AccountId: 011433970860
ContactId: dfcb5785-2413-4b55-9a77-0ad51db59fe7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 750979 ms
Total Talk Time (AGENT): 228603 ms
Total Talk Time (CUSTOMER): 475351 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/dfcb5785-2413-4b55-9a77-0ad51db59fe7_20250226T16:48_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from AdventHealth. I'm trying to verify a patient's benefits.
[AGENT][POSITIVE] It would be my pleasure to assist you with those benefits, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] It is [PII]. I tried setting up access on the portal, but I guess.
[CUSTOMER][NEUTRAL] The ID number does isn't the patient account number so it wouldn't let me create a to do it.
[AGENT][NEUTRAL] Yes ma'am, that is correct. The the the patient account number is the account with your facility and access to that portal is for claim status. EOBs in claim submission. So once we receive the claim and it's processed, then you can set up that account, but I'll be happy to help you with eligibility and benefits. [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] OK, so we haven't filled.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so she's got 2, so she's coming in for outpatient, so it's gonna be the 02493493 [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] All right, thank you, and I can help you with her eligibility. [PII], I'm showing her policy is active. Effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy to the policyholders' major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything else I can help you with?
[CUSTOMER][NEUTRAL] And what do you guys cover? Do you guys pay out to the patient or to us?
[AGENT][NEUTRAL] We do pay the provider if the provider files a claim.
[CUSTOMER][NEUTRAL] OK, and is there a
[AGENT][NEUTRAL] And we will need the primary EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, is there a max that you guys pay out?
[AGENT][NEUTRAL] For her outpatient?
[CUSTOMER][NEUTRAL] Like her patient responsibility.
[AGENT][NEUTRAL] Mhm. So we
[CUSTOMER][NEUTRAL] Yeah, for her surgery is 29.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 100
[AGENT][NEUTRAL] So she does have an outpatient benefit. The maximum we can pay per calendar year is $1500. Now that is what we pay toward her deductible, co-pay, or co-insurance of her major medical, and that is a verification coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's why I asked. And has she used any of that this year?
[AGENT][NEUTRAL] For [PII], she has that full benefit remaining at this time.
[CUSTOMER][NEUTRAL] OK. And we'll just deduct that then off of what her major medical pays out then.
[CUSTOMER][NEUTRAL] Um, is there a reference number or is it just your name?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] OK, and claims just go to the [PII] in [PII]. That's on the card?
[AGENT][NEUTRAL] Yes, ma'am. The 248,950. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, I appreciate your help today. You have a wonderful day.
[AGENT][POSITIVE] Well, [PII], it's been my pleasure to help you with those benefits for [PII]. Thank you for calling APL and I hope you have a wonderful day as well. Take care and enjoy the warmer wet while you're in. Are you in [PII]?
[CUSTOMER][NEUTRAL] I am in [PII].
[AGENT][POSITIVE] Well, your, your weather's always warmer, never mind. But enjoy your day.
[CUSTOMER][NEUTRAL] It's, uh, we've had a cold front, so it's been like, well, [PII], but I call [PII] cold. So are you in [PII]?
[AGENT][POSITIVE] Cooler, huh?
[AGENT][NEUTRAL] Actually, I'm in [PII], so we're cold one week and warm the next week and freezing the next week.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We get it all. OK.
[CUSTOMER][NEUTRAL] I used to
[CUSTOMER][NEUTRAL] Um, my now former best friend, um,
[CUSTOMER][NEUTRAL] She moved down here and stole from me, so we're no longer friends. Um, this year, well, the end of last year. So I say 4 more now, um, but I used to go out to [PII] 3 times a year, 3 times a year to visit her and her kids, and we've been friends for like 18 years and um
[AGENT][NEGATIVE] Oh, no.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] I would freeze when I would go out there in like November because, you know, [PII] girl born and raised, so, you know, when it drops below like 70 here.
[CUSTOMER][NEUTRAL] And I'm just dead, and I'm anemic on top of it, so forget about it, like, I just want to die and crawl underneath covers like now I have like a fuzzy blanket on my lap sitting at my desk at home with a long sleeve shirt on.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Well, I like warmer weather in [PII] is on my bucket list to move to, so.
[AGENT][NEUTRAL] One day.
[CUSTOMER][NEUTRAL] Oh, it is so expensive here. I will tell you, since COVID, it used to not be since, I mean, I've looked, like I said, I've lived here my whole life since COVID.
[AGENT][NEUTRAL] Yeah, that's what I hear.
[CUSTOMER][NEUTRAL] Um, the prices have skyrocketed. So, I, this apartment that I used to live in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The rent for one bedroom was $500 a month.
[CUSTOMER][NEUTRAL] The rent in that same apartment now is $1300 a month.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Oh, I'm afraid I'd have to just get a little shack.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's absolutely ridiculous, um, and like the pay ranges.
[AGENT][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Having really compensated for the.
[AGENT][NEUTRAL] Cost of living.
[CUSTOMER][NEUTRAL] Yeah, they try, but
[AGENT][NEUTRAL] Can't keep up, can they?
[CUSTOMER][NEUTRAL] Like where I work they do.
[CUSTOMER][NEUTRAL] Yeah, where I work with Advent, they do twice a year cost of living like adjustments, but
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There's only so much that a company can put out really.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then they looked at other markets in [PII] and so that's what they compare it to not.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEGATIVE] It's not really the true.
[CUSTOMER][NEUTRAL] Nationally, like they should.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] But yeah, it's expensive now in [PII]. Um, if my entire family didn't live here, um, and I didn't, I wasn't like an ocean baby, um.
[AGENT][NEUTRAL] Yeah, that's me too.
[CUSTOMER][NEUTRAL] I, I, yeah, I probably wouldn't live here, um.
[CUSTOMER][NEUTRAL] But I am like a water baby, so.
[AGENT][NEUTRAL] Me too. And I don't live, I mean, the closest water, which I wouldn't get into in [PII] Coast is 3 hours away.
[AGENT][NEGATIVE] And it just, it just hurts my soul not to be close to the water.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] I've drove through [PII], so I don't know if I go in that Mississippi River.
[AGENT][NEUTRAL] Mm hm. Not the Mississippi River, not the Mississippi, um, mm, I just, hm.
[CUSTOMER][NEUTRAL] No, yeah, I drove through there. I drove over there, yeah, um, just coming from [PII] where the water is, um,
[AGENT][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Blue
[AGENT][POSITIVE] Beautiful. Yeah, and you can see it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, I've gone, I live on the golf side, so there's certain areas on the golf side where it's a little bit murkier. Um, it's clearer the more south you go, and the more north you go. It's weird. Um, where I'm at, so I'm in like the [PII] area, so we're in that like enclave, so to speak, um, which thankfully,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] We always seem to miss the hurricanes direct hits because of that. I don't know why, but Sat Baby Jesus, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because we invent, um,
[CUSTOMER][NEUTRAL] And there's like an old wives tale about a Native American like.
[CUSTOMER][NEUTRAL] Um, not curse, but like prayer over our area.
[CUSTOMER][NEUTRAL] Um, again, for the native and to this area, um.
[CUSTOMER][POSITIVE] That protects us from being ever directly hit.
[AGENT][POSITIVE] Oh neat.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, they always mention it whenever.
[CUSTOMER][NEUTRAL] There's a storm coming, um.
[CUSTOMER][NEUTRAL] But over here, if you go to the beaches locally here, they're not as like
[CUSTOMER][POSITIVE] Clear, clear.
[CUSTOMER][NEUTRAL] But they're clear if that makes sense. They're.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So pretty, but
[AGENT][NEUTRAL] It's not
[AGENT][NEUTRAL] You can, you can still see what's a part of your leg under the water.
[AGENT][NEUTRAL] [PII] Coast you get in, you, you can't see anything below water.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] If you ever come just to visit, I will say the best beaches that I've gone to, me and my ex, we went down to um
[CUSTOMER][NEUTRAL] The other coast.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Down and
[CUSTOMER][NEUTRAL] West Palm area.
[CUSTOMER][NEUTRAL] They have the most.
[CUSTOMER][POSITIVE] Prettiest blue water you will ever see in your life.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] And you can see straight through it, everything that's there and it is just gorgeous. So if you ever come on vacation, um, we rented a house and it was like we rented it for a week and
[CUSTOMER][NEUTRAL] Through um.
[CUSTOMER][NEUTRAL] I don't remember the app now but through one of the apps um.
[CUSTOMER][NEUTRAL] And it was like $1000 for the entire week and it was me, him, and three of his kids and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] We had a great time.
[CUSTOMER][NEUTRAL] So we were 1 mile from the ocean.
[AGENT][POSITIVE] Oh, that sounds great.
[CUSTOMER][NEUTRAL] I don't even think a mile. I wouldn't walk because it was over a bridge, but
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. So if you ever just want a vacation and there's an airport down by there.
[CUSTOMER][NEUTRAL] That's the area. It wasn't West Palm, but it's in that West Palm Golf Resort type area. I can't remember the exact name of the town, but it's a small town in that area.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. Well, good to know. Thank you.
[CUSTOMER][NEUTRAL] It's like 4 something. You're welcome.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Just a little tidbit if you ever just want a vacation and you sound like you like the water, that was the most beautiful beach in Florida I've seen. And I've been to we, my family lived in [PII].
[AGENT][POSITIVE] It's been a pleasure to talk to you. Yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Saint Pete, like all over [PII], so I've seen them all.
[AGENT][POSITIVE] That sounds good.
[CUSTOMER][NEUTRAL] So,
[AGENT][POSITIVE] Well, that is good to know, and I really do appreciate that. I hope you do too. And thank you for calling APL.
[CUSTOMER][POSITIVE] Well, you have a great day.
[CUSTOMER][POSITIVE] You're welcome and don't freeze.
[AGENT][NEUTRAL] I, I
[AGENT][NEUTRAL] I'm going outside, as they say, until the temperature is greater than my age.
[AGENT][NEUTRAL] And it's gotta be pretty warm.
[AGENT][POSITIVE] But I do thank you. Thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you [PII], bye bye.