AccountId: 011433970860
ContactId: 578df9a0-4d31-42e4-9897-d44b96188f96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269160 ms
Total Talk Time (AGENT): 142064 ms
Total Talk Time (CUSTOMER): 141102 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/578df9a0-4d31-42e4-9897-d44b96188f96_20250327T19:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII] and I'm calling from Orthopedic Associates of New Orleans. I'm trying to see if a patient's policy is active and what their benefits would be for a specialist office visit.
[AGENT][NEUTRAL] Sure, I can check eligibility and benefits for you. Uh, sir, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, area code [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and no extension.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, let's see, policy number is 02584629.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] The name is gonna be [PII] and [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan. So in short it is designed to, um, it pays a set dollar amount per covered procedure or office visit. If you'll give me one moment, I will get that policy pulled up and see if you did say specialist office visit.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Is this, uh, like a routine, um, consultation or, uh, will, uh, is it regarding a sickness or an accident?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Well, he's new, so I guess he's just come here to get checked out and, and we are a um orthopedic office, so just to see what's going on so I'm assuming he has pain somewhere.
[AGENT][NEUTRAL] Orthopedic, OK.
[AGENT][NEUTRAL] Got you. OK, let's see. Give me just a moment. Of course, I will let you know verification of coverage is not a guarantee of payment for claims.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What's your insurance?
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] So if it is regarding uh sickness, um, that benefit per visit is $75 and maximum visits per calendar year are $5.
[CUSTOMER][NEUTRAL] Is it community plan?
[CUSTOMER][NEUTRAL] We do not take that insurance, but I can give you the numbers at LSU orthopedics and I believe they do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And there are some additional benefits, for example, um, if a diagnostic test was required like uh an MRI, um, or CT scan, that's an additional benefit of $250 per test.
[CUSTOMER][NEUTRAL] So on your insurance card, does it say United Healthcare Community plan?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and let me paying $75. 5 visits. Do you know how many visits he's used?
[AGENT][NEUTRAL] I can see if he's used any this year. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] No, no, we're private.
[CUSTOMER][NEUTRAL] OK, and you all pay 75 towards the visit and the versus patient responsibility.
[AGENT][NEUTRAL] That's correct. The, the, excuse me, maximum benefit amount is $75 per visit.
[CUSTOMER][NEUTRAL] Oh, the LSU orthopedics.
[CUSTOMER][NEUTRAL] OK, and then, um, you said diagnostics like if we because we do, we, we do X-rays here in house so what would happen with that, um, that would be on him to pay for the X-rays.
[AGENT][NEUTRAL] Diagnostic diagnostic tests, uh, pay that benefit is $250 per test. If you give me one moment because they can be a bit um specific as to what would be considered a diagnostic test. So give me just a moment.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so that diagnostic test benefit is limited to MRIs, CT scans, and colonoscopies. Those are gonna be the only covered with diagnostic testing benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so X-ray is not covered. And what about injections? We do offer injections like a cortisone or something like that.
[AGENT][NEUTRAL] That's not going to be a benefit. It would just be that office visit and then if there were that was a diagnostic test.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, such as an MRI or CT, got it. OK, and do you have a reference number?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. So my name is spelled [PII] Last [PII] is [PII] Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's gonna be it, Miss [PII]. Thank you so much.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL have great rest of your day.
[CUSTOMER][NEUTRAL] Alright, you do the same.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye bye.