AccountId: 011433970860
ContactId: b4e124a6-6b36-4d48-b26b-6f2e0105656c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206710 ms
Total Talk Time (AGENT): 123790 ms
Total Talk Time (CUSTOMER): 82826 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/b4e124a6-6b36-4d48-b26b-6f2e0105656c_20250305T20:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. Last name [PII] I'm calling from the hospital to verify benefits and eligibility for a patient.
[AGENT][POSITIVE] Well, I'd be glad to help you, but go ahead and give me a good policy number, please.
[CUSTOMER][NEUTRAL] I got 0245.
[CUSTOMER][NEUTRAL] 4266 ML 8.
[AGENT][POSITIVE] Alrighty, but thank you so much for that information. Now while I'm pulling this up for you, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. All right, [PII], thank you for all that information. Now, your patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you for all that information. All but it looks like [PII] is the insured on this medical supplemental plan. I do show his original effective date, excuse me, it's [PII]. He is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say won't hospital benefit. Is that correct?
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's hospital benefit, correct.
[AGENT][NEUTRAL] OK, is it inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's an outpatient procedure.
[AGENT][NEUTRAL] Outpatient procedure. All right, let me get that pulled up. Let's see. OK, now, of course, what we are, Alba is his medical supplemental plan. So the only thing that we will pick up and pay on is anything for sickness and injury that is applied to which his deductible, co-pay, or co-insurance at his primary insurance carrier. We pay nothing for routine no matter what.
[AGENT][NEUTRAL] Now his outpatient hospital benefit here is going to be a zero deductible, no pre-cert, and he has a $750 benefit payable per calendar year, I mean per calendar day.
[CUSTOMER][NEUTRAL] be
[CUSTOMER][NEUTRAL] OK perfect um so for example if he's coming in to do to take off I think it's uh a mask.
[CUSTOMER][NEUTRAL] Um, the, this won't be covered only for sickness or injury.
[AGENT][NEGATIVE] Sickness and injury. And if it's got a routine diagnosis, it would not be covered here at all.
[AGENT][NEUTRAL] But if it's due to a medical condition with a medical diagnosis, that is something that we would look at to review and, and pay.
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] OK, and there's no way that you'd be able to help me out to see if it's something that would be covered?
[AGENT][NEUTRAL] No ma'am, not until we get the actual billing and the ELB from the primary.
[CUSTOMER][NEUTRAL] Mm, OK, yeah, because it's gonna be for a biopsy of a lymphoma on his back.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, it sounds like it's probably gonna have a medical diagnosis though. I don't sound routine. Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, I'll let him know.
[AGENT][POSITIVE] Yeah, but that will be a benefit.
[CUSTOMER][POSITIVE] OK, perfect. I'm sorry, he was just under the impression that um it was covered more and I when I let him know that it was 7:50 so I was calling just to confirm reconfirm from my end. OK, alright, thank you so much.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am. Was that all I can help you with, [PII]?
[CUSTOMER][POSITIVE] Alright thank you so much for your help have a good day.
[AGENT][POSITIVE] You as well, but thanks for calling APL. Mhm. Bye-bye.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] No problem bye.