AccountId: 011433970860
ContactId: 1ee52729-821c-4467-bfd2-ed6f40cfdf2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313079 ms
Total Talk Time (AGENT): 166110 ms
Total Talk Time (CUSTOMER): 130529 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/1ee52729-821c-4467-bfd2-ed6f40cfdf2d_20250206T21:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, hi, good afternoon, Ms. So. I'm trying to check for benefits for and offer requirements, please for a patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure. I can assist you with benefits and authorization. And may I have your name?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. It is spelled [PII] Last name initial is [PII].
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. And may I have a callback number just in case we get disconnected and the name of where you're calling from?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, yes, um, my name is, um, what I'm so sorry, what did you say? I'm sorry.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The name of where you're calling from like the institution or the provider.
[CUSTOMER][NEUTRAL] Um, oh, he, uh, [PII] MRI and diagnostic imaging. Sorry, it's been a long day like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's alright, understand and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, it feels like a Monday. I don't know why.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I've been up since I don't know [PII] so I'm like.
[AGENT][POSITIVE] Oh boy, yeah, yeah, you definitely do need to go to rest. All right. And may I have the patience, yeah.
[CUSTOMER][NEUTRAL] Oh my oh.
[AGENT][NEUTRAL] Pa's policy number, Miss [PII].
[CUSTOMER][NEUTRAL] Yes, it's 02581675.
[AGENT][NEUTRAL] All right. OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, OK, so, and what type of service is being rendered for benefits and authorization?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it's a CT scan of the lumbar spine because this patient has, do you see any other insurance on file? Because this patient actually has another insurance, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yeah, this is the secondary insurance, so he should have, um, a primary, let me see who's the primary, bear with me.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me pull the group because it's not pulling up here. OK. One minute. OK.
[AGENT][NEUTRAL] OK, so this food is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I mean, I already, I already verified the, the, the primary insurance. I just wanna know how, how do you guys coordinate, yeah, yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, we're secondary. Oh.
[AGENT][NEUTRAL] I thought you needed the primary insurance information. We are secondary. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, no, I, no, I, mhm, and so how do you guys coordinate and what do you guys pick up?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we are the secondary, so we help with the secondary policy deductibles, um, with the primary deductibles, co-payment and co-insurance, um, and this is, um, let's see for outpatient service, this is gonna be outpatient facility, correct?
[CUSTOMER][NEUTRAL] Yes, so whenever I spoke with the first, uh, the primary insurance, it's a $300 co-payment. So what do you guys pick, pick that, so what do you guys pick for that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, uh, this one in particular has an outpatient maximum of 250 per day. So the maximum we cover is 250.
[CUSTOMER][NEUTRAL] OK, so the patient would be responsible for $50 then, correct?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, so what, what do you, how do you say reword it again? I'm so sorry, my bad.
[AGENT][NEUTRAL] Uh, this is OK. This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Mhm and so you guys pick up 250 or you guys cover?
[AGENT][NEUTRAL] We cover up to 250 for any outpatient service daily.
[CUSTOMER][NEUTRAL] Outpatient service, does it matter if it's diagnostic imaging?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It doesn't matter if it's an ER visit, diagnostic, um, surgery, um anything outpatient.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, alrighty, no worries, and would all be required so.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, because we're just a secondary so authorization is not required from us.
[CUSTOMER][NEUTRAL] OK, so it's SOL correct?
[AGENT][NEUTRAL] Yes, that is correct. Last initial [PII]
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] OK, and when is the effective, what is the effective date of the changes plan?
[AGENT][NEUTRAL] OK, the effective date on this one is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Would it automatically cross over or we have to send it out?
[AGENT][NEUTRAL] No, it has to be sent to us.
[CUSTOMER][NEUTRAL] OK, alrighty, Miss [PII], can I have a reference number for this phone call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Alrighty thank you ma'am you have a good day.
[AGENT][POSITIVE] OK, you're welcome. Thank you for calling. You as well. Have a good evening. Bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] You too