AccountId: 011433970860
ContactId: d8ba6dd4-e9ba-4727-bbe4-d48fc771b464
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261798 ms
Total Talk Time (AGENT): 110424 ms
Total Talk Time (CUSTOMER): 96700 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d8ba6dd4-e9ba-4727-bbe4-d48fc771b464_20250122T18:07_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Jackson Memorial Hospital. I'm trying to verify benefits please.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'd love to help you with some benefits today, Ms. [PII]. Do you mind if I grab a good callback number for you real quick?
[CUSTOMER][NEUTRAL] Sure, direct line [PII].
[AGENT][POSITIVE] Thank you, I appreciate that. And the member's policy number?
[CUSTOMER][NEUTRAL] OK. So I have here.
[CUSTOMER][NEUTRAL] The Group number, effective date, I have a certificate number. I don't know if that's the policy number or not.
[AGENT][NEUTRAL] Oh, that'll be it, you betcha.
[CUSTOMER][NEUTRAL] OK, so I have 01975672 M like [PII], it looks like because he sent me a copy but I have it's blurred it looked like ML 7 maybe.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Can we check by name? Oh, I found it, OK.
[AGENT][NEUTRAL] No, I think that was it. And then, um, would you be able to verify for me pretty please your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] So this is for [PII]. Let me see if I have his date of birth. One moment.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you perfect. I do see [PII] here it looks like he's been effective since uh [PII] and you said you're looking for eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, this is actually for his son, so I'd like to make sure his son is gonna be covered under this plan as well.
[AGENT][NEUTRAL] Oh, you betcha. What is the um name of the son, I, the name and date of birth?
[CUSTOMER][NEUTRAL] So this is gonna be for [PII] [PII].
[AGENT][POSITIVE] Perfect. OK, so [PII] is also on this policy. He's also active with us, and it was that same effective date, [PII].
[AGENT][NEUTRAL] And for benefits are you looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] Out, outpatient, please.
[AGENT][NEUTRAL] OK perfect. I do wanna let you know any benefit information I give you over the phone is just a verification of coverage and not a guaranteed payment, um, but it does look like [PII]'s outpatient benefit with us is $200 per calendar day.
[AGENT][NEUTRAL] And then was there any other information you're requiring for [PII]?
[CUSTOMER][NEUTRAL] So you guys will only cover $200 per day?
[AGENT][NEUTRAL] Um, yep, uh, $200. We're a secondary insurance, so we try to pick up and pay on what major medical applies to co-pay, co-insurance, or deductible.
[CUSTOMER][NEUTRAL] Right, so, so you will cover the copays and co-insurance?
[AGENT][NEUTRAL] Um, I mean, I can't guarantee payment over the phone. It's all about what comes through on the claim form, but yeah, we're the gap policy.
[CUSTOMER][NEUTRAL] insurance, OK, because he does have a pretty big, uh, deductible and out of pocket, so you guys will cover some of it, but you don't know exactly.
[CUSTOMER][NEUTRAL] How much of it?
[AGENT][NEUTRAL] Yeah, I wouldn't, we wouldn't be able to know without seeing the EOB and the procedure codes and diagnosis codes and all of that that come through on that claim form.
[CUSTOMER][NEUTRAL] OK, but it's up to $200 a day you were saying?
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] 230. OK, may I get a, do you provide reference numbers?
[AGENT][NEUTRAL] Um, they're not numbers, but yes, it's my name, [PII] My last initial [PII], and today's date.
[CUSTOMER][POSITIVE] B like boy and then today's date you said [PII]. Thank you so much Miss [PII] and I hope you have a great great day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Hey thank you you too as well, Mrs. [PII] take care and thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.