AccountId: 011433970860
ContactId: d13115ec-adce-480a-9abf-d3af0b74cd30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400570 ms
Total Talk Time (AGENT): 150494 ms
Total Talk Time (CUSTOMER): 137501 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/d13115ec-adce-480a-9abf-d3af0b74cd30_20250424T15:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I just have a few questions regarding a patient's medical plan.
[AGENT][NEUTRAL] OK, uh, I can help you with that. Did you say [PII]?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, thank you. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it'll be [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, ID number that I have is 02353767.
[AGENT][NEUTRAL] And what's that patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I put a uh.
[CUSTOMER][NEUTRAL] Uh, sorry.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Um, can you tell if we're in network with this patient's plan or out of network with their medical plan?
[AGENT][NEUTRAL] Um, so it's like a supplemental policy, so there's no network.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Thank you. And then you said it's a supplemental policy?
[AGENT][NEUTRAL] Yes, it's a limited hospital indemnity plan.
[CUSTOMER][POSITIVE] Thank you and are you able to provide me with a group.
[AGENT][NEUTRAL] Do you need the benefits?
[CUSTOMER][POSITIVE] Oh, I'm sorry?
[AGENT][NEUTRAL] Do you need the benefits on it or?
[CUSTOMER][NEUTRAL] Uh, yes, but I do have specific questions regarding the benefits if you don't mind me asking.
[AGENT][NEUTRAL] OK, sure. uh group number that is 70055.
[CUSTOMER][NEUTRAL] Thank you. And the group name for the patients plan?
[AGENT][NEUTRAL] That group name is.
[AGENT][NEUTRAL] TRC Staffing Services Inc.
[CUSTOMER][NEUTRAL] Thank you and are you able to provide me with the effective date for their plan?
[AGENT][NEUTRAL] Uh, yes, that effective date is.
[AGENT][NEUTRAL] Effective [PII] policy is active.
[CUSTOMER][NEUTRAL] Thank you and is it based on a calendar year or a policy year?
[AGENT][NEUTRAL] Um, it's calendar year.
[CUSTOMER][NEUTRAL] Alright and uh are you guys primary?
[AGENT][NEUTRAL] So it's, I, it's like a hospital indemnity plan, a limited plan, so it doesn't really coordinate benefits with anything. It just pays out certain dollar amounts for certain procedures and benefits and services.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. And so,
[CUSTOMER][NEUTRAL] Would a referral be required or no referral would be required then?
[AGENT][NEUTRAL] The referral.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you. And then,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, are you able to provide me with benefits for how a specialist office visit would be covered as well as in-office X-rays, or is it just, would that be not covered under the patient's plan?
[AGENT][NEUTRAL] Uh, let me pull up the policy, and this is not a guarantee of payment. It's a basic outline of the plan.
[AGENT][NEUTRAL] A physician office visit pays $50 maximum per day, and there's a max of 4 visits per calendar year.
[AGENT][NEUTRAL] Um, let me see if they have diagnostic testing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the diagnostic testing benefit, they do have that benefit, but it's specific on what it will cover, um, which is MRI, CAT scan, um, CT scan, and PET scan.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Uh, it doesn't look like it has any benefit for X-ray.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Thank you. And then I did have a specific CBT codes. I was wondering if they are covered under the patient's medical plan.
[AGENT][NEUTRAL] Um, I, I can't search CPT codes, but you can, is it like a surgery or?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, it's like sedation or anesthesia and then pathology and uh for ectomy.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So would that be like a surgery?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For ectomy would be, but like the others would not. Like, it would just be like anesthesia and then pathology would just
[CUSTOMER][NEUTRAL] Let me see how that would be under.
[AGENT][NEUTRAL] Uh, it looks like, so they do have a surgery benefit, um, that would be for surgery. Surgery in a hospital or freestanding facility would be 250 max per day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the maximum payout and it's only once per calendar year.
[AGENT][NEUTRAL] If surgery is performed in a physician's office, it's $125 per day. That's a maximum of 2 days per calendar year.
[AGENT][NEUTRAL] Um, I don't really see anything in here for pathology. Uh.
[AGENT][NEUTRAL] So pathology would not be covered.
[CUSTOMER][POSITIVE] Thank you. What about anesthesia?
[AGENT][NEUTRAL] Um, I don't see anything for anesthesia either.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] And does this patient have like a deductible or out of pocket?
[AGENT][NEUTRAL] No, no deductible or out of pocket. It's just, uh, like I said, the dollar amounts payable for certain things.
[CUSTOMER][NEUTRAL] Mm, OK, thank you. And would a pre-ser be required for any of those?
[AGENT][NEUTRAL] Uh, no, no preacher, no prior.
[CUSTOMER][NEUTRAL] That we're covered.
[CUSTOMER][NEUTRAL] OK, thank you and are you able to provide me with your payer ID?
[AGENT][NEUTRAL] Yes, payer ID is 60801.
[CUSTOMER][POSITIVE] Awesome thank you and that is all the questions that I have for you today. Thank you so much for your help. I really appreciate it. Can I just get a reference number for today's call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Alrighty thank you again for your help I really appreciate it.
[AGENT][POSITIVE] All right, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Hey you.