AccountId: 011433970860
ContactId: a5426125-ebcb-4b13-9e40-c3277c1ba197
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327579 ms
Total Talk Time (AGENT): 151787 ms
Total Talk Time (CUSTOMER): 76413 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/a5426125-ebcb-4b13-9e40-c3277c1ba197_20250212T16:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I was just transferred over. I needed to verify um a patient's plan to see if it would cover a breast biopsy done in an outpatient hospital setting in radiology.
[AGENT][NEUTRAL] OK, yeah, let's take a look. What's the patient's um policy number?
[CUSTOMER][NEUTRAL] They did tell me that you probably wouldn't be able to pull it up with the policy number I have, but that you could do it by her name and date of birth. Um, I guess we can try the policy number though. It starts with a D.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then 46401588.
[AGENT][NEUTRAL] OK, thank you. Yeah, we can't pull with that number. What is um the patient's name, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII] is one word, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So it looks like the patient does have an active plan. The effective date is [PII]. Do you want the policy number that we have?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, policy number is 02574120.
[CUSTOMER][NEUTRAL] And this is the policy number we would use when we file the claims.
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said they were being seen for
[CUSTOMER][NEUTRAL] It's an ultrasound guided breast biopsy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like their outpatient benefit in the surgery center is going to be a benefit max of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I don't know if they're gonna be actually in the hospital, hospital admission, the plan pays, I thought.
[CUSTOMER][NEUTRAL] No, it's just, uh, oh sorry, yeah, it's just gonna be an outpatient hospital and then they'll leave same day.
[AGENT][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it shows a diagnostic testing benefit. I'm not sure if this would apply. Um, it looks like that's $100 per day.
[AGENT][NEUTRAL] And then the plan pays an addition it pays also $125 per day.
[AGENT][NEUTRAL] Uh, towards the physician, it looks like for surgery.
[CUSTOMER][NEUTRAL] Would there be any kind of prior authorization required for something like this?
[AGENT][NEUTRAL] No, it's not. It's a limited benefit plan, so it does just pay these like set uh set amounts depending upon what they're being seen for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][POSITIVE] I think I've got everything that I need then if I could just get a call reference number and then I'll be good to go.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is going to be my name with my last initial and then today's date. my name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Oh, you know what, I do have one more question. Um,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh, I need to get a claims address since you guys are gonna be managing the hospital benefits, that piece I did not have.
[AGENT][POSITIVE] Yeah, absolutely. Let me grab that for you here, one second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like when you submit claims, those are actually gonna go to attention IMA Inc.
[AGENT][NEUTRAL] And the address for that is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII], which is [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is also a payer ID I don't know if you want that.
[CUSTOMER][POSITIVE] Yeah, I can take that as well.
[AGENT][NEUTRAL] Uh, the payer ID is 64556.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for all of that information. I really, really appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye.