AccountId: 011433970860
ContactId: 05046256-785c-4351-a2b1-52509c33085d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660119 ms
Total Talk Time (AGENT): 237066 ms
Total Talk Time (CUSTOMER): 150515 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/05046256-785c-4351-a2b1-52509c33085d_20250320T19:50_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, my name is [PII]. I'm calling from Ortho Carolina. I'm calling because I'm trying to get the member's benefit for a particular CPT code.
[AGENT][NEUTRAL] OK, [PII], I can help you with that uh benefits for the CPT code. Do you have the, do you have a good call back number first?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, I don't have the only number I have. It starts with a D, and when I spoke to another representative, she told me that that's not the number you guys are gonna need, so I don't have that number. Um, I can give you her name and date of birth.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the last name?
[CUSTOMER][NEUTRAL] Uh last name is [PII]
[AGENT][NEUTRAL] And what's that first name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And um what kind of service is this for?
[CUSTOMER][NEUTRAL] Uh, so this is a surgical procedure. It's for an, an injection in the, let me see if it's in her lumbar spine. Uh.
[CUSTOMER][NEUTRAL] No, actually this is for a uh EMG and nerve conduction study.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So and then it'll be diagnostic testing in an outpatient facility.
[CUSTOMER][POSITIVE] Yes, I'm sorry.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yes, that's well it'll be done in the provider's office actually.
[AGENT][NEUTRAL] Oh the provider's office? OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, did you have her date of birth?
[CUSTOMER][NEUTRAL] I do. It is [PII] no, hold on, not that patient. It is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] So she does have a.
[AGENT][NEUTRAL] Hospital indemnity program or a policy.
[AGENT][NEUTRAL] See, that is, and this is not a guarantee of payment, just a basic outline of the policy.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Let's see that one's effective.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is a secondary or supplemental policy so it's gonna work.
[AGENT][NEUTRAL] Um, after the primary insurance pays, it'll potentially cover deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] And let's see if that is covered.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so you're saying that you guys are secondary?
[AGENT][NEUTRAL] Well, we're a supplemental policy so any claim that you file with us you'll have to have the primary explanation of benefits.
[AGENT][NEUTRAL] And then we, we will pay based upon the policy and then also whatever.
[AGENT][NEUTRAL] Primary had paid, so.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] It does. I'm just trying to figure out then if you guys because she only has one card on her.
[CUSTOMER][NEUTRAL] In her chart so then I'm trying to figure out if you guys are not.
[CUSTOMER][NEUTRAL] Primary, who is primary?
[AGENT][NEUTRAL] Um, actually, hold on one moment, let me look at something real quick.
[CUSTOMER][NEUTRAL] She didn't have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Actually, I don't think we.
[AGENT][NEUTRAL] Hold on, can you hold one moment?
[CUSTOMER][NEUTRAL] Sure, of course.
[AGENT][POSITIVE] OK thank you
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, you're on mute. Hey, I was just catching myself. We don't coordinate benefits on HI, right?
[AGENT][NEUTRAL] OK alright OK OK so we don't give and we don't care at all about the.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, the primary.
[AGENT][NEUTRAL] OK, OK, just wanna make sure um I told her the wrong thing so now I, I'm seeing, OK, so.
[AGENT][NEUTRAL] A nerve conduction study, which should be diagnostic testing, they have a benefit for that and I just quote the the dollar amount. OK, all right. I just wanna.
[AGENT][NEUTRAL] I make sure cause.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, it is 258-638-1.
[AGENT][NEUTRAL] I believe that's what she said, but I will confirm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So what is the um OK the wellness.
[AGENT][NEUTRAL] Well, what's the diagnostic test benefit rider?
[AGENT][NEUTRAL] Uh, OK, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, that makes sense.
[AGENT][NEUTRAL] Let me, uh,
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK alright that makes sense, yeah, that makes sense thank you so much.
[AGENT][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] OK, sorry about that. Thank you so much for holding. I was trying to clarify. I was giving you the wrong information. Um, sorry about that. Uh, I was thinking of another kind of policy. This does not coordinate with primary insurance, so that's not, it's not required for this plan. But, um, diagnostic testing, they are very specific about what's covered under that, and that's only for MRIs, CAT scans, and colonoscopies, so they're not gonna cover any other type of diagnostic procedures.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK, so this is not a cover benefit on the member's plan.
[AGENT][NEUTRAL] Yeah, based on that.
[AGENT][NEUTRAL] Definition for this policy.
[CUSTOMER][NEUTRAL] OK, perfect. Alright and then um I know we were talking about, you said this is still a supplement plan though, this is not the primary insurance for the patient or it is?
[AGENT][NEUTRAL] Correct, yeah, this is not their primary major medical.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Do you happen to have the information of the primary?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see if I can if that's loaded in.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] No, I'm not finding.
[AGENT][NEUTRAL] Yeah, I'm not seeing where what their major medical is.
[CUSTOMER][NEUTRAL] OK, because I know I spoke to a lady from, that's OK, 90 degree benefit and she stated that it's just, uh, she has minimal benefits. It's a preventive plan.
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] And so then that's when she transferred me to you guys at APL because she said you guys would handle.
[AGENT][NEUTRAL] Yeah, we don't
[CUSTOMER][NEUTRAL] Other thing.
[AGENT][NEUTRAL] Right, yes, this is the hospital indemnity plan which again is not major medical so if you I'd reach back out to the.
[AGENT][NEUTRAL] Patient see if she has any other type of maybe employer sponsored or whatever type of benefit through someone else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not that we don't do major medical, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, that's fine. OK, no problem. And then I'm sorry, what was your name again?
[AGENT][NEUTRAL] Uh my name is [PII]'s [PII]. And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, that was it. I greatly appreciate your help today.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a terrific afternoon.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Thank you, bye.
[CUSTOMER][NEUTRAL] You too. 01 last thing, is there a call reference for the call?
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Um, so it's my 1st 1st name, last initial, and today's.
[CUSTOMER][NEUTRAL] I'll take that.
[AGENT][NEUTRAL] 8. That would be the reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you, [PII], you take care.
[AGENT][POSITIVE] Thank you you too bye.
[CUSTOMER][POSITIVE] Thanks. Bye bye.