AccountId: 011433970860
ContactId: a43ec639-52ba-445e-a9f8-d413254026e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285130 ms
Total Talk Time (AGENT): 129695 ms
Total Talk Time (CUSTOMER): 67028 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/a43ec639-52ba-445e-a9f8-d413254026e2_20250210T23:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. I'm calling from Saint John's Regional Medical Center to verify, uh, medical benefits for a patient that was seen in the emergency room.
[AGENT][NEUTRAL] OK, I could check those benefits for you. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] It's D as in David 46401494.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers, [PII], that is true, uh, they're called 90 Degrees, um, I can give you their information or if you maybe have their social I can see if they have any policies with us.
[CUSTOMER][NEUTRAL] Let me see, I have a social of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] And what was the name for the patient?
[CUSTOMER][NEUTRAL] This is for Mr. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, do you have uh his date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK perfect so I did find a policy he has with us um that is active. The effective date was [PII] and now this is a limited indemnity medical plan.
[AGENT][NEUTRAL] And you said this was for um he had an emergency room visit?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, it was just uh outpatient?
[CUSTOMER][NEUTRAL] Outpatient, yes.
[AGENT][NEUTRAL] OK. Give me just a moment. I'm gonna get his policy pulled up, um, and see if that is a covered benefit under this policy. Give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Bear with me. I appreciate your patience. It's thinking about it.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Did he receive a uh surgery or anything like that?
[CUSTOMER][NEUTRAL] No, nothing like that. He was just treated and released. Let me see why he was here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess he fell. He fell and he had some facial injuries.
[AGENT][NEUTRAL] OK. Um, did he receive any, um, like medical, medical, uh, imaging tests or anything like that?
[CUSTOMER][NEUTRAL] Oh let me double check here.
[AGENT][NEUTRAL] So this plan is a bit different. It is uh very in particular.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, I get it. That's it.
[CUSTOMER][NEUTRAL] Yep, he had a CT scan.
[AGENT][NEUTRAL] OK, alright, and of course I will let you know that uh verification of coverage is not a guarantee of payment for claims, um, so he does not have any benefits for emergency room visit.
[AGENT][NEUTRAL] At all like period. Um, he does have a diagnostic testing for medical imaging tests, and that is $100 per day. And that seems to be the only relevant uh benefit that he has for this visit.
[CUSTOMER][NEUTRAL] So should we even bill it to the insurance or no?
[AGENT][NEUTRAL] I would pay $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right and uh do I have the correct ID number for him?
[AGENT][NEUTRAL] Let's see, um, so that one, you gave me the one for 90 degrees, um, I'm not sure if he might have anything additional with them this is a part of multi plan I can give you the policy number he has with us whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK it is 02.
[AGENT][NEUTRAL] 55
[AGENT][NEUTRAL] 7066.
[CUSTOMER][NEUTRAL] 025577066
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, all right, [PII], thank you so much for your help.
[AGENT][POSITIVE] Yes, of course. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] That that's all thank you.
[AGENT][POSITIVE] Alright, well thanks for giving us a call [PII]. You have a great rest of your day.
[CUSTOMER][POSITIVE] You do the same thank you.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.