AccountId: 011433970860
ContactId: 9d3f9bf6-01fe-4d99-8210-ca535d5c63b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359649 ms
Total Talk Time (AGENT): 162020 ms
Total Talk Time (CUSTOMER): 116040 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/9d3f9bf6-01fe-4d99-8210-ca535d5c63b7_20250424T15:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning. I'm calling from Jackson Memorial. I'm calling to see if this patient, uh, is active with you guys and if it was if this test will be covered under.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility and benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] fax number is [PII].
[AGENT][NEUTRAL] That's your fax number or a good contact number?
[CUSTOMER][NEUTRAL] Fax number is that fax number?
[AGENT][NEUTRAL] No, I asked for a contact number in case we're disconnected.
[CUSTOMER][NEUTRAL] Is that what you said?
[CUSTOMER][NEUTRAL] Oh, a contact number. I'm so sorry. It's [PII]. I'm so sorry, [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 25.
[CUSTOMER][NEUTRAL] I'm sorry, it's 0258.
[CUSTOMER][NEUTRAL] 3150 ML 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Is that for the oh wait no.
[CUSTOMER][NEUTRAL] Is that for that says inpatient. I'm sorry. It's outpatient.
[AGENT][NEUTRAL] No, no, it's OK. The numbers are the same.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I believe I have the patient here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] His first name is [PII].
[CUSTOMER][NEUTRAL] I'm gonna spell it the other name [PII]
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment, let me see because this policy.
[AGENT][NEUTRAL] It's no longer active, but they do have an active one, so let me get that for you.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so the active policy number is 214.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0821.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's showing that this policy has been active since [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Since [PII]?
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] So the, the, so it would be 21, 40 82 1 and then it will be the MLA 8 or no?
[AGENT][NEUTRAL] Um, the ML 7 or 8 is really just for the card. We, we, we can't use it in our system, um, so the, the numbers would just be the policy number for us.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a 0 before the tour or no?
[AGENT][MIXED] Um, it shows on the card, but not in the system. You don't have to put the 0, but if you do, it's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now he's getting, um, he's seeing a doctor today for the vascular. I wanna make sure that it's gonna get covered before I register him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So vascular specialist, are you, are you considered like a specialist office or?
[CUSTOMER][NEUTRAL] Mm, that would be a specialist office, yeah.
[AGENT][NEUTRAL] OK. The reason I'm asking is because the policy is broken down into this first this is their secondary policy, but it's broken down into inpatient and outpatient.
[CUSTOMER][NEUTRAL] It is, it's for us, yeah.
[AGENT][NEUTRAL] So under the outpatient the policy will
[CUSTOMER][NEUTRAL] Mhm, this will be an outpatient.
[AGENT][NEUTRAL] The policy would pay up to $7900 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now the policy itself does not have any coverage for like a facility charge, but they do have the office treatment rider. So any treatment in the office as long as it's not cosmetic, could be covered up to that 7900.
[CUSTOMER][NEUTRAL] Good, this is a hospital. I'm calling from a hospital.
[CUSTOMER][NEUTRAL] and then we see a.
[AGENT][NEUTRAL] OK, so it would still be the 7900.
[CUSTOMER][NEUTRAL] Is it covered for the hospital?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, wait a minute, because I, you, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's a hospital and but it's an outpatient for outpatient.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Outpatient hospital or outpatient specialist office?
[CUSTOMER][NEUTRAL] It's a it's for outpatient hospital.
[AGENT][NEUTRAL] Would this be considered diagnostic testing?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it still would be the 7900. The diagnostic testing is in a hospital outpatient facility or freestanding outpatient surgery center. Did you want me to see if any of the 7900 has been used for the year?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and so far none of the benefits have been used for [PII], so they still have the full 7900 for outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, can I get a reference number and your name please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name. Again, it's [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's no reference number.
[AGENT][NEUTRAL] Right, it would be my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] OK you too thank you.
[AGENT][POSITIVE] Thank you.