AccountId: 011433970860
ContactId: f065857d-60b0-45e0-8e21-5a32b7fbfcbf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197770 ms
Total Talk Time (AGENT): 95761 ms
Total Talk Time (CUSTOMER): 67999 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/f065857d-60b0-45e0-8e21-5a32b7fbfcbf_20250620T13:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling for Nicholas Children's Hospital.
[CUSTOMER][NEUTRAL] And I want to check the patient eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I can help you with that. I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, and my callback number it is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Sure, and the patient ID number it is 02042058 M as in Mike L as in Lima and the number 8.
[AGENT][NEUTRAL] OK thank you one moment while I get the numbers information pulled up please.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any 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 please and date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's first name is [PII] and the last name it is [PII]. And his date of birth it is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I, I do show that he is a dependent on the supplemental policy and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It is for the specialist office visit.
[AGENT][NEUTRAL] OK, so on this policy, office visits are not covered.
[AGENT][NEUTRAL] If he were to receive some type of treatment in the office, he does have a treatment writer on the policy in which we could review benefits under there, but the office visit is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the outpatient benefit maximum?
[CUSTOMER][NEUTRAL] I can connect
[AGENT][NEUTRAL] Or not.
[CUSTOMER][NEUTRAL] Yeah, no, thank you so much and uh can I get the reference number please? No. And uh can I get the reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you would use my name along with today's date. And just in case, um, [PII], you all were to end up filing a claim for him.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You would need to also send us the primary insurance company's explanation of benefits, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. Well, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh no thank you so much, [PII]. You have been extremely helpful and uh have a wonderful day.
[AGENT][POSITIVE] OK. Well, I hope you have a wonderful day too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Mhm take care bye bye.
[AGENT][POSITIVE] Yes, you too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.