AccountId: 011433970860
ContactId: a840ac39-1507-4984-8c6c-4c837c8a99d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475279 ms
Total Talk Time (AGENT): 200098 ms
Total Talk Time (CUSTOMER): 138549 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/a840ac39-1507-4984-8c6c-4c837c8a99d0_20250424T13:45_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] Hi [PII], this is [PII] at Wood County Hospital Presearch. Um, I am trying to find out some information for a patient, um.
[CUSTOMER][NEUTRAL] If she is active, if pre-cert would be required for an outpatient MRI and um if we are in network and what the benefits would be.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and benefits. And, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, phone number [PII].
[CUSTOMER][NEUTRAL] And the policy number that I think is D as in Delta 40409175.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Kinda, yeah, I don't have the actual card but she emailed me like pictures of it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you see?
[CUSTOMER][NEUTRAL] But there's 4 different cards, so I'm not sure what one is what.
[AGENT][NEUTRAL] Goes to who? OK. Um, so we're looking for the inpatient or outpatient policy er number. It should start with a 01 or 02.
[CUSTOMER][NEUTRAL] Let's see what
[AGENT][NEUTRAL] Or I can um also look it up with the member's social if you like, whichever is easier.
[CUSTOMER][NEUTRAL] I am trying to look at all these.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][NEUTRAL] I don't see anything like that um.
[CUSTOMER][NEUTRAL] Let me see if I have her so hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the member's first and last name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you need me to spell that?
[AGENT][NEUTRAL] Um, no, it's OK. I think this is her.
[AGENT][NEUTRAL] She is the only one I think I found it. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, this is her. All right, well, thank you so much for verifying her information. All the information provided is a verification of benefits, not a guarantee of payment. So her APL policy number is 261.
[AGENT][NEUTRAL] 6906.
[AGENT][NEUTRAL] And the policy has been active since, oh, I'm sorry.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is APL I guess what I don't see that anywhere on any of these cards.
[AGENT][NEUTRAL] Oh, American Public Life, we um have her hostel indemnity policy, um.
[AGENT][NEUTRAL] She has a hospital indemnity policy with us, so it's American Public Life is through her employer. Um, hold on one moment, I'm going through the screens. Um, [PII], so this is employee benefits through her job.
[CUSTOMER][NEUTRAL] And this is what would cover.
[CUSTOMER][NEUTRAL] Medical like uh uh an outpatient MRI.
[AGENT][NEUTRAL] So this is a hospital indemnity policy, so I'm gonna see what's covered under it, but yes, this is the the medical policy that she has with us. I don't know if she has any others, but this is what she has with us, um.
[AGENT][NEUTRAL] For MRI diagnostic testing, um, the policy will pay up to $100.01 test per calendar year. If any follow-up testing is needed, it would pay up to $25.01 follow-up per year.
[AGENT][NEUTRAL] And then that's the only benefits that this policy has for diagnostic testing. There's also um
[CUSTOMER][NEUTRAL] So that if she has so if she has two different diagnostic testings like an MRI and an ultrasound at the same time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That would only cover $100 on one of those?
[AGENT][NEUTRAL] Correct, because this is a hospital indemnity policy. It's not a major medical policy, it's a limited medical policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's why I'm saying, I don't know if she has any, she could have other, you know, medical insurance. This is just the policy she chose for.
[AGENT][NEUTRAL] Um, her employer, or she may not because we only have access to this. If we had, we also have like secondary policies, then I could have seen the primary, but this one is just this policy. I don't, I can't see any others if she does have one.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Because I show.
[CUSTOMER][NEUTRAL] I have some type of card that says submit claims to IMA incorporated. I don't know.
[AGENT][NEUTRAL] Mhm. Um, let me see.
[CUSTOMER][NEUTRAL] But I don't
[AGENT][NEUTRAL] If these go to IMA, yeah, her claims do go to IMA. So IMA is like repricing, so you'll send the claim to IMA they'll look over it, see if they can apply any additional benefits or discounts, and then they'll send it over to us to finish the processing.
[CUSTOMER][NEUTRAL] OK, so would they cover something and then you guys would cover the rest?
[AGENT][NEUTRAL] No, IMA is not an insurance company, it's a repricing company. So the policy is the same. They just, yeah, see if there's any other discounts or something that they can apply to bring the balance down.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, and it doesn't matter where she has testing at?
[AGENT][NEUTRAL] As in like outpatient or inpatient? No, ma'am, not for the diagnostic testing benefit, but let me double-check just to make sure.
[CUSTOMER][NEUTRAL] Like there it doesn't matter the facility she goes to I guess right?
[AGENT][NEUTRAL] Right, it does there as long whatever, wherever it comes from, we'll see that the coding is diagnostic testing and then they'll apply those benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right, is there a reference number to this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, nope, that'll be it.
[AGENT][POSITIVE] Alright, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.