AccountId: 011433970860
ContactId: 440e0afa-c87a-4364-affe-12964d597363
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231130 ms
Total Talk Time (AGENT): 94691 ms
Total Talk Time (CUSTOMER): 85858 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/440e0afa-c87a-4364-affe-12964d597363_20250228T15:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Sure, [PII], I'm, I'm calling from a medical provider's office. I wanna check benefits for a specific service, am I right?
[AGENT][NEUTRAL] OK, and may I ask who's calling?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Mm, sure, [PII].
[AGENT][NEUTRAL] And do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, let me see, I'm looking at the card. It has two numbers. It says insured coverage family group plan. It says Medlink select. It's uh it has an inhospital benefits cert number and outpatient cert number. It would be the outpatient, correct?
[AGENT][NEUTRAL] Yes, either one of those.
[CUSTOMER][NEUTRAL] Yeah 020.
[CUSTOMER][NEUTRAL] 69594.
[CUSTOMER][NEUTRAL] The letters M as in Mary, L as in Larry, and the number 8.
[AGENT][NEUTRAL] Thank you, [PII], hold on one moment please.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Um, [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits for MRI outpatient?
[CUSTOMER][NEUTRAL] Yeah, for MRI, mhm.
[AGENT][NEUTRAL] OK, hold on one moment, please.
[AGENT][NEUTRAL] OK, that one canceled 8124. They do have a new policy number. It is 02.
[AGENT][NEUTRAL] 538149
[CUSTOMER][NEUTRAL] That's a new policy.
[AGENT][NEUTRAL] Yes, ma'am. It was effective 8124.
[CUSTOMER][NEUTRAL] No, wait, I stopped on 49 you gave me 02538149.
[AGENT][NEUTRAL] That's their policy number. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So can you check the benefits under this policy?
[AGENT][NEUTRAL] Yes, ma'am, that's what I was giving you. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy coordinates with the primary insurance. Whatever the primary applies to their deductible, co-pay, or co-insurance only, we'll pay up to $250 per calendar day.
[CUSTOMER][NEUTRAL] So this is not a primary insurance, it's a supplemental insurance?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So we basically we need to build first the the primary correct?
[AGENT][NEUTRAL] Primary, uh-huh.
[CUSTOMER][NEUTRAL] Oh OK, they only gave us this.
[CUSTOMER][NEUTRAL] So you would pay
[AGENT][NEUTRAL] They have to have a primary to have this one.
[CUSTOMER][NEUTRAL] Whatever goes towards the.
[CUSTOMER][NEUTRAL] This is not the primary.
[AGENT][NEUTRAL] No, ma'am. They have to have a primary uh uh insurance to have this insurance.
[CUSTOMER][NEUTRAL] OK, so I wouldn't bill you guys I would build the primary first and then whatever they don't pay I will bill you.
[AGENT][NEUTRAL] Right, you would send a claim with the explanation of benefits from the primary with the claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. All right, understood, thank you so much.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.