AccountId: 011433970860
ContactId: f656a0e2-5e0f-4032-8eb9-2aec19d3da40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201699 ms
Total Talk Time (AGENT): 108588 ms
Total Talk Time (CUSTOMER): 48966 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f656a0e2-5e0f-4032-8eb9-2aec19d3da40_20250410T18:58_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], my name is [PII]. I'm calling from Nicholas Children's Hospital Authorization department. I'm calling to find out uh patient coverage for an outpatient service.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And you did say your name is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] OK. Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] The policy number 02608267.
[AGENT][POSITIVE] Thank you, one moment.
[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 and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And do you also need eligibility or strictly just benefits?
[CUSTOMER][NEUTRAL] Uh, specifically, I just need to know, uh, well, I would need the effective date and what the coverage is for outpatient services, uh, patient schedule for an outpatient, uh, X-ray.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do say that she is a excuse me, a dependent on the supplemental policy, and the supplemental policy is active. The effective date on the plan is for [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And the outpatient benefit maximum on this policy for covered outpatient services is going to be $3000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person.
[AGENT][NEUTRAL] Because this is a supplement to the primary insurance, [PII], when the claim is submitted to us for review, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which claims data should be able to be checked for us and that portal website is located at [PII].
[CUSTOMER][NEUTRAL] And can I ask, how is anything used from the max of 3000?
[AGENT][NEUTRAL] I can check that for you. One moment. As of now, no ma'am, there is not.
[CUSTOMER][NEUTRAL] OK, perfect. Can I have a reference number, please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK thank you have a great day.
[AGENT][POSITIVE] Well, you're very welcome. And if that's all then that I can help you with, thank you for calling APL and I hope you have a great afternoon as well.