AccountId: 011433970860
ContactId: e005b05a-1646-487c-a23d-61e832cac095
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264600 ms
Total Talk Time (AGENT): 94161 ms
Total Talk Time (CUSTOMER): 113881 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/e005b05a-1646-487c-a23d-61e832cac095_20250214T19:38_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from Nationwide Children's Hospital in [PII], an attempt to verify some benefit details and authorization requirements for service, and I do have some specific CBT codes for the request.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can verify benefits for you, Ms. [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number that we currently show is 02557107.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] First name [PII] spelled [PII], last name [PII], [PII] date of birth is [PII].
[AGENT][NEUTRAL] OK. I'm showing an effective date of [PII], policy is active, and what benefits are needing?
[CUSTOMER][NEUTRAL] So it's gonna be outpatient hospital benefit for facility billing.
[CUSTOMER][NEUTRAL] For medical.
[AGENT][NEUTRAL] Well, well.
[AGENT][NEUTRAL] Well, the type of policy the patient has is a limited medical indemnity plan, um, and it's as far as facility, um, for outpatient, it only covers for ER urgent care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, there's no coverage for medical?
[CUSTOMER][NEUTRAL] For outpatient services.
[AGENT][NEUTRAL] Uh, not for outpatient facility besides for ER or urgent care. Um, they do have other benefits, uh, like for surgery or diagnostic, just not for the facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] So not for facility billing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, where would we send claims for this? Uh, do you have a claims address and electronic payer ID?
[AGENT][NEUTRAL] Uh, yes, ma'am. The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh wait, [PII]. I'm sorry, ma'am. Can you, can you back up? [PII].
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and that's to American Public Life, correct?
[AGENT][NEUTRAL] Uh, APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see, and do you have an electronic payer ID?
[AGENT][NEUTRAL] Uh yes, ma'am. It's 64556.
[CUSTOMER][NEUTRAL] All right. And can I have the spelling of your first name, initial to your last, and a call reference number for our call today?
[AGENT][NEUTRAL] Sure. It's
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] And you stated that there are no medical benefits outside of the emergency room or
[AGENT][NEUTRAL] Uh, for the facility, uh, ER or urgent care, any other outpatient facility is not covered.
[CUSTOMER][NEUTRAL] So, what you're stating is there is only coverage for the emergency room or urgent care, correct?
[AGENT][NEUTRAL] For the facility, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I have a call reference number for our call today?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you can use my name in today's date.
[CUSTOMER][POSITIVE] Alright, and I will put the time at [PII] Eastern Standard Time. Thanks so much for your assistance. I appreciate your help and hope you have a great day. Take care.