AccountId: 011433970860
ContactId: aaeab0eb-1b64-4266-ab96-a95e4c2d5b59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647559 ms
Total Talk Time (AGENT): 181520 ms
Total Talk Time (CUSTOMER): 170373 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/aaeab0eb-1b64-4266-ab96-a95e4c2d5b59_20250317T14:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] Can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is Yo [PII]. I'm calling with South Miami Hospital. I'm hoping to verify benefits for a patient.
[AGENT][POSITIVE] OK, and spell your first name for me please thank you.
[CUSTOMER][NEUTRAL] Yeah, of course, it's [PII]
[AGENT][POSITIVE] Thank you and also may I have your call back number please?
[CUSTOMER][NEUTRAL] Yes, of course, that's [PII].
[AGENT][POSITIVE] Thank you so much and may I have the policy number please?
[CUSTOMER][NEUTRAL] Yes, that would be, let me see here. I have a 025987257 MLH.
[AGENT][NEUTRAL] OK, let me just repeat that to you. I have 025987257 ML 8.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, give me one moment please.
[AGENT][NEUTRAL] OK, give me one moment. That's too many numbers, I believe. Give me one second please.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] Yeah, that's too many numbers. Can you please recheck that number, please, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, I'm rechecking now. I don't have the like the physical card to verify. I just have the numbers that were put in when the schedule was, um, sent over to us. Um, I have the patient's date of birth, name, address, uh, let me see what else I have her social.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you just re-verify the policy number for me please? Can you just repeat that to me.
[CUSTOMER][NEUTRAL] 025987257 ML8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the social?
[CUSTOMER][NEUTRAL] The patient social is [PII].
[AGENT][NEUTRAL] And what is the patient's last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and her first name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Do you know if this is a supplemental policy for the member or a limited indemnity policy for the member? I'm, I'm so sorry.
[CUSTOMER][NEUTRAL] No, it's fine. Um, it may be a supplemental or a gap policy. Um, she has primary with a different insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you happen to have her group number please?
[CUSTOMER][NEUTRAL] I see a group number of 23109.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, let me try that one.
[AGENT][NEUTRAL] Can I place you on hold please?
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] When is Ms. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII]. And while I was on hold, I was looking through her her account and I did find a different um policy number that was much shorter than the one I originally gave you. Um, we can try that one if you'd like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Yeah, of course, no problem. That the one that I found is 02464243.
[AGENT][POSITIVE] OK, thank you very much for that.
[CUSTOMER][NEUTRAL] And I did also notice that this plan belongs to her husband, and she, you know, may be a dependent of the policy.
[AGENT][NEUTRAL] OK, thank you so much. Thank you very much and you said date of birth is [PII]. Thank you. With that, uh, policy number I was able to locate her and you were calling for eligibility and benefits, and this particular policy shows that it termed as of [PII]. Now if you would bear with me, let me check to see if there's an active policy, please, please, please.
[CUSTOMER][POSITIVE] Perfect, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you for your patience. I was able to locate an active policy.
[AGENT][NEUTRAL] OK, so I'll give you that for you one moment. OK, so the policy number, the, the correct policy number is 02598257.
[CUSTOMER][NEUTRAL] That was 02598257?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect. OK, and this one is active.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's
[AGENT][NEUTRAL] Yes, and this policy shows effective as of [PII], and you need outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, outpatient benefits.
[AGENT][NEUTRAL] OK, let me get that for you.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guaranteed payment. We will pay up to $1000 per calendar day for covered services. Now would this be for an office setting?
[CUSTOMER][NEUTRAL] Outpatient um.
[AGENT][NEUTRAL] OK, facility OK.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, alright, thank you. We will pay up to $1000 per day for coverage services and of course we help with the major medicals, deductible, co-pay and or co-insurance.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][POSITIVE] And I appreciate your patience with me, thank you.
[CUSTOMER][POSITIVE] No problem thank you so much for your help. I do appreciate it.
[AGENT][POSITIVE] You're welcome, you're welcome.
[CUSTOMER][NEUTRAL] That was $1000 per day.
[AGENT][POSITIVE] Yes, 1000 per calendar day, that is correct.
[CUSTOMER][NEUTRAL] For calendar day OK.
[CUSTOMER][NEUTRAL] And then you guys cover um deductible, co-insurance, and co-pay.
[AGENT][POSITIVE] Yes, for covered services, that is correct.
[CUSTOMER][NEUTRAL] For cover services, OK.
[CUSTOMER][POSITIVE] All righty. I believe that is all I needed for today. If I can get a reference number for the call, [PII], that'll be great.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We do not provide reference numbers. I apologize, but you can use my name and today's date. My last initials [PII].
[CUSTOMER][POSITIVE] Perfect, thank you so much. Hope you have a great day.
[AGENT][POSITIVE] You as well thank you for calling APL Yale. You have a great day as well. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.