AccountId: 011433970860
ContactId: e38361ba-9b5c-4adb-bf13-ce7cc2c0ca1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508339 ms
Total Talk Time (AGENT): 205754 ms
Total Talk Time (CUSTOMER): 133411 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/e38361ba-9b5c-4adb-bf13-ce7cc2c0ca1d_20250506T20:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from our Children's Hospital. I would like to check the uh eligibility and benefits of the patient. Could you please help me for that?
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for one patient. Is that correct, [PII]?
[CUSTOMER][POSITIVE] Yes, you're perfect, yeah.
[AGENT][POSITIVE] Yes, I can
[AGENT][NEUTRAL] I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Mm, sure.
[CUSTOMER][NEUTRAL] The policy number of the patient is 01659757 M as in Michael, L as in Larry 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, on the policy that you gave me, that policy is no longer active. There is another policy that is currently active.
[AGENT][NEUTRAL] The policy number you gave me termed as of [PII], but there is another policy again that is active, and I can give you that correct policy number.
[AGENT][NEUTRAL] Is this for a future data service or for a data service after [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. What is the policy active number?
[AGENT][NEUTRAL] The current active policy is 01659757.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, that's not the correct policy number. Just one moment, I apologize.
[CUSTOMER][NEUTRAL] Yeah, because already this policy number only I have that only you told to me it is uh
[AGENT][POSITIVE] Yes, but yes, I'm gonna give you.
[CUSTOMER][NEGATIVE] Not eligible.
[AGENT][NEUTRAL] Right, I gave you the term date on the policy number that you gave me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's an old policy.
[AGENT][NEUTRAL] The active policy.
[CUSTOMER][NEUTRAL] What is the new policy number, yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, please take your own time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're welcome. What is your name?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][POSITIVE] Oh, thank you, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the correct policy number that you should have is 0249.
[AGENT][NEUTRAL] 763 7.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need on this supplemental policy inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Specialist.
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] Is this for an office visit? is that correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, so just one moment, please.
[AGENT][NEUTRAL] It's still loading the information for me [PII], so bear with me please.
[CUSTOMER][NEUTRAL] Uh, no, no problem. I'll just, uh,
[CUSTOMER][NEUTRAL] Actually, this was the supplemental plan.
[AGENT][NEUTRAL] This is a supplemental plan to the primary insurance, yes, ma'am.
[AGENT][NEUTRAL] And for a specialist office, the visit, for a specialist office visit, the benefit is up to $50 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what is the exact co-pay amount that is the $50?
[AGENT][NEUTRAL] The benefit maximum on the supplemental policy is up to $50 per visit, maximum of 4 visits per calendar year.
[AGENT][NEUTRAL] And because this is a supplemental policy to their primary insurance.
[AGENT][NEUTRAL] If you are going to be filing a claim on this policy, we will have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Along with the claim for review.
[CUSTOMER][NEUTRAL] It is available, correct, [PII]? Just a moment. Uh, per year for this this is available for this patient, correct?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I'm sorry, what did you ask?
[CUSTOMER][NEUTRAL] No, I'm just asking you the 4 visits available for this patient per year, correct?
[CUSTOMER][NEUTRAL] And the maximum amount is $50.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And because this is a supplemental policy.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] We must also receive a copy of the primary insurance explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL Lisa, we do have a portal that you should be able to check our claim status in by going to secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information.
[CUSTOMER][POSITIVE] Uh yes, this much information only I need [PII] actually. Thank you so much. And this is a no authorization. It is a supplemental plan, correct? Yes, thank you.
[AGENT][POSITIVE] Oh, you're very welcome.
[AGENT][POSITIVE] This is a supplemental plan. Yes, ma'am. So that's all then [PII] that I can help you with today. Thank you again for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][NEUTRAL] You too. Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] I'll just uh drop the call. Thank you.