AccountId: 011433970860
ContactId: 092ec04e-4fc7-44b9-a53e-1b6d88ff5016
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290769 ms
Total Talk Time (AGENT): 93332 ms
Total Talk Time (CUSTOMER): 100959 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/092ec04e-4fc7-44b9-a53e-1b6d88ff5016_20250428T16:35_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] I'm calling to check a patient's benefits. They provided this card to us in the office.
[AGENT][NEUTRAL] OK. May I ask who's calling?
[CUSTOMER][NEUTRAL] My name's [PII]. I'm calling from RSV dermatology.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] Yes my direct line is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02475958.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you were just needing benefits?
[CUSTOMER][NEUTRAL] Uh, yes, he indicated that this plan will cover all of his patient responsibility from his primary, um, but it doesn't have any, you know, uh, online eligibility, so we just needed to understand what it's gonna cover.
[AGENT][NEUTRAL] OK, I can help you with that. Is this for outpatient, inpatient, or doctor's office?
[CUSTOMER][NEUTRAL] It's place of service 11, so it will be office, doctor's office.
[AGENT][NEUTRAL] OK. Is it for the office visit or you having something done in the doctor's office?
[CUSTOMER][NEUTRAL] Um, well, right now he is in the office, so he's still being assessed for sure. He is going to be having, um, an office visit, so an E&M code, um, but I believe it might be from what I'm hearing, it might be a, a biopsy as well. Uh, maybe a lesion destruction. I'm not 100% sure. The doctor's still in with him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the effective date is [PII]. Any benefits given over the phone is not a guarantee of payment, and this policy does coordinate with his primary insurance, but we only pick up whatever his primary applies to his deductible, co-pay, or co-insurance only. Let me see if the office visits covered. Hold on one moment.
[CUSTOMER][POSITIVE] Alright perfect thank you.
[AGENT][NEUTRAL] OK, I'm not showing that it's gonna cover the actual office visit that will cover services in the doctor's office, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see how much we'll pay for that.
[AGENT][NEUTRAL] We'll pay up to 5000.
[CUSTOMER][NEUTRAL] OK, so it's got a $5000 out of uh max, so $5000 pay max.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alrighty. And so it's likely that for the office visit itself, he would still have a co-pay from the primary and that secondary would essentially just cover any deductible co-pay, co-insurance from the procedures.
[AGENT][NEUTRAL] Right, it just wouldn't cover the actual office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect that's great do you have a reference number at all?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name and today's date.
[CUSTOMER][NEUTRAL] OK, and what was your name one more time?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] All right, well thank you very much, Ms. [PII]. I appreciate your assistance.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Good thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.