AccountId: 011433970860
ContactId: b92a4844-2cdf-46b3-ad63-3eefb92cec6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315760 ms
Total Talk Time (AGENT): 145250 ms
Total Talk Time (CUSTOMER): 119909 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/b92a4844-2cdf-46b3-ad63-3eefb92cec6f_20250131T16:36_UTC.wav
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[CUSTOMER][NEUTRAL] Doctor I trying to find out if she can order MRI on him and is it gonna be covered. Hi, this is [PII]. This is [PII]. I'm calling for a doctor's facility. I'm trying to get some information on a patient that sent up today with your insurance.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] OK, do we just need to check uh eligibility?
[CUSTOMER][NEUTRAL] Well, actually I'm trying, we wanna send him for um MRI and we're trying to see if he has a deductible that he has to meet before we send him over. He wanted to see if he had to pay anything out of pocket before he go.
[AGENT][NEUTRAL] Sure, OK, oh yeah, I can check that for you wanna, um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, it's [PII] and [PII].
[AGENT][NEUTRAL] OK, thank you, and then do you have the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is, um, let's see, 02441374.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Name is [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, and so we were just needing to check to see if he needed to meet a deductible to get an MRI, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, mhm.
[AGENT][NEUTRAL] OK, so, uh, this plan is active. Effective date was [PII]. Uh, so this is a limited indemnity medical plan, uh, so as it's not like traditional major medical, uh, like Blue Cross or Aetna, um, so there's no co-pay, no deductible, nothing like that. It just pays a set dollar amount per procedure or office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if, if, if he would have to pay 100% for whatever he's having done is what is that what you're saying?
[AGENT][NEUTRAL] No, I could just add, excuse me, my goodness, I can see if he's got typically these have a diagnostic, uh, testing benefit, um, it's just set to pay that that set dollar amount for it. So give me just a moment, let me get this pulled up, see if I can get his policy pulled up here, and we will take a look.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I, I need to be explained and uh.
[CUSTOMER][POSITIVE] Their terms exactly what we're saying.
[AGENT][POSITIVE] Say that again, I'm so sorry.
[AGENT][NEUTRAL] What was that, [PII]?
[CUSTOMER][NEUTRAL] OK, I see it a pre-certification, no, no pre-certification requirement. So the hospital will bill the insurance and if there's anything that he don't necessarily have anything to cover, they would pay basically at 100% for the procedure.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so the, the claims would go directly to us, um, we don't say what is patient responsibility that would be up to the provider, um, if you'll give me one moment, I am going to get that benefit pulled up again these plans, they almost always have um MRI coverage, but just give me a moment so I can get you an exact amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause they, he, he, he wanna go a little deeper than you. He got the doctor stopping what she doing ask so.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Of course, yeah, and these plans are a bit different, you know, they, they're a little bit different, so give me just a moment.
[CUSTOMER][NEUTRAL] Yes, cause we got one. It's covered everything but except medical so she can't even use it for her doctor visit, but she can have procedures at the hospital.
[AGENT][NEUTRAL] Covers everything but medical?
[AGENT][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, well, my programs are not wanting to work with me. I'm sorry, give me just a moment.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] I'm sorry, every day is feeling like a Monday more and more.
[AGENT][NEUTRAL] [PII], I apologize. um, is it alright if I give you a call right back? I think I need to restart this program it's just not working with me, uh, to get the policy pulled up. Um, do you mind if I give you a call back?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Oh, [PII], I'm so sorry.
[CUSTOMER][NEUTRAL] Not [PII]. Mhm. Yeah.
[AGENT][NEUTRAL] OK, um, let me repeat the callback number, uh, to you just to make sure that I heard it correctly initially, uh, that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][POSITIVE] OK perfect all right, bear with me just a moment I apologize. I will give you a call right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] Mhm. Alright, bye.