AccountId: 011433970860
ContactId: d5032c37-1e3c-4cec-930e-fa41cb0baaba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283420 ms
Total Talk Time (AGENT): 136031 ms
Total Talk Time (CUSTOMER): 130871 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/d5032c37-1e3c-4cec-930e-fa41cb0baaba_20250626T15:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Um, yes, I'm calling from Nicholas Children's Hospital. I have a patient here that needs to do X-rays in an outpatient hospital, so I need to know how much they have available for X-rays.
[AGENT][NEUTRAL] OK, so you're needing outpatient benefits for members, is that correct? Yes, ma'am. I can help you with that. Do you also?
[CUSTOMER][NEUTRAL] Yes, outpatient benefits, yes, yes, yes, so I just basically wanna know how much they have available.
[AGENT][NEUTRAL] OK, sure. Do you need eligibility or just the benefit information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, um, like just the effective date and the benefit information.
[AGENT][POSITIVE] Yes ma'am, I can help you. And who am I speaking with please?
[CUSTOMER][NEUTRAL] OK, my name is [PII] A.
[AGENT][POSITIVE] Thank you. And your callback number, please, [PII].
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] The policy number, let me see if I can find it somewhere else. Hold on, let me make something.
[CUSTOMER][NEUTRAL] Hold on because I like to see it on the card. Hold on. The ID number is because I know what we have on this sheet is wrong. Oh shoot, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The ID number that I have is 024. 0 my God, I can't read this. Hold on, so 0 yeah 024.
[AGENT][NEUTRAL] 000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 569.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 88
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and then the number 8.
[AGENT][NEUTRAL] OK, thank you [PII]. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK, OK, OK, alright.
[CUSTOMER][NEUTRAL] What did you say?
[AGENT][NEUTRAL] And any information provided today [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And if you need a CPT code I have it.
[AGENT][NEUTRAL] No, ma'am, I don't need that. So just one moment.
[AGENT][NEUTRAL] OK, so on this policy I do show that [PII] is a dependent and the policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this policy, the outpatient benefit maximum.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Per calendar day for covered outpatient services is $400.
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Per covered person and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK, per calendar date per calendar day, per person, how much is it?
[AGENT][NEUTRAL] Her
[AGENT][NEUTRAL] $400?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's good because the X-rays are not gonna equal that much.
[AGENT][NEUTRAL] With no outpatient.
[AGENT][NEUTRAL] Um, for, and with no outpatient deductible now because this is a supplemental policy, [PII], to the primary insurance, when the claim is submitted to us for review, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then once our claim has been processed, we have our portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the effective date again is [PII] and they have $400 available per calendar year per per per day per person, but tell me again.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] He calendar day for covered outpatient services, yes ma'am, per calendar day.
[CUSTOMER][NEUTRAL] Per calendar day, so that means every day they have $400 of it $400 per person.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] For covering outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, OK, alright, may I have um a reference number for this call, please?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] What did you say your name was again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], is it [PII] or [PII]?
[AGENT][NEUTRAL] Neither [PII] I.
[CUSTOMER][NEUTRAL] [PII], I like that. OK, and the first letter of your last name please?
[AGENT][POSITIVE] Mhm, thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and then today's date.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so much for everything, [PII].
[AGENT][NEUTRAL] Oh, well, you're welcome, sir. Can I help you with anything else, [PII]?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] OK. Well then, thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you you too thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK then.