AccountId: 011433970860
ContactId: 847f4d08-3a9c-43b0-8ab3-b110ed3156d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499779 ms
Total Talk Time (AGENT): 148435 ms
Total Talk Time (CUSTOMER): 135079 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/847f4d08-3a9c-43b0-8ab3-b110ed3156d8_20250312T21:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Hunt Regional Medical Center. I'm needing to get benefits for an outpatient ultrasound.
[AGENT][NEUTRAL] OK, well, I can verify benefits for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] Thank you. And what's that policy number, please?
[CUSTOMER][NEUTRAL] Um, so the only number that I have is 4437-312-10.
[AGENT][POSITIVE] I apologize one more time.
[CUSTOMER][NEUTRAL] Uh, it's D437-312-10.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. What's the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII], last name [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Uh, what state is she from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, do not show her in our system.
[AGENT][NEUTRAL] And you don't have a medical card?
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Um, I have the insurance card, um, that the patient gave us, but that is the only ID number that is on this card, um, and I had spoke with, um, I believe it was 90 degree before they had transferred me over to you and they told me that you guys probably wouldn't be able to look her up with that ID that you could look her up by name and date of birth. Um, now she does have a different name on her driver's license and maybe it's under that. Can you check by the other last name?
[AGENT][NEUTRAL] What's the other last name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, no, ma'am. I don't show her in the system. You don't see like a policy slash er number, start with 01 or 02.
[CUSTOMER][NEUTRAL] No, ma'am, I don't have any of that information. This is the only thing that I have for this patient. Let me look one more place. Hold on just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just to make sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that is the only number that I have um now I do see here in our system where we have her name hyphenated as well.
[AGENT][NEUTRAL] Huh, do you have her social?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me see, I believe I do hold on just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I have a social of [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, I think I found her.
[AGENT][NEUTRAL] [PII]. OK, yes, I have found her.
[CUSTOMER][POSITIVE] Awesome
[AGENT][NEUTRAL] OK, I can give you her policy number with our company when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, it is 2,504,700.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And her, oh, I forgot to ask, what is a good callback number in case the call drops?
[CUSTOMER][NEUTRAL] Um, number is [PII].
[AGENT][NEUTRAL] OK, and you say you're calling to verify benefits uh for outpatient, correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Is this for an outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, I'm sure the type of policy she has with us is a limited medical indemnity plan, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has benefits for inpatient facility, diagnostic, and for surgery, but no benefits specifically for an outpatient facility.
[CUSTOMER][NEUTRAL] OK, um, so it wouldn't be they wouldn't, it wouldn't be covered under diagnostic outpatient?
[AGENT][NEUTRAL] What kind of service is she having?
[CUSTOMER][NEUTRAL] It's an ultrasound.
[AGENT][NEUTRAL] Uh, let me double check, but I don't believe an ultrasound is covered under the plan. Give me one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, no, ma'am, it's not covered. Under her diagnostic benefits, she has benefits like for MRI, CT, CAT scan, PET scan, um.
[AGENT][NEUTRAL] Radioactive iodine test or angiogram.
[AGENT][NEGATIVE] Very enema, stress tests, uh sleep study, but nothing for ultrasound.
[CUSTOMER][NEUTRAL] OK, and then you said um it does cover like inpatient diagnostic and did you say emergency room? I'm sorry.
[AGENT][NEUTRAL] No, inpatient confinement. Like if she was confined inpatient in the hospital, she has a benefit that helps with the facility charges, and she has surgery benefits, um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But nothing as far as the outpatient facility, but like I said, not for an ultrasound, it's not covered.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, if I could just get your name again and a reference number for the call.
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII] and the reference number is my name and today's date.
[CUSTOMER][POSITIVE] All right well thank you so much for your help I appreciate your time.
[AGENT][POSITIVE] Oh, you're welcome, Ms. [PII] and thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.