AccountId: 011433970860
ContactId: ac2b6de0-f770-4de1-acfc-2597081e699b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261649 ms
Total Talk Time (AGENT): 116740 ms
Total Talk Time (CUSTOMER): 122033 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/ac2b6de0-f770-4de1-acfc-2597081e699b_20250326T17:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Memorial Herman Healthcare System. Uh, I have an insured, uh, here. I'm needing to get benefits on, please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] excuse me [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 02556533
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] This is for [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active, it's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, this is for an outpatient, uh, is a lung, um.
[CUSTOMER][NEUTRAL] String ring screening.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Some type of screening.
[AGENT][NEUTRAL] So for outpatient, the benefit is up to $1000 per calendar year. Did you want me to see if any of that balance has been used for this year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] So is this paid to the um to the insured or the provider uh uh either?
[AGENT][NEUTRAL] It depends. It could be both. Um, so once we get the explanation of benefits, like if the insured has to pay a co-pay or something for the services, they could be reimbursed for that, but if primary, like there's still something owed to you all as the provider, we could pay towards that too.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, but can it come from the uh insured? Can he send it in as well?
[AGENT][NEUTRAL] Like can the insurer file a claim?
[CUSTOMER][NEUTRAL] Like if you get a statement, uh-huh, like what if he get a statement saying like the uh primary insurance is paid and this is his balance, would he be able to send that to you all for you all to pay, pay him and then he pay the facility?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yes, the
[AGENT][NEUTRAL] So the insurer can file the claim, um, we encourage the provider to, but yes, the insurer does have the option to file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are there uh any type of benefits for like a CAT scan?
[AGENT][NEUTRAL] So it's not our policy so the secondary policy isn't really broken down into what's being done is where. So for outpatient it's just that that uh balance or maximum I guess I should say.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, just the maximum. OK, OK, so it's just a $1000 max. OK, OK, what was your name?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] My name is [PII] and the first initial of my last name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and you say [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, and is there a call reference number?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] And what time is it where you are?
[AGENT][NEUTRAL] Um, well,
[AGENT][NEUTRAL] I'm in [PII], but everything else is central, so it's 102 on my work computer, but it's 2 here. So which one do you want my work or where I am.
[CUSTOMER][NEUTRAL] Oh it's 2 there, so you're Eastern time. Well, you are. I, I know how to do it. OK, just tell me Eastern and I got you.
[AGENT][NEUTRAL] I'm Eastern, yes.
[AGENT][NEUTRAL] Our system, OK.
[CUSTOMER][NEUTRAL] OK, Eastern time. OK, OK, and uh, what about the mailing address?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So it's
[CUSTOMER][NEUTRAL] Is that the [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, that's what I needed. Thank you so much, [PII], and you have a good day.
[AGENT][POSITIVE] Thank you, Ms. [PII]. You also, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, not at this time.
[AGENT][POSITIVE] All right. Have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome bye bye.