AccountId: 011433970860
ContactId: 077c05c0-e4dc-404e-acd5-a072ae54d71f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215029 ms
Total Talk Time (AGENT): 92155 ms
Total Talk Time (CUSTOMER): 100691 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/077c05c0-e4dc-404e-acd5-a072ae54d71f_20250206T14:44_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, good morning. My name is [PII]. I'm calling from Saint James Parish Hospital. Last initial is [PII], and what's your name? [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Um, OK, so I was calling concerning this patient's policy just to find out exactly how does this policy work to get some clarity on it. Um, I have a member ID number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, sure, I can assist you with that information. May I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 2180312.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is uh [PII].
[AGENT][NEUTRAL] All right, thank you. All right. And I see that um Mr. [PII] has a secondary supplemental plan to the major medical, and this is to help with the deductibles, co-payment, and co-insurance from the major medical. And you said you're calling from a hospital?
[CUSTOMER][NEUTRAL] Yes, I'm calling from Saint James's Parish Hospital. The patient is coming in for a scan at our facility, and I want to know on this secondary APL insurance, how does it pay? Does it pay directly towards us or does it pay to the patient?
[AGENT][NEUTRAL] Oh, it pays to the provider.
[CUSTOMER][NEUTRAL] Cause the patient's gonna have a response, it pays to us to the provider.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, so uh that's what I was trying to find out to see if I have to collect from the patients, so it pays to the provider.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm. Yes. Yes. And let me give you the benefit, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this member has an outpatient maximum of 6000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so this is, so let me understand it. OK, so this insurance plan that he has, the patient has up to $6000 to use.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] 6 $6000 reserved for this patient to use to pay for the primary services.
[AGENT][NEUTRAL] to pay for any amounts applied towards the deductible, co-payment and co-insurance and outpatient service.
[CUSTOMER][NEUTRAL] So let me get, so let me give you an example. The patients coming in for a scan. If this scan costs $1000 we submit the bill to you guys. You guys are gonna pick up this $1000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If that $1000 was applied towards the deductible co-payment and co-insurance from the major medical, we'll go ahead and pick up that $1000. Yes. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so.
[CUSTOMER][NEUTRAL] Alright, and can I get a reference number for this call, please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] All right then, thank you so much.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you appreciate it.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mhm