AccountId: 011433970860
ContactId: ca0d41a0-f96d-423f-b118-42b49d3c5d74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316640 ms
Total Talk Time (AGENT): 125864 ms
Total Talk Time (CUSTOMER): 103972 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ca0d41a0-f96d-423f-b118-42b49d3c5d74_20250425T15:01_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling um to check on a patient's benefits, uh.
[AGENT][POSITIVE] OK. Sure. I can assist you with benefits, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Um, perfect.
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] OK. Thank you. And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Murphy and Wayner Orthopedics. We're a division of Southeastern Orthopedic specialists.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] That is 02596682.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And with this policy we have um benefits for specialists. Um, it's going to be $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Who what is it?
[CUSTOMER][NEUTRAL] OK, what about they're trying to schedule him for where is it?
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Hold on, I'm sorry.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, so they're trying to schedule him for a CT of his left shoulder.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that a covered benefit?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let me check and see if that one is covered. Um, let me go to this other benefit. One moment, so.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I'm waiting on the documents to pull up, OK?
[CUSTOMER][POSITIVE] Yeah, you're good.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he does have the medical imaging test benefit which is $100 per day, one day per cover person per calendar year. Medical imaging test includes
[AGENT][NEUTRAL] MRI, CT scan, PET scan, and thorough intake.
[CUSTOMER][NEUTRAL] OK, is, can you tell me if prior authorization is needed for the CT?
[AGENT][NEUTRAL] Uh, it is not needed because this is just a limited policy.
[CUSTOMER][NEUTRAL] OK mm.
[CUSTOMER][NEUTRAL] PA needed.
[CUSTOMER][NEUTRAL] RCT.
[CUSTOMER][NEUTRAL] OK, and so like it's a $100 copay for the CT is that.
[AGENT][NEUTRAL] It's a $100 flat payment.
[CUSTOMER][NEUTRAL] Flat payment OK.
[AGENT][NEUTRAL] Mhm. Yes, and the $50 for the visit is a flat payment, so this is an indemnity plan. It is not a major medical, so it just pays indemnity amounts.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is it I'm sorry, I just wanna make sure the $100 that's what you're gonna pay the facility for doing the CT?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] That's for the CT itself.
[CUSTOMER][NEUTRAL] Or that's like what the patient pays.
[AGENT][NEUTRAL] That's for the testing.
[CUSTOMER][NEUTRAL] That's what the paycheck.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what you pay, OK.
[AGENT][NEUTRAL] That's what we pay. Mhm.
[CUSTOMER][NEUTRAL] OK, so he needs to find in a network provider.
[CUSTOMER][NEUTRAL] OK, alright, um, maybe you need for the CT, OK, and so is there a call reference for today?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will. Um, do you need the spelling or any other information?
[CUSTOMER][POSITIVE] Yeah, if you could spell your first name for me that'd be great.
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Awesome thank you so much for your help today I do appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. You have a good weekend, Miss [PII].
[CUSTOMER][POSITIVE] You you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.