AccountId: 011433970860
ContactId: f04bed05-8c99-4390-b94c-3fefed5e5320
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311820 ms
Total Talk Time (AGENT): 127805 ms
Total Talk Time (CUSTOMER): 127552 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/f04bed05-8c99-4390-b94c-3fefed5e5320_20250618T20:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I am an admissions, um, oh my gosh, coordinator here at Ohio Health Rehabilitation Hospital. Um, I was just calling um to verify if a potential patient has coverage through you guys. Um, it says it on the hospital face sheet, but there's been some back and forth and um we just wanna solidify that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, absolutely. What is the, do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, it says member ID, so I assume that's what that is.
[AGENT][NEUTRAL] Does it start with a D like in Delta or does it start with a number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A number.
[AGENT][NEUTRAL] OK, yeah, go ahead with that.
[CUSTOMER][NEUTRAL] OK, so it's 724-419.
[AGENT][NEUTRAL] And what is the uh patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you. So patient is active. The effective date on the plan is [PII].
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] So is this a like uh a regular primary insurance company or is this like um.
[CUSTOMER][NEUTRAL] I don't know what I'm trying to say like he comes and then submits his bills later.
[AGENT][NEUTRAL] So it's a limited benefit plan where it pays a set amount just depending upon what the patient's being seen or treated for. Um, I can give you the benefits. Are they being seen for like an office visit or?
[CUSTOMER][NEUTRAL] So, um, he would be coming here for physical rehab inpatient.
[AGENT][NEUTRAL] Rehab inpatient. OK, let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] should not include any.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So it has a hospital benefit. However, under the hospital definitions, it does state the term hospital is not to include an institution used for a place of rehabilitation, nursing or convalescent home, long-term nursing unit.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Based off of what I'm seeing on their policy certificate, they don't have any sort of benefit with this plan to help with that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, all right, so no hospital.
[CUSTOMER][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I'm trying to think if there's anything else I need to ask you.
[CUSTOMER][NEUTRAL] Uh, so I was gonna say the patient is going to um.
[CUSTOMER][NEUTRAL] Oh, what am I trying to say they're gonna privately pay, but I'm trying to to figure out if our company needs like a denial from APL first before they would um let them private pay just because um it looks kinda you know strange for a patient to private pay so if if we do indeed have to get some kind of denial from you guys, um, do you know where we would um send a.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, you can fax we have also a mailing address I can give you both of those if you'd like.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then our mailing address is gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And then that policy number I gave you is correct, correct.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect. All right, um, I think that's all I need. Thank you very much for your help. um I are you able to provide me with the reference number?
[AGENT][NEUTRAL] Absolutely. Uh call reference is gonna be my name with today's date. My name again is [PII] and that's [PII] My last initial is [PII] and then today's date.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.