AccountId: 011433970860
ContactId: dc7e3139-87c6-4527-a511-c14c8d62ee14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307600 ms
Total Talk Time (AGENT): 151256 ms
Total Talk Time (CUSTOMER): 136001 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/dc7e3139-87c6-4527-a511-c14c8d62ee14_20250407T15:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII]. I'm calling from a provider's office regarding a member that is currently pregnant, so I just wanted to know if I could speak to someone regarding benefits.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Yes, thank you so much it's [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, thank you. The policy number is 02517406.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And what's the name of the facility you're calling from my patients.
[CUSTOMER][NEUTRAL] Yes, I'm calling from Beacon Hollandale OBGYN and the provider is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][POSITIVE] Yeah of course.
[CUSTOMER][NEUTRAL] Yes, the patient is [PII], last name [PII], and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, 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. This is one of our secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] And let me go ahead and get the benefits pulled up for us, one moment.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so with this one we have the outpatient maximum is 5000 per person per calendar year. Now this includes let's see.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] You said for outpatients?
[AGENT][POSITIVE] Outpatient, mhm, correct, yes.
[CUSTOMER][NEUTRAL] What about impatient because she's pregnant and it's regarding her delivery.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so you're calling about her delivering, not her office visit.
[CUSTOMER][NEUTRAL] No, for delivery, for it would be impatient for provider services.
[AGENT][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Got you. OK. All right. For inpatient, the inpatient max is 5000 as well. It's a separate 5000 for inpatient.
[AGENT][NEUTRAL] Per calendar year. Mhm.
[CUSTOMER][NEUTRAL] OK, got it, so per calendar year, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I guess at this moment are you able to see if she used any of her inpatient?
[AGENT][POSITIVE] Yeah, I can check on it for you. Let's see.
[CUSTOMER][POSITIVE] Thank you so much for all of your help.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. As of today, she has not used her inpatient benefits, so she still have the full amount available for [PII].
[CUSTOMER][POSITIVE] OK, got it thank you so much for your help, I guess, and does she need any authorization or anything to your knowledge?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, authorization is not gonna be required because we're just a secondary policy. Mhm.
[CUSTOMER][NEUTRAL] The secondary, OK, got it just wanted to confirm. OK, thank you so much. Are you able to give me a reference or service number?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like Miss [PII], do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, please because I'm bad with spelling.
[AGENT][NEUTRAL] It's OK, no problem. The spelling is [PII].
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, got it, because I don't know I feel like these days everyone's name is spelled unique.
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Thing because my name is not even spelled normal. My name is [PII]. You would think it's [PII], but it's [PII]
[AGENT][POSITIVE] I'm with you on that one.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] STO? Oh boy. OK, yeah, I had it wrong then.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's I think.
[AGENT][POSITIVE] Yeah, you're right on that
[CUSTOMER][POSITIVE] So I have to always double check. Thank you so much for your help. Have a great day, so take care and bless you. Bye-bye. Thank you. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, is there anything else? You're welcome. You as well, Ms. [PII]. Bye-bye. You're welcome.