AccountId: 011433970860
ContactId: 00545bb0-e24b-45fc-b053-f6ad8c152bc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225669 ms
Total Talk Time (AGENT): 119388 ms
Total Talk Time (CUSTOMER): 69478 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/00545bb0-e24b-45fc-b053-f6ad8c152bc1_20250422T13:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling uh for benefits for patients that's coming in for a specialist office visit as well as an ultrasound being done in the office.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the benefits and the eligibility. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], uh, phone number [PII].
[AGENT][NEUTRAL] Hold on one moment. I'm typing and it's not typing. Hold on one second, I'm sorry.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK, here we go. Sorry about that, [PII]. Can you repeat your phone number for me?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And you said you needed benefits for ultrasound and what was the second part?
[CUSTOMER][NEUTRAL] Yeah, uh, specialist office visit if that's covered and ultrasound in the being done in the office.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] 02216511 ML 8.
[AGENT][NEUTRAL] 02216511?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII], and let me see the benefits. Hold on one moment.
[AGENT][NEUTRAL] OK, so the policy itself doesn't have any coverage for the office setting. However, under outpatient, which the benefit is $200 up to $200 per calendar day, um, she does have the office treatment writer, so any treatment that's done in the office as long as it's not cosmetic, um, could be covered up to that $200 per day.
[AGENT][NEUTRAL] Um, but if you all charge for like a, you know, how you bill for facility or treatment or sometimes they bill both, if you do bill facilities separately, that would most likely be denied because she doesn't have any in-office setting, just the treatment rather.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, OK, um, let's see how that would work then, yeah, because it'd be just the ultrasound done in the office we would charge like.
[CUSTOMER][NEUTRAL] I guess the
[CUSTOMER][NEUTRAL] Physician services, I don't know how that would work.
[AGENT][NEUTRAL] So like if you use like a special, OK, so like let me give this is just an example. So like if you guys bill for 99213 or 99214, that's place of service, so that would be most likely denied, but if you're billing for the ultrasound or, you know.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Some treatment done in the office that rider should take care of. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] The procedure itself.
[CUSTOMER][NEUTRAL] Got it. OK, alright, makes sense. Alright, what was your name again? I'm sorry.
[AGENT][NEUTRAL] Hi, my name is [PII]. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK cool what's the reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK perfect all right thank you for your help.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.