AccountId: 011433970860
ContactId: 528126a1-5398-4894-8d95-dd373455bbd5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274369 ms
Total Talk Time (AGENT): 168015 ms
Total Talk Time (CUSTOMER): 95610 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/528126a1-5398-4894-8d95-dd373455bbd5_20250113T20:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name is [PII]. I'm calling from Jackson Memorial Hospital. I wanted to check if a member has any coverage or benefits.
[AGENT][POSITIVE] OK, I can help you with that, [PII].
[CUSTOMER][NEUTRAL] Um, they're they're actually, yeah, they're actually coming in for an MRI and I wanted to know if their deductible or copays are covered.
[AGENT][POSITIVE] OK. All right. I will certainly look at that. Can I get a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and what is the policy number for that patient?
[CUSTOMER][NEUTRAL] Uh, yes, so the policy is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One second
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 01797040 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] All right, let me get over there and get that pulled up and we'll see what's going on here.
[AGENT][NEUTRAL] All right, can you verify the name and date of birth for me?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] All right, excuse me, I guess I took a little sip of something. I got choked up.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh goodness. OK, so just to let you know, this is a limited benefit supplement plan. So we will be secondary to their primary insurance.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As far as deductibles, let me see if they have any, and this is gonna be on an outpatient basis correct?
[CUSTOMER][POSITIVE] Correct, that's correct.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, so as far as their outpatient benefits, let's see here.
[AGENT][NEUTRAL] They do have coverage for imaging on an outpatient basis um no authorization is needed and no deductible as long as it's not like an ER visit like if they're being seen in the ER it would be considered we would have a deductible but if it is just hey they're coming in for imaging and leaving um there is no deductible from us.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Perfect. So now they have their primary United Healthcare. They do have a copayment with United Healthcare. Do you guys cover that co-pay uh and deductible and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that is what this supplemental will pick up we um as long as there's no deductible that needs to be covered and it's a covered benefit because like I said it is limited, um, and it is, it's limited both in what is covered and the amount per either per occurrence or per year or whatever however the policy is set up for that particular patient.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] It's limited in that nature too, so, um, but it does pick up any patient responsibility that is in the form of co-pay, co-insurance or deductible, so they have the diagnostic testing and they have $11,000 per calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then the remaining gets billed out to the patient, so we pretty much have to send out the claim, right?
[AGENT][NEUTRAL] That's gonna
[AGENT][NEUTRAL] Yes, so you would send us the claim with the primary payers EOB we would cover whatever we are able to cover and then we would send you, you know, if we are able to pay, we would send you payment and um if there's a remaining balance because this is supplemental um we actually don't make any patient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Responsibility determinations, any remaining balances will be up to the facility on how they wanna handle that, whether they write it off or bill the patient, however they wanna handle it that's completely up to them because we're not gonna make those determinations that's not how our policies are set up.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Perfect and it's you said it's up to $1000 per calendar year.
[AGENT][POSITIVE] Correct, per calendar year.
[CUSTOMER][NEUTRAL] How do you see if the member has um met and has um used any of it or it's too soon.
[AGENT][NEUTRAL] I do not have any claims on file for this patient ever and she's had her policy for like 6 years now, nearly 6 years, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this will be the first?
[AGENT][POSITIVE] Yeah, so she's good as of right now, right, yeah, as of right now she's good.
[CUSTOMER][POSITIVE] OK perfect perfect perfect awesome thank you so much is there a reference number for this call?
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Yeah, it would just be my name, so that's [PII], last initials [PII] and you would use today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Perfect thank you so much for your help.
[AGENT][POSITIVE] Yeah, of course, have a great day, [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you, you thank you bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye.