AccountId: 011433970860
ContactId: 0902452d-bffd-4228-bd30-246cb7aeccdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457820 ms
Total Talk Time (AGENT): 123620 ms
Total Talk Time (CUSTOMER): 235464 ms
Interruptions: 3
Overall Sentiment: AGENT=-1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/0902452d-bffd-4228-bd30-246cb7aeccdf_20250625T14:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. Good morning. My name is [PII] and the last initial is [PII], and I'm calling from provider office and I need to verify eligibility and benefits for the member's policies. So can you verify that information with me?
[AGENT][POSITIVE] Yes, I can help with eligibility and benefits. [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, and the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, the member's number uh the policy number was.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 02569352
[AGENT][NEUTRAL] OK, I'm sorry, could you repeat that again?
[CUSTOMER][NEUTRAL] Yes, the member ID number is 02569352.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's name was [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] It looks like the policy is active and effective [PII].
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And you needed benefits, is it outpatient services or?
[CUSTOMER][NEUTRAL] No, only general benefits that was needed for specialist office visit.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] This is not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Uh, let me get that pulled up. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Uh, for physician's office visit, this plan pays $75 per day, max of 6 days per calendar year.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] Mhm. OK. And how many visits are remaining?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, he's got 5 visits remaining.
[CUSTOMER][NEUTRAL] Mhm. OK. It means, uh, patient has 6 visits per year and uh available 5 visits, am I right? and the specialist of copay was $75.
[AGENT][NEUTRAL] It's not a, it's not a co-pay, that's the max we'll we will pay.
[CUSTOMER][NEUTRAL] Oh yeah, it's uh, yes, yes, for each uh visit patient was paid. OK, no worry. And for the member's policy, any PCP referral is required or not required?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, what was the question?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yes, the question was any PCP referral is required or not required for the member's policy?
[AGENT][NEUTRAL] Not required.
[CUSTOMER][NEUTRAL] Uh-huh. OK, no worries. And for the member's policy, I have 3 CPT codes for CT scan and PET scan. So can you tell me that, uh, the facil uh the services is covered or not covered and what is the benefits for that, uh, services?
[AGENT][NEUTRAL] Um, what type of services were it diagnosis or diagnostic testing or?
[CUSTOMER][NEUTRAL] Mm, that thing I don't know but uh.
[AGENT][NEUTRAL] What's the code?
[CUSTOMER][NEUTRAL] I have 3 CPT codes. It's an emerging services like it's emerging services.
[CUSTOMER][NEUTRAL] I need to verify benefits for that services some services I have.
[AGENT][NEUTRAL] OK, you said imaging services?
[CUSTOMER][NEUTRAL] Yes, like radiology, biopsy, CT scan, PET scan like that.
[AGENT][NEUTRAL] OK, uh, looks like, so for this policy, they don't have any benefits for that. It only pays for hospital admission, confinement, ICU and rehab, and office visits. So it doesn't have any coverage for
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Imaging
[CUSTOMER][NEUTRAL] Mhm mhm. OK. OK. So it means the radiologist service is not covered, am I right?
[AGENT][NEUTRAL] The Office visits covered, just not imaging.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I just uh general benefits for that, uh, because if I don't have any CPT codes and for that, uh, for CT scan and PET scan for that, I have CPT codes. So once can you check the service is covered or not covered?
[AGENT][NEUTRAL] OK, what are they?
[AGENT][NEUTRAL] What are the codes?
[CUSTOMER][NEUTRAL] Yes, the first one CPT code is 71271. 2nd one code is 78815, and the last code is 78816.
[AGENT][NEUTRAL] OK, yes, those are not covered under this policy. The office visit will be covered.
[CUSTOMER][NEUTRAL] Uh-huh. OK. and radiology is covered or not covered? It's also not covered, am I right?
[AGENT][NEUTRAL] Radiology services are not covered. The office visit is covered.
[CUSTOMER][NEUTRAL] And OK, and biopsy?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mammogram.
[AGENT][NEGATIVE] And not covered.
[CUSTOMER][NEUTRAL] Uh, psychology.
[AGENT][NEUTRAL] Psychology.
[CUSTOMER][NEUTRAL] Mhm, yes, the psychologist service is covered or not covered?
[AGENT][NEUTRAL] It would be considered under a physician's office visit.
[CUSTOMER][NEUTRAL] Mhm. OK. And radiation oncology and chemotherapy?
[AGENT][NEGATIVE] Um, those are not covered.
[CUSTOMER][NEUTRAL] Mhm. OK. And for lab services?
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm. OK. And the last it's uh palliative care.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] What
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm. OK. And for the member's policy, I have 3 therapies like uh physical therapy, occupational therapy, and speech therapy. So the therapies are covered and uh if they covered. So what is the benefits for that uh member's policy?
[AGENT][NEUTRAL] Uh, those are 15
[CUSTOMER][NEUTRAL] And for that services?
[AGENT][NEUTRAL] $15 payable per day, max of 1 day per year.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] $15.
[CUSTOMER][NEUTRAL] One moment, one moment.
[CUSTOMER][NEUTRAL] Mhm. It's $50 am I right? for each uh each uh each therapy?
[AGENT][NEUTRAL] It's $15 per day, a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] Mhm. OK. And is there any visit limit for that therapies?
[AGENT][NEUTRAL] One day per calendar year.
[CUSTOMER][POSITIVE] Mhm OK, no worries.
[CUSTOMER][NEUTRAL] And for the member's policy, uh, for the wall information, give me the reference number, your name and last initial.
[AGENT][NEUTRAL] [PII] and last first initial to last name is [PII] and references my name in today's date.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Mhm. OK, no worry. Have a nice day and have a good day. Bye-bye, [PII].
[AGENT][POSITIVE] Thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK.