AccountId: 011433970860
ContactId: d61c84ee-c7a7-40fe-8aed-82df83b71aa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259480 ms
Total Talk Time (AGENT): 81037 ms
Total Talk Time (CUSTOMER): 127144 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/d61c84ee-c7a7-40fe-8aed-82df83b71aa3_20250609T14:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], I'm [PII] calling from Boca Regional Hospitals Women's Institute.
[CUSTOMER][NEUTRAL] I am calling to verify benefits on a patient that is coming to have a breast MRI. I wanna see if there's I think will be covered for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And policy number for that patient?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] Uh, what is it? Is it the payer ID?
[AGENT][NEUTRAL] Uh, payer ID? Uh, no, it's the, it should be a policy certificate number.
[CUSTOMER][NEUTRAL] OK, let's see coverage effective date plan.
[CUSTOMER][NEUTRAL] In house benefits.
[AGENT][NEUTRAL] Yeah, that would be fine, that number.
[CUSTOMER][NEUTRAL] Hospital benefit certification outpatient benefit. OK, this is outpatient, so I'll give you this 1 0245095.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] Her name is [PII] and her birth date is [PII].
[CUSTOMER][NEUTRAL] Hey this uh.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, it looks like this policy is effective [PII]. It's currently active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And outpatient benefits, it's not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Um, for her benefits, she has a benefit of $750 per calendar day coverage. So after primary processes the claim, whatever is left over, we pay 100% up to $750.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she has to be 750.
[AGENT][NEUTRAL] No, we pay 750.
[CUSTOMER][NEUTRAL] Because she's having an MRI of the breast and a copay is 1500.
[CUSTOMER][NEUTRAL] So we're just trying to calculate and see how much she would have to pay because she told us to bill APL after her primary it's it's.
[AGENT][NEUTRAL] Oh, OK, yeah.
[AGENT][NEUTRAL] Yeah, so 1500 is left over, we would pay 100% up to 750.
[CUSTOMER][NEUTRAL] So you'll pay up to 750.
[CUSTOMER][NEUTRAL] So she'll have to pay the other half.
[CUSTOMER][NEUTRAL] Say they pay 700.
[CUSTOMER][NEUTRAL] 100 you say up to 750 correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, 700, so she have to pay.
[CUSTOMER][NEGATIVE] That don't work I don't think so she'll have to pay the difference.
[AGENT][NEUTRAL] Are you, I, we can't instruct on patient responsibility. I can just tell you what the plan pays, so.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Oh, but there's no guarantee in payment.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's just a simple disclaimer or any kind of benefit quote.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so there's no guarantee.
[AGENT][NEUTRAL] Right, because she could term or anything like that, but she got her active as long as she's active on the plan when the claim is submitted for this for this date of service, then we would pay the 750.
[CUSTOMER][NEUTRAL] OK, you have a
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Then you'll pay the 750.
[CUSTOMER][NEUTRAL] OK, do you have a reference number to the call?
[AGENT][NEUTRAL] Uh, it's my name, [PII]. First initial to last name, [PII], today's date. And anything else I can help with today?
[CUSTOMER][POSITIVE] No, that'll be all thank you so much.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] OK, you too.