AccountId: 011433970860
ContactId: eb1743e8-6324-4458-926c-17f419c62ac0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329089 ms
Total Talk Time (AGENT): 139187 ms
Total Talk Time (CUSTOMER): 136354 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/eb1743e8-6324-4458-926c-17f419c62ac0_20250311T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII] to my [PII] [PII], and yours [PII]?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Hi, thank you. The reason for my call, [PII], I'm just calling to check if um the plan is active for a patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility, Ms. [PII]. What is the um name of the facility you're calling from, please, and the phone number?
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] OK. And a good callback number if we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the member ID benefit number I guess it's this 1 02137628 M as in Mary, L as in Larry the number 8.
[AGENT][NEUTRAL] OK, let me pull up that number real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that this policy for [PII] is no longer active. The policy lapsed on [PII]. Let me check to see if she does have an active policy though.
[CUSTOMER][NEUTRAL] Um, I am seeing a different member ID, so maybe I gave you the wrong member ID. I'm looking here from what the card we have in 22, and there's a different number on file here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me give you
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Yes, is it 2?
[CUSTOMER][NEUTRAL] So I have 02.
[AGENT][NEUTRAL] 566. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] 456-680
[AGENT][NEUTRAL] Yes, that's correct. That's the active policy, and the effective date of that policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Breaking up a little bit, Tory.
[AGENT][NEUTRAL] Uh, I'm sorry. The effective date of the policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem. And what about um benefits, um, breakdown? Just like deductible, out of pocket, um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, um, this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has uh inpatient benefit amount of.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] You're breaking up a little bit. You're going in and out, but I can hear you now a little bit better.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, she has, um, this policy is billed secondary to the primary.
[AGENT][NEUTRAL] It helps with deductible, co-pay and co-insurance. She has an inpatient benefit amount of $8150 per calendar year, and then she also has an outpatient benefit amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8100.
[AGENT][NEUTRAL] And then she also has outpatient benefit amount of $2000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's a deductible?
[AGENT][NEUTRAL] No, this helps with the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So does she have a flat deductible amount or just that benefit that is also helping with the co-pay?
[AGENT][NEUTRAL] She does not have a deductible amount, um, it's just this benefit that helps with deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she doesn't have an out of pocket either.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] So just that 2000 that help with the coverage.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let me see here.
[CUSTOMER][NEUTRAL] I think that's pretty much it.
[CUSTOMER][NEUTRAL] And obviously she wouldn't have any copay on this since it's a secondary plan to or primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Inpatient outpatient deductible. OK, alright, I got it. Alright, thank you so much, um, [PII] for the information.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, I think that was it. Thank you so much.
[AGENT][POSITIVE] You're welcome you have a good day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.