AccountId: 011433970860
ContactId: 2bbde7ac-edfe-4bfc-85e4-5d405efa3194
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402799 ms
Total Talk Time (AGENT): 226336 ms
Total Talk Time (CUSTOMER): 185444 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/2bbde7ac-edfe-4bfc-85e4-5d405efa3194_20250114T16:46_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hey, this, um, I'm calling from urology specialist of Georgia.
[CUSTOMER][NEUTRAL] And I just have a question about a payment we received and just kind of get a little um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Idea of what type of insurance this patient has and.
[CUSTOMER][NEUTRAL] Because they're having a CT scan today and we only got $50 on a claim for 4/29 dollars so I just wanna make sure this is a limited benefit, so just let me know what you need from me and I can give you what I have.
[AGENT][POSITIVE] Yeah, absolutely. Do you mind if I just start with your name and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][POSITIVE] Thank you so much, Ms. [PII]. And what's your member's policy number today?
[CUSTOMER][NEUTRAL] Well, let me give you the one that's on the check because we have a D number in front of ours because I don't know but anyway she's only one we've got like that um 022.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 39995.
[AGENT][NEUTRAL] And their first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you. Um, so, Ms. [PII], I do see her policy here. This is a limited hospital indemnity policy, and let me take a look at some of her benefit information so we can see what's going on.
[CUSTOMER][NEUTRAL] OK, yeah, because she had a CT scan today.
[CUSTOMER][NEUTRAL] And we did call and get um.
[CUSTOMER][NEUTRAL] [PII], were you able to get authorization or no pre-cert was required? Probably because they ain't gonna pay it. This is a limited hospital policy.
[CUSTOMER][NEUTRAL] These new cards, it's so hard to know what's what.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm seeing it was her outpatient um benefit for a physician's office and so there's no like difference between specialty if they're in a physician's office it's underneath that and they get I believe it's 4 times a year up to $50 a visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I bet it doesn't cover CT scans or X-rays, does it?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, they do have a diagnostic imaging benefit, but I, I know again like it's a limited plan, it's limited to what's covered in that imaging.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right. Yeah. And she's, um, and the, um, it would be diagnostic with us, of course, um, but, um, let me see what he was looking for because it, it didn't even pay her urine, it just, but like you said, it doesn't really matter. It just groups what you're saying just groups in there and she can get up to 4 times a year up to $50.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Up to $50 and if she's in for a CT scan today, I'm just that might fall in her diagnostic testing benefit. It looks like it covers MRI CAT scan, um, RIAIU, the.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] A CT and a pet.
[CUSTOMER][MIXED] OK, but it doesn't tell how much.
[AGENT][NEUTRAL] So and then that benefit is up to $100 and I believe she only has it once a year, yes.
[CUSTOMER][NEUTRAL] 2 100, OK.
[CUSTOMER][NEUTRAL] One time a year, OK, alright, that helps now are, are all the cards like are they are when it says benefits in a card, are they all like follow the same benefit thing?
[AGENT][NEUTRAL] So it's really hard because we actually like unlike a lot of companies we don't have like one type of coverage we sell we like tailor the coverage to the company that wants it um so it is hard to tell with our benefits in the card they do all typically use a hospital indemnity policy um and so their benefit options might be different they might have more coverage or less coverage depending.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so it's, it's always just really hard to tell, but if it is a benefits in the card, it is gonna be typically that hospital indemnity policy on there.
[CUSTOMER][NEUTRAL] Got you. And let me ask you this now on the EOB we have, it doesn't have anything patient responsibility, no adjustments, it's just straight $50. Do y'all allow us to build the patient if, um, but if we accept it, is that do you all have like a.
[AGENT][NEUTRAL] Oh, because we're not major medical, we don't, um, we don't determine patient responsibility we just have like a limited benefit that they're allowed with us and we pay that and then whatever happens after they're out of that is out of our hands.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, that answers my question, but.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Um, I'm so sorry. I also did just want to let you know that as far as the policy number, the one you gave me, that's their policy number with us, and then that D number is their policy number for multiplan and 90 degree benefits, so they have like the two different numbers, um, but that 022 number, that's the one you'll use with the APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Now what would that mean to me as far as 90 degrees and multi-plane because we're in network with 90 degrees and multi-plan. What does that mean to us?
[AGENT][NEUTRAL] Um, so typically with multi plan like um they're offered a discount, um.
[AGENT][NEUTRAL] Because you're a multi-plan provider, so like there's a discount there for them, um, and then the 90 degree benefits honestly from my understanding is 90 degree degree benefits carries more of like a wellness benefit for them where we have like this limited hospital indemnity, but I can't know for sure because I don't actually work with them and nobody's ever like told me.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] What do we um and and now you've thrown me into another question so do we send the claims to y'all and then how do we, I mean, or can we send them to the multi plan or?
[AGENT][NEUTRAL] So typically you're sending them to [PII], right?
[CUSTOMER][NEUTRAL] Let me see
[AGENT][NEUTRAL] Is that the claim address, the [PII]?
[CUSTOMER][NEUTRAL] Um, let me look and see which one we have. Yes, yes.
[AGENT][NEUTRAL] OK, so that's exactly what happens is you send it there and they look and they're like, oh, does this go to us or does it go to APL and then they'll send it on to us.
[CUSTOMER][NEUTRAL] OK, so they decide where it goes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so in the payer ID is 64556.
[AGENT][NEUTRAL] Yep, yep.
[CUSTOMER][MIXED] OK, all right, OK, that's a little confusing but OK.
[AGENT][NEUTRAL] I know it's a lot and then I'm so sorry just to throw more at you, but I, I realized I didn't say this and I just wanna let you know that any benefit information I give you over the phone is just a verification of coverage and never a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, perfect. OK and um could I um get your call reference number if I note all this stuff I will note it after we hang up.
[AGENT][NEUTRAL] Yes, absolutely. My reference number is [PII]. Well, it's my name, [PII] for boy for my last initial and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, alright, well thank you so much [PII] and I do appreciate that.
[AGENT][POSITIVE] Hey, it's my pleasure, Ms. [PII]. Thanks for giving us a call and I hope you have a fabulous afternoon.
[CUSTOMER][POSITIVE] Alright you too alright bye bye.
[AGENT][POSITIVE] Thanks bye bye.