AccountId: 011433970860
ContactId: 8c8a25ac-cfd9-4128-b0bc-793b5d8a30ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424950 ms
Total Talk Time (AGENT): 147001 ms
Total Talk Time (CUSTOMER): 112017 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/8c8a25ac-cfd9-4128-b0bc-793b5d8a30ba_20250529T18:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from
[CUSTOMER][NEUTRAL] Good Samaritan Hospital. I'm trying to verify patients eligibility and benefits.
[AGENT][NEUTRAL] Alright, [PII], happy to check on eligibility and benefits. What is her policy number?
[CUSTOMER][NEUTRAL] I have, OK, let me go ahead. I'll give you the policy number.
[CUSTOMER][NEUTRAL] OK. The ID number that I have is 02123881.
[AGENT][NEUTRAL] All right, thank you. And then can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, that is [PII], [PII].
[AGENT][NEUTRAL] Alright, thank you. So the patient is active. The effective date [PII] is gonna be [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is playing use a network for the facility charges, or do you know if that is like an open access?
[AGENT][NEUTRAL] Yeah, so there's no network required for usage. It looks like the plan type is a limited benefit hospital indemnity plan, so it's only gonna pay just a set amount depending upon what they're being seen for.
[CUSTOMER][NEUTRAL] OK, cause it's a limited plan, yes. OK, and it looks like patients coming in for an ultrasound of the thyroid. Do you know if that is a covered benefit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me pull up their policy and see what we have here. One moment.
[AGENT][NEUTRAL] All right. It does have a diagnostic benefit, but I believe that's just for wellness. Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I don't know if that's gonna include like an ultrasound.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So under the outpatient, there is, it's not gonna fall under the diagnostic, unfortunately, cause that's a wellness benefit. So that would just be for um like blood or X-rays, things of that nature. It does have a laboratory X-ray benefit. It doesn't really state ultrasounds are covered. It just says that the benefit is payable when the patient has either an X-ray or test performed.
[AGENT][POSITIVE] And it's a $100 benefit towards that.
[CUSTOMER][NEUTRAL] So chances are plan would pay about $100.
[AGENT][NEGATIVE] Yeah, so it's not gonna pay anything over that it looks like cause if it is covered, it definitely is gonna fall under that category.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Like, is patient limited to how many times they can come in for that? or is it just per day?
[AGENT][NEUTRAL] I do believe there, let me go back down here. There is a limit, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a maximum of twice per calendar year.
[CUSTOMER][NEUTRAL] OK. And this is, has patient used any of their ste yet?
[AGENT][NEUTRAL] Uh, let's see if anything has been here.
[AGENT][NEUTRAL] I don't see anything has been used thus far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now this $100 did you say that's on like on X-rays, uh, laboratory?
[AGENT][NEUTRAL] Yeah, that's under the outpatient diagnostics or like X-ray laboratory benefit. Mhm.
[CUSTOMER][NEUTRAL] Testing.
[CUSTOMER][NEUTRAL] OK, diagnostic that works and do you have a call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely. Call reference would be my name. What's today's date? My name again is [PII], that's [PII] Last initial is [PII] like [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, um, does this plan use a network for the facility side?
[AGENT][NEUTRAL] Um, you mean to do claims and things like that of that nature?
[CUSTOMER][NEUTRAL] For it's, yes, for like, yeah, for like facility charges like if it uses like multi-plan or first out.
[AGENT][NEUTRAL] Let me pull that up and see here sometimes these plans do use multipla I'm not let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah well maybe patient could still receive an additional discount.
[AGENT][POSITIVE] Yeah, so it looks like it does go through, uh, you can go through the multi plan, yeah, absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then patient probably for a network with multiplayer then patient may receive a discount. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, well thank you so much, [PII]. You have a wonderful weekend coming up.
[AGENT][POSITIVE] You too, [PII]. Take care. Have a good rest of your week.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Mm bye-bye.