a0ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325600 ms
Total Talk Time (AGENT): 122337 ms
Total Talk Time (CUSTOMER): 179808 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/aa57d85e-6132-4438-b0a1-0292b541a0ec_20250321T21:58_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, good afternoon, um, you said APL is that what you said?
[AGENT][NEUTRAL] Yes, APR American Public Life.
[CUSTOMER][NEUTRAL] OK, hi, my name is [PII]. I'm calling on behalf of Jackson Memorial Miami. I'm calling to verify if this patient is active under your plan provider for, um, the, it's, it's for uh the child and the mom just presented the, this gap insurance so I need to know if it's valid and billable. Um, he had a, a scheduled um infusion therapy.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, today, as a matter of fact, for nephrology, PD nephrology. So, um, I need to know what does this cover exactly and is it active? And what is your name?
[AGENT][NEUTRAL] OK. My name is [PII]. That[PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], uh, what type of, um, sickness is it for, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My name is [PII]. Mhm.
[AGENT][NEUTRAL] Oh, I'm sorry. OK.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Yeah, nephrotic syndrome. That's exactly what it is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I know the patient came in for an infusion.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK. All right. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Mom just presented this insurance this morning and she never not wanted in for me yesterday, no two days ago, she didn't tell me about it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine. All right. And may I have uh the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, let me see what they scanned.
[CUSTOMER][NEGATIVE] Would it be the group number because I don't even see the, I don't even see the policy number.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's gonna be the policy certificate outpatient, it will be in the bottom.
[AGENT][NEUTRAL] Of the card.
[CUSTOMER][NEUTRAL] Oh, the hospital benefits certificate number?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK, for outpatient, I see it's uh because it is an outpatient, 022.
[CUSTOMER][NEUTRAL] 164.
[CUSTOMER][NEUTRAL] 77 M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK, thank you. And what is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The last name is uh one second.
[CUSTOMER][NEUTRAL] I just noticed her name on this card. [PII], hold one second. The last name of the patient is [PII], first name is [PII]. He's a [PII].
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So, um, she, it seems like she gave me, she gave the hospital her insurance card. I guess she doesn't have one for him, I guess.
[AGENT][NEUTRAL] It's OK. Thank you. All right. And um let's see one more question. Is this considered an off is it gonna be billable as an office or outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient facility.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. This is a secondary supplemental plan to the major medical, so we help with the deductibles, co-payment, and co-insurance from the major medical.
[AGENT][NEUTRAL] Um, so it has to be approved.
[CUSTOMER][NEUTRAL] So you pay
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so you help with uh the co-pay, deductible?
[AGENT][NEUTRAL] And co-insurance.
[CUSTOMER][NEUTRAL] And the coinsurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's secondary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, what is the effective date on the policy?
[AGENT][NEUTRAL] All right, let me go back to that.
[CUSTOMER][NEUTRAL] I mean this card says [PII].
[AGENT][NEUTRAL] It is, yes, [PII] is the effective date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And still ongoing.
[AGENT][POSITIVE] It is active at the moment, that's correct.
[AGENT][NEUTRAL] And let me give you the benefit. The benefit amount that we cover is $200 per day.
[CUSTOMER][NEUTRAL] $200 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you uncover it, so that's the max.
[AGENT][NEUTRAL] That is the maximum benefit covered per day, 200.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And I'm guessing we don't need an off for anything it's just outpatient.
[AGENT][NEUTRAL] Correct. Yes, authorization is not required. Mhm.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] That's what I thought, and the, the, the claims, excuse me, the claims address I see on this card is the [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][POSITIVE] Perfect. OK. All right. Well, I just wanna make sure it was really active cause I mean, I, I've called his mom multiple times even last year. She didn't mention it to me. But thank you very much, my love. I appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. No problem. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. You have a good afternoon. Happy weekend.
[CUSTOMER][POSITIVE] You too, love. You um have a blessed one. Thank you. Be safe. Bye-bye.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, thank you. No.