AccountId: 011433970860
ContactId: a201062f-0535-4c3f-8a56-98f8c0c9082a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321369 ms
Total Talk Time (AGENT): 132792 ms
Total Talk Time (CUSTOMER): 95120 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/a201062f-0535-4c3f-8a56-98f8c0c9082a_20250401T16:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm so sorry. Uh, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hi, [PII], uh, my name is [PII]. I'm with Reno Diagnostic Center.
[CUSTOMER][NEUTRAL] Um, I had a patient, um, that I inquired about yesterday, but I don't think we have the right information. He finally called me back and I wanted to reconfirm, uh, one more time to see if the patient is eligible and benefits.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, so the policy number they gave is 02585017.
[AGENT][NEUTRAL] And [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] Uh, my direct phone number is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, um, it's [PII], but on the insurance card, he said that on Ramirez, the letter Z at the very end is not on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then there's a space between the two last names, no dash.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I've got him active and effective [PII].
[AGENT][NEUTRAL] And then what type of benefits were were you needing or do you need benefits?
[CUSTOMER][POSITIVE] Yay.
[CUSTOMER][NEUTRAL] Yes, uh, benefits, um, he's scheduled for an ultrasound, um, at a freestanding imaging facility. It's like an office setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, just a basic outline of the policy.
[AGENT][NEUTRAL] Uh, let's see what we've got.
[AGENT][NEUTRAL] OK, so, outpatient diagnostic.
[AGENT][NEUTRAL] Uh, it looks like for that benefit, he has a $400 per day benefit and it's a maximum of 1 day per calendar year. So that's what it would pay out um once per calendar year.
[CUSTOMER][NEUTRAL] OK. Um, does it show like if he has to pay like a co-pay or if it's per like co-insurance or anything like that?
[AGENT][NEUTRAL] No, um, there's no copays or co-insurance. It's just that's if he receives diagnostic testing, medical imaging tests, let me make sure, let me look up and make sure that the ultrasound is under that definition. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so medical imaging tests that are covered under the policy that it would pay that 400. It's only for MRIs.
[AGENT][NEUTRAL] Um, CAT scans, PET scans, and then radioactive iodine uptake tests.
[AGENT][NEUTRAL] So I don't see.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Let's see ultrasound on here.
[CUSTOMER][NEUTRAL] Does it show like an ultrasound as a covered benefit, or?
[AGENT][NEUTRAL] No, that would be what it would fall under because it's a diagnostic test unless
[AGENT][NEUTRAL] He had um let's see.
[CUSTOMER][NEUTRAL] Like a routine.
[CUSTOMER][NEUTRAL] Imaging.
[AGENT][NEUTRAL] I'm making sure I'm not missing anything here.
[AGENT][NEUTRAL] Yeah, I don't show coverage, um, because he's got like, he has coverage for a hospital admission, hospital confinement, ICU rehab, surgery.
[AGENT][NEUTRAL] Um, ER, urgent care, physician's office, physical therapy, speech and occupational therapy.
[AGENT][NEUTRAL] Yeah, it defines it's specific on those medical imaging tests, so it seems based on that, based on his policy, it wouldn't be covered.
[CUSTOMER][NEUTRAL] OK, so the imaging is not covered.
[AGENT][NEUTRAL] That specific imaging test, yeah.
[CUSTOMER][NEUTRAL] Uh it covers.
[CUSTOMER][NEUTRAL] OK. I will let the patient know. um, and then do you give out call reference numbers?
[AGENT][NEUTRAL] Uh, reference number is just my name, [PII], and then first initial to my last name which is [PII] as in dog, and then today's date. And is there anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you so much. I do appreciate your help.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] Yeah. All right, bye.