AccountId: 011433970860
ContactId: 4c15c1ab-4478-45e9-8178-a528cb84e403
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306980 ms
Total Talk Time (AGENT): 179200 ms
Total Talk Time (CUSTOMER): 113202 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/4c15c1ab-4478-45e9-8178-a528cb84e403_20250401T18:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, this is [PII] with Ascension open MRI. I need to verify benefits for a patient. I have the policy number and everything.
[AGENT][NEUTRAL] Sure, yeah, I could check those benefits. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then I can go ahead and take that policy number.
[CUSTOMER][NEUTRAL] OK, it's 02585395.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Perfect. Thank you for verifying that, [PII]. Uh, so this policy actually terminated [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you give me one moment, I'll see if they have one that's active. It might just be a different policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] OK, uh, she does have one that is currently active. Let me know when you're ready. I could give you that updated policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, hold on one second. Let me, let me wait the other one out quick.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK, what is it?
[AGENT][NEUTRAL] It is 02595746.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, and what about group number?
[AGENT][NEUTRAL] Uh, that should be the same, but let me verify that.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] 18735.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, got that, yeah.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Alright, so again, this one is currently active. Uh, that effective date just picked up where that other left off, uh, [PII], and of course this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Um, let's see, of course, I will let you know verification of coverage is not a guarantee of payment for claims. So this is for um outpatient, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the code is, um, yeah, it's an outpatient uh MRI, um, the code is 70553.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, um, OK, so the outpatient benefit, let's see, that is $6900 per calendar year, and they do have a $1000 deductible for this.
[CUSTOMER][NEUTRAL] Just one
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Policy, give me just a moment. I will see if any of that has been used or met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has met that deductible, um, and she has used $1,954.30 of that outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how, so how would that work? Um.
[CUSTOMER][NEUTRAL] So what she
[CUSTOMER][NEUTRAL] So like her Blue Cross remaining for her primary would be 62437. That's what she would be due at time of service, so how that would work on that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, so that again that entire benefit amount goes towards co-pay, deductible or co-insurance, so it will go towards any and all of that until that benefit amount has reached its maximum for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what's the benefit amount again? I'm sorry.
[AGENT][NEUTRAL] No, that's OK. Um, I was gonna try to do some math cause.
[AGENT][NEUTRAL] I need a calculator.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm good at some things. Math is not one of them. Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the total outpatient benefit amount per calendar year is $6900. So with what she has used and of course has met that deductible, she has a remaining benefit amount of $4,945.70.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so she should be good then, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, and calendar year, alright.
[CUSTOMER][NEUTRAL] That's what I needed, um, so we would just file. It doesn't need like an authorization or anything?
[AGENT][NEUTRAL] All right, yeah, was there anything else I can help you with?
[AGENT][NEUTRAL] No authorization is not required. This policy is very dependent on major medical, so as long as they are willing to pay, then this policy can.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK, so basically she would not owe anything because she would have see she still has benefit amounts left. OK, that's what I needed thank you and what's your name? just so I have it.
[AGENT][NEUTRAL] All right. [PII]
[CUSTOMER][NEUTRAL] OK, and just a reference number.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. So my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] If you have one
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that's it. Thank you very much.
[AGENT][POSITIVE] All right. Yes, ma'am. Thank you. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.