AccountId: 011433970860
ContactId: dd1ce1b7-cb7c-4566-9a2a-7088ba78eea9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235449 ms
Total Talk Time (AGENT): 120653 ms
Total Talk Time (CUSTOMER): 62469 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/dd1ce1b7-cb7c-4566-9a2a-7088ba78eea9_20250624T18:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from Children's Hospital in [PII]. I'm calling to get uh outpatient benefits for an observation stay and since you need to do an authorization.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits and authorization information and may I have a callback number just in case we get disconnect Let me [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I'm sorry, and my extension is 3535.
[AGENT][NEUTRAL] 3535. OK. Uh, OK, I got it. Thank you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 02494500
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, all right.
[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. Um, this particular policy is a hospital indemnity policy, which is a limited policy. Um, let me go ahead and pull the benefits on this one, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for this one authorization is not required um.
[AGENT][NEUTRAL] And you said he's in observation. Has he been there 24 hours or more or less than 24?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Less than 24.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right then.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm. OK, so for this one, there is, uh, I don't have an outpatient benefit. Um, the only outpatient benefits that I see here is like an um emergency room visit, but other than that, um, for the facility unless it's a surgery, there's no other benefits.
[AGENT][NEUTRAL] So just the emergency room or a surgery?
[CUSTOMER][NEUTRAL] Well, he had a
[CUSTOMER][NEUTRAL] OK. He had an outpatient surgery and now they're keeping him overnight. So what was the outpatient surgery benefit?
[AGENT][NEUTRAL] OK, OK, and this is not a guarantee of payment, just a verification of coverage. Surgery in a hospital is 1000 per day maximum of 1 day.
[CUSTOMER][NEUTRAL] OK, one day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, now you 1000 you'll pay, right? That's what you mean, correct?
[AGENT][POSITIVE] Yes, that is correct, yes.
[CUSTOMER][NEUTRAL] And you said no off needed.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And this effective date? Do you have that?
[AGENT][NEUTRAL] Um, yes, the effective date on this policy for [PII] is [PII].
[CUSTOMER][NEUTRAL] All right. And you said your name is?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] All righty. Thank you so much, so.
[AGENT][POSITIVE] You're welcome. Is there any anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] No, that's all I needed.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good afternoon, Miss [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you.