AccountId: 011433970860
ContactId: c4497fad-f43b-4b1f-a774-0ea8a9d3981b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259190 ms
Total Talk Time (AGENT): 100721 ms
Total Talk Time (CUSTOMER): 79257 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/c4497fad-f43b-4b1f-a774-0ea8a9d3981b_20250530T17:30_UTC.wav
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[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for calling AL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning. This is [PII]. I'm calling from provider's office. I need to check eligibility and benefits for a mutual patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility and benefits [PII]. What is your callback number, ma'am, just in case the call is disconnected and your facility name?
[CUSTOMER][NEUTRAL] OK, first name is Nicholas Children's Hospital. Our callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Which one first name is [PII], I'm sorry.
[CUSTOMER][NEUTRAL] [PII], last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, 01611873. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK. I do have [PII] pulled up and she does have an effective active policy. Let me give you the effective date. [PII]'s effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy is current and active.
[CUSTOMER][NEUTRAL] I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry. Uh, you, you said [PII]?
[AGENT][NEUTRAL] Let me go back, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify benefits, it's not a guarantee of payment. She has a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, did you need inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient benefit specialized office visit.
[AGENT][NEUTRAL] OK, she has an outpatient calendar year benefit amount of $1500.
[AGENT][NEUTRAL] And let me see if office visits are covered under the policy.
[AGENT][NEUTRAL] It's gonna be just a moment while I pull up the policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Office visits are not covered under the patient's plan.
[AGENT][NEUTRAL] But treatment in the office is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They have the.
[CUSTOMER][NEUTRAL] It's covered 100%, right? There is no co-pay cover deductible number, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. This patient is requires referral or what?
[AGENT][NEUTRAL] No, ma'am, this is not the major medical insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. May I know the call reference number and your name, please?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date for your reference number.
[CUSTOMER][POSITIVE] Yeah, OK, [PII], thank you for assisting this wonderful information today and have a great day and happy weekend. See you.
[AGENT][POSITIVE] You have a blessed weekend too, [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] And thank you bye bye.