AccountId: 011433970860
ContactId: 4b97220c-8155-4789-8bd4-7b83373265ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226720 ms
Total Talk Time (AGENT): 118448 ms
Total Talk Time (CUSTOMER): 63861 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/4b97220c-8155-4789-8bd4-7b83373265ac_20250206T17:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling to see about the policy for this patient. Um, they do have Blue Blue Cross as their primary with a very high deductible, but I saw this had limited benefits of $1000 and he's scheduled for an MRI, and I was calling to see how that works with you guys.
[AGENT][NEUTRAL] OK, Ms. [PII], I can um help you with the benefits for your patient. Um, what is your callback number, ma'am, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you ma'am and then what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Mid-state Orthopedic and Sports Medicine Center.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number, please.
[CUSTOMER][NEUTRAL] 1451412
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] I pull that policy in. OK, I do show that [PII] does have um an active policy. His effective date is [PII], and you are correct, this is a supplemental insurance policy. Um, it does help with um deductible copay and co-insurance, and this is just to um verify his benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He does have if he does go inpatient, he does have an inpatient calendar year benefit amount at 2500 and outpatient is a calendar year benefit amount of 1000 to help with the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, and it is, uh, he can use in an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK, what about office setting?
[CUSTOMER][NEUTRAL] Like for an MRI.
[AGENT][NEUTRAL] Let me look in
[AGENT][NEUTRAL] Let me check and see if he has office visits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm gonna pull up this policy. It's gonna take just a second for the computer to load it for me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me look at it real quick to see what it says.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] About an office visit.
[AGENT][NEUTRAL] Yes, it does not cover the physician's office visit fee.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, so, um, but it does an outpatient setting.
[AGENT][NEUTRAL] Yes, in an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that's exactly what I needed, Miss [PII].
[AGENT][POSITIVE] OK, all right, well, Miss [PII], I hope you have a good rest of your day and we appreciate you calling APL.
[CUSTOMER][POSITIVE] You have a good day as well thank you so much.
[AGENT][POSITIVE] Thank you. You take care. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.