AccountId: 011433970860
ContactId: ff4f3a9d-c193-40a1-bc71-884ec560085a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339959 ms
Total Talk Time (AGENT): 110808 ms
Total Talk Time (CUSTOMER): 130374 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/ff4f3a9d-c193-40a1-bc71-884ec560085a_20250411T16:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I am calling from an uh ordering doctor's office.
[CUSTOMER][NEUTRAL] I am just calling um.
[CUSTOMER][NEUTRAL] Because um my doctor's ordering an MRI for the patient, and I'm calling to see, just to see, I'm not, I'm not sure it didn't look too promising on the card, um if the patient is covered for radiology.
[AGENT][NEUTRAL] I'll be happy to verify benefits. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure, I have 579-710-286.
[AGENT][NEUTRAL] That is not our policy number.
[AGENT][NEUTRAL] Would that be the social security number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that I'm not sure of. I don't have access to social security numbers, so I do not think that that is. OK, OK.
[AGENT][NEUTRAL] I can do a name search.
[AGENT][NEUTRAL] May I have the first and last name and the date of birth?
[CUSTOMER][NEUTRAL] Sure. First name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and [PII], may I have a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Just waiting on the system one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And thank you for verifying that information. I have the policy pulled up and please be advised verification of coverage does not guarantee the payment of a claim. So her policy number will be 02519477.
[AGENT][NEUTRAL] And the place of service, is this inpatient, outpatient?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so under this plan, we will pick up the co-pays, the co-insurance, and our deductibles up to the benefit amount, and for outpatient, it allows $2,025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See if she's used and no benefits have been applied for 2025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, so when, so she, does she require authorization for outpatient imaging?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No, OK. So,
[CUSTOMER][NEUTRAL] We just submit the claim for whatever you guys will pay, which is, let's just say we submit it for she's having an MRI. Let's just say that we submitted a bill for $1000 you guys would pay for the $1000. She would just be responsible for anything after [PII].
[AGENT][NEUTRAL] Correct. We follow the primary, so if that's the co-pay coinsurance and our deductibles, that's what this plan will pick up as long as those benefits are available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So her primary is only Medicare A.
[AGENT][NEUTRAL] OK, to have this plan, she has to have a primary, whether it be Aetna, Blue Cross. She has to have any, Medicare will always be there with this plan.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] With there, OK. So, huh.
[AGENT][NEUTRAL] So she has to have
[CUSTOMER][NEUTRAL] So she does have to have a different.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And normally we see it once the claims are submitted we'll see who the primaries are.
[CUSTOMER][NEUTRAL] OK, and she doesn't have any claims for this year, so that's why you can't say it, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Got you, OK.
[CUSTOMER][NEUTRAL] OK. Yeah, cause I'm only seeing an A in her in her um
[CUSTOMER][NEUTRAL] In her in
[CUSTOMER][NEUTRAL] Like a folder, we call it media. I'm only seeing a Medicare hospital benefits only. So, OK, I'll just reach out to the patient and see what type of insurance they now have.
[AGENT][POSITIVE] OK. And if you need further assistance, we'll be happy to assist you. Just give us a call back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah. Thanks you as well. Bye-bye.