AccountId: 011433970860
ContactId: 04a798e8-b465-451f-9830-1321ddcbaa2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285850 ms
Total Talk Time (AGENT): 90788 ms
Total Talk Time (CUSTOMER): 85014 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/04a798e8-b465-451f-9830-1321ddcbaa2f_20250528T17:47_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm calling from UPMC Children's Hospital of Pittsburgh uh Cardiology. I'm checking eligibility for a patient and also to see whether they require authorization for an echocardiogram.
[AGENT][POSITIVE] OK, I'll be happy to assist with benefits and eligibility today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] 06138805
[AGENT][NEUTRAL] Um, that is not a valid policy number. Do you have a social?
[CUSTOMER][NEUTRAL] Uh, no, the child.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] First name is [PII], last name [PII], [PII] His date of birth is [PII].
[CUSTOMER][NEUTRAL] And they have two insurances listed. One has the letter [PII] [PII] at the beginning, but the same numbers I just gave you.
[AGENT][POSITIVE] Thank you for that information um.
[AGENT][NEUTRAL] Please be advised the verification of coverage is not a guarantee of payment. Now I do show that um let me give you the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 02602924.
[AGENT][NEUTRAL] And I do show the policy is active.
[CUSTOMER][NEUTRAL] OK, that's very different.
[AGENT][NEUTRAL] Effective date is [PII]. Now, where will the treatment take place?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] UPMC Children's Hospital of Pittsburgh, um, in the area office.
[AGENT][NEUTRAL] OK, so this is gonna, so y'all are gonna bill as a doctor's office?
[CUSTOMER][NEUTRAL] Um, well, as an outpatient.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for outpatient.
[AGENT][NEUTRAL] So I'm showing that coverage for outpatient is only limited to the emergency room, and urgent care facility, physician's office, or physical speech or occupational therapy facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, maybe it does go through as a doctor's office. I'm not on the billing side, so.
[AGENT][NEUTRAL] OK, so if it's
[CUSTOMER][NEUTRAL] I don't know that um.
[AGENT][NEUTRAL] A doctor's office if it's billed as a physician's office visit, then that would be the.
[AGENT][NEUTRAL] $50 benefit per day with 3 visits per year per covered person.
[CUSTOMER][NEUTRAL] All right, would you be able to look up a procedure code to see if it needs an authorization?
[AGENT][NEUTRAL] It wouldn't be the code, it would be the, it's place of ser the benefits are place of service driven, not procedure driven.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Oh I see OK.
[CUSTOMER][NEUTRAL] All right, um, and could you tell me the group number please?
[AGENT][NEUTRAL] Group number is one moment.
[AGENT][NEUTRAL] 25565.
[CUSTOMER][POSITIVE] 25565. OK, very good, thank you.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No that was it thanks a lot.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] You too thanks bye bye.