AccountId: 011433970860
ContactId: ac9c68fc-c723-4fdc-9f7a-1b290f2fbfb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 158919 ms
Total Talk Time (AGENT): 75496 ms
Total Talk Time (CUSTOMER): 32873 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/ac9c68fc-c723-4fdc-9f7a-1b290f2fbfb2_20250217T18:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon. I'm calling on behalf of Homestead Hospital to verify member eligibility and benefits for an emergency room visit with us.
[AGENT][POSITIVE] Alright, I'm happy to check benefits and eligibility today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I have 1679286.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] And if I could just grab your first name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] Uh, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you. So the patient's plan is active. Effective date is [PII].
[AGENT][NEUTRAL] And we're the member secondary insurance, so this would cover deductible, co-pay, co-insurance. The primary does not.
[CUSTOMER][NEUTRAL] Alrighty, is there a group name with the plan?
[AGENT][NEUTRAL] Oh yeah, let me take a look, let's see.
[AGENT][NEUTRAL] Uh, so the employer group is City of Homestead and there's a group number 2 if you need that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Group number is 22392.
[CUSTOMER][NEUTRAL] All right, very well, and uh would you happen to have like the benefits for ER coverage?
[AGENT][NEUTRAL] Oh yeah, let's take a look and see what the.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Right, so it looks like the outpatient benefit amount max for the calendar year is 1500 that would apply um if they're in the emergency room, um, less than 18 hours. If it's over 18 hours, it would be considered inpatient. That benefit max for the calendar year is going to be 2500.
[CUSTOMER][POSITIVE] All right, excellent, and I thank you for your time today.
[AGENT][POSITIVE] Yeah, no problem. [PII]. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Um, bye bye.