AccountId: 011433970860
ContactId: cf844b5c-be70-4995-9f15-1c3d8ac70209
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267750 ms
Total Talk Time (AGENT): 147612 ms
Total Talk Time (CUSTOMER): 70370 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/cf844b5c-be70-4995-9f15-1c3d8ac70209_20250131T13:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. This is [PII]. I'm calling from Nicholas Children's Hospital. I'm calling to get benefits and eligibility for a patient.
[AGENT][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] OK, you need benefits and eligibility, is that correct? Yes, ma'am, I can help you and what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Um, [PII] and that's a direct number.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Sure, 018.
[CUSTOMER][NEUTRAL] 223.
[CUSTOMER][NEUTRAL] 04, the letter M as in Mary, L as in Larry, the number 7.
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments, [PII], to get the member's information pulled up, please.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, is this for a future data service, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, the patient was already here for urgent care services on, I'll tell you, on, uh, the [PII], uh, yesterday.
[AGENT][NEUTRAL] OK. So, um, OK, so first off, let's just go ahead and verify a couple of things. Um, any information that I provide for you will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, the name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So first off [PII], I need to give you another policy number because that policy number that you gave me terminated.
[AGENT][NEUTRAL] 121 of 2023 and there is another policy that is now active, effective 12-12023. So the correct policy number to use when filing the claim will be 02443492.
[CUSTOMER][POSITIVE] Oh OK thank you.
[CUSTOMER][POSITIVE] OK perfect thank you for that.
[AGENT][NEUTRAL] OK, you're very welcome. So give me a moment to uh get that information pulled up.
[AGENT][NEUTRAL] OK, so again he is covered on this policy. The policy number I gave you is the one that you would use now for uh claims, and it is active effective 121 [PII] 2023, and you said that you were needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, urgent care to be specific.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on the supplemental policy, the outpatient benefit maximum, which urgent care would fall under.
[AGENT][NEUTRAL] Per cover person per calendar year for covered outpatient services is $6000.
[CUSTOMER][NEUTRAL] 1000 per year.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] Deductible. OK, great.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to their primary insurance insurance, [PII], we will also have to have a copy of their primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Along with the claim for review and then once we have processed our claim you should be able to check status.
[AGENT][NEUTRAL] By going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No, that was it. Thank you so much. Um, [PII], is there, oh sorry, is there a call reference number for today?
[AGENT][NEUTRAL] Were you or mhm.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help today I really appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thank you you too, [PII] bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.