AccountId: 011433970860
ContactId: d8efa79e-e4b1-469c-8a6e-26cca1fa8945
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499410 ms
Total Talk Time (AGENT): 128740 ms
Total Talk Time (CUSTOMER): 94289 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/d8efa79e-e4b1-469c-8a6e-26cca1fa8945_20250211T18:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], how are you? I'm calling from Nicola Children's Hospital is in regards uh eligibility and benefits verification on one of your members.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, sure. I can assist you with eligibility and benefits. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02260129 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Gonna be a minute. I'm sorry. My system is not responding. Bear with me.
[CUSTOMER][NEUTRAL] Do you want me to give you the, the, the name of the patient?
[AGENT][NEUTRAL] Uh, no, bear with me just a second. I'm trying to pull it up. My system was not responding. OK, one moment.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, it's not responding now, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Date of date of birth is [PII].
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] All right, and you say you need eligibility and benefits, and this is gonna be.
[CUSTOMER][NEUTRAL] And benefits for outpatient hospital, X-ray.
[AGENT][NEUTRAL] Hospital.
[AGENT][NEUTRAL] OK. All right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is one of our secondary supplemental plans to the major medical. Um we have an effective date of [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh.
[AGENT][NEUTRAL] OK, we have an outpatient maximum of 6600 per covered person per calendar year.
[CUSTOMER][NEUTRAL] It's family or is individual?
[AGENT][NEUTRAL] That one is per person per calendar year. There is a family cap, um, let me see how much it is. One moment.
[AGENT][NEUTRAL] All the documents.
[AGENT][NEUTRAL] And I'm waiting on the system, bear with me.
[AGENT][NEUTRAL] um.
[AGENT][NEUTRAL] OK, here we go. All right, so the family cap is at 13,200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 13 to
[CUSTOMER][NEUTRAL] Um, the, the maximum has been satisfied or, or not yet?
[AGENT][NEUTRAL] No, it started all over again this year, um.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I can check and see if they have used any, but yeah, let me check.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We're gonna go
[AGENT][NEUTRAL] OK. So as of today, um, they have only used $39.57.
[CUSTOMER][NEUTRAL] 39 and 57, so practically the, the, the full amount is available.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Basically, yes. Mhm.
[CUSTOMER][NEUTRAL] Yeah. OK. OK. So, so what is the first letter of your last name?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Is there any reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's name.
[CUSTOMER][POSITIVE] And today it. OK. So have a wonderful day. Thank you very much for your help and time. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye. Thank you for calling.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] in here.
[CUSTOMER][NEGATIVE] You are on hold.