AccountId: 011433970860
ContactId: c0c80769-5977-4b07-bff9-c5463cbf80c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281540 ms
Total Talk Time (AGENT): 120137 ms
Total Talk Time (CUSTOMER): 85188 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/c0c80769-5977-4b07-bff9-c5463cbf80c2_20241231T14:14_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm calling from Nicholas Children's Hospital. I'm just calling to get benefits and eligibility for two patients, if I may.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Uh yes it is.
[CUSTOMER][NEUTRAL] 02003143.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's a direct number.
[AGENT][NEUTRAL] Thank you. And so is it for two different families?
[CUSTOMER][NEUTRAL] It's for the same family, just 2 siblings.
[AGENT][NEUTRAL] OK, OK, got it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the uh two patients' names and dates of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] What's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, let me give you the current policy number.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's 246.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2866.
[AGENT][NEUTRAL] And the policy effective date is [PII]. Uh, I show the policy is active for both patients at this time, and you stated that this is for outpatient facility or hospitals.
[CUSTOMER][NEUTRAL] Yeah, specifically urgent care services.
[AGENT][NEUTRAL] OK, so I'm showing that the outpatient benefit is up to $2000.
[AGENT][NEUTRAL] That is a per calendar year benefit.
[AGENT][NEUTRAL] And that is per covered person.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me verify what the family maximum is for all covered persons combined.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Under this policy there is not a family maximum, so it's 2000 per covered person per calendar. I'm sorry, this is per calendar day, not per calendar year.
[CUSTOMER][NEUTRAL] 2000 per day?
[AGENT][POSITIVE] Yes, 2000 per covered person per calendar day for covered outpatient services so there's that's why there's no family maximum. It's a pretty good policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Got it. OK, yeah, that's pretty good policy.
[AGENT][NEUTRAL] 2000 per calendar day per covered person and I think I gave the disclaimer, the information provided is verification, not a guarantee of payment and so since it's per calendar day um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the service hasn't been done yet.
[AGENT][NEUTRAL] None of that has been. Oh, it has? OK.
[CUSTOMER][NEUTRAL] It has, it was.
[CUSTOMER][NEUTRAL] Yeah yeah yeah it it was it was on.
[CUSTOMER][NEUTRAL] It was on.
[CUSTOMER][NEUTRAL] They came in on the [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, I'm sorry, [PII].
[AGENT][NEUTRAL] Yeah, no claims on file for that file for that data service at this time.
[CUSTOMER][POSITIVE] OK, that's no problem.
[AGENT][NEUTRAL] All right. Anything else?
[CUSTOMER][NEUTRAL] Alrighty, um, [PII], is there a call reference number for today?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, uh [PII].
[AGENT][NEUTRAL] [PII] and first initial last name is [PII] and did you have any other questions I can help out with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much I really appreciate your time and I hope you have a nice thing, uh, [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] You're welcome same to you and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too thanks so much thanks bye bye.
[AGENT][NEUTRAL] Uh, bye-bye.