AccountId: 011433970860
ContactId: 11522358-39e6-4816-9a96-3738dab9dfae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371089 ms
Total Talk Time (AGENT): 158413 ms
Total Talk Time (CUSTOMER): 82332 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/11522358-39e6-4816-9a96-3738dab9dfae_20250106T15:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, I was wanting to get eligibility and benefits on a patient.
[AGENT][POSITIVE] Alright, I'm happy to check eligibility and benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] 02474924
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Alright, thank you so much for that. Let me pull this up here.
[AGENT][NEUTRAL] And then if you don't mind, if I could grab your first name and a callback number.
[CUSTOMER][NEUTRAL] Sure, my first name's [PII] callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and the patient name and date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII], date of birth is um [PII].
[AGENT][NEUTRAL] Thank you for that, [PII]. So patient plan is active. The effective date on this is [PII], it looks like.
[CUSTOMER][NEUTRAL] I wanted to check on a CPT code to see if it is covered.
[AGENT][NEUTRAL] OK, we don't have any way to check a code. Is it for like an outpatient? What, what are they being seen for?
[CUSTOMER][NEUTRAL] Yes, it's cardiac rehab, it's outpatient cardiac rehab.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Give me 1 2nd here, [PII].
[CUSTOMER][NEUTRAL] Sure, of course.
[AGENT][NEUTRAL] So the member has, so the plan that the member has is a limited benefit, a hospital indemnity plan, so it just pays a set amount depending upon what they're being seen for.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm just pulling this up to see what the outpatient benefit on it is.
[AGENT][NEUTRAL] OK, so it looks like this plan, so for any sort of like office visit or fee, um, it would allow the patient 5 visits in a year and then it's gonna pay $75 towards any sort of visit, any sort of diagnostic testing, it looks like the benefit amount is $250 towards testing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But you're not able to see if there's um coverage for cardiac rehab correct? Do you?
[AGENT][NEUTRAL] No, we don't, we don't have a way to check the CPT code. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] So I just don't want to.
[CUSTOMER][NEUTRAL] Uh, I mean I'm just concerned about as far as if it's covered or not because um.
[CUSTOMER][NEGATIVE] From the last um person that actually verified the insurance they put that it wasn't covered it wasn't a coverage that was, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's why I'm just concerned about if the patient's gonna be, you know, responsible for all of the added cost here for cardiac rehab.
[CUSTOMER][NEUTRAL] That's the
[AGENT][NEUTRAL] rehab let me see.
[AGENT][NEUTRAL] So under cardiovascular system, let me see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, iPad.
[AGENT][NEUTRAL] Transplant looking for rehab. Let me see if I can find anything listed on here for like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so when I look at this, [PII], I mean, it looks like there was definitely a surgical benefit, but that's obviously not applicable to this particular situation.
[AGENT][NEUTRAL] So I don't see anything, you know, listed here as far as like rehabilitation. It looks like a lot of this coverage is mostly treatment in hospital, um, and then if the patient, like I said, had like the office visit, the fee, or, you know, something like that. I don't, yeah, I'm not seeing any benefit payment towards specifically like rehab facilitation or like treatment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, aside from that office visit fee, that's all that I see would be covered.
[CUSTOMER][NEUTRAL] OK, all right, and what was, um, and what is your name?
[AGENT][NEUTRAL] My name is [PII], that's spelled [PII] Last initial to my name is [PII], and that's the call reference.
[CUSTOMER][NEUTRAL] And that's the call reference number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then today's date.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK, thank you so much for all your help I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye bye.