AccountId: 011433970860
ContactId: af188ef6-d93f-402d-ac44-de3de72503d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498579 ms
Total Talk Time (AGENT): 148291 ms
Total Talk Time (CUSTOMER): 81761 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/af188ef6-d93f-402d-ac44-de3de72503d2_20250117T18:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. I'm calling from Breast care specialist. I just need to see if a patient is in network.
[AGENT][NEUTRAL] OK, I can check network for you please, Miss [PII]. um, can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then what is the patient's name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] Sorry, one second.
[AGENT][POSITIVE] Yes ma'am. Take your time.
[CUSTOMER][NEUTRAL] Would it be her outpatient benefit number?
[AGENT][POSITIVE] Yes ma'am, you can give me that number.
[CUSTOMER][NEUTRAL] OK, it's 0250.
[CUSTOMER][NEUTRAL] 242.
[CUSTOMER][NEUTRAL] 8 M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] OK, let me pull that policy in real quick for us.
[AGENT][POSITIVE] OK, I do show that [PII] does have an active policy.
[AGENT][NEUTRAL] Her effective date is [PII].
[AGENT][NEUTRAL] Because this is not the major medical insurance, a network, um, we're not, she's not in a network.
[AGENT][NEUTRAL] This is a supplemental gap insurance.
[CUSTOMER][NEUTRAL] Can you tell me if this picks up the deductible for her primary insurance?
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] Verify her coverage. It's not a guarantee of payment. It is, um, an insurance that does help with her deductible copay or co-insurance. She has an inpatient benefit calendar year of $4000 and then she also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] amount of $4000.
[CUSTOMER][NEUTRAL] I'm sorry you were breaking up really bad. I heard the 24,000s, but what are they for?
[AGENT][NEUTRAL] Uh, outpatient and inpatient.
[CUSTOMER][NEUTRAL] OK, so does she need to meet that 4000 before it'll pick up the deductible for her primary?
[AGENT][NEUTRAL] No, that's her 4000.
[AGENT][POSITIVE] Benefit to help with deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] And is there, can you check a specific code or is that just in general it'll pick up her deductible copay co-insurance?
[AGENT][NEUTRAL] Uh, it's just in general, uh, what the facility are you?
[CUSTOMER][NEUTRAL] You said what type?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Professional.
[CUSTOMER][NEUTRAL] We're just a specialist.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] So like uh it'll be considered like an office visit.
[CUSTOMER][NEUTRAL] We're looking at an MRI charge.
[AGENT][NEUTRAL] OK, so her policy is good in an ER urgent care center and imaging center or laboratory center.
[CUSTOMER][NEUTRAL] I'm sorry, you're breaking up. Can you repeat that for me?
[AGENT][NEUTRAL] Yes, um, it's, she can use it in an ER.
[AGENT][NEUTRAL] Urgent care center.
[AGENT][NEUTRAL] MRI imaging center.
[AGENT][NEUTRAL] Or an ambulatory center.
[CUSTOMER][NEUTRAL] OK, so we do our MRI's in office, so we're not an MRI imaging center. Does that still count?
[AGENT][NEUTRAL] Let me pull her policy in to see if she has office visits. If she has office visits, then it would cover, but let me look for you real quick.
[AGENT][NEUTRAL] It's gonna be just a second while the computer loads her policy.
[CUSTOMER][POSITIVE] You're fine take your time.
[AGENT][NEUTRAL] The policy is loading now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it's gonna be just a moment while I scroll through it to see if she has office visits on this let's see.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, she does have physician's office visits on her policy, so, um.
[AGENT][NEUTRAL] Your facility would be OK.
[CUSTOMER][NEUTRAL] OK, all right, perfect. Do you mind if I grab your name and a reference number please?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII]
[AGENT][NEUTRAL] And you can use my name and today's date.
[CUSTOMER][POSITIVE] OK perfect [PII] thanks so much have a good day.
[AGENT][POSITIVE] You're very welcome Miss [PII] have a great weekend thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm