AccountId: 011433970860
ContactId: 13d7d9b9-90ee-43a0-8c99-8ba478581581
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278320 ms
Total Talk Time (AGENT): 86511 ms
Total Talk Time (CUSTOMER): 147131 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/13d7d9b9-90ee-43a0-8c99-8ba478581581_20250417T16:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. Um, you say your name is [PII]?
[AGENT][NEUTRAL] Could you repeat that, please?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from United Sleep Diagnostics. I don't know if you can please help me to verify the patient's um, coverage for, um.
[CUSTOMER][NEUTRAL] If you cover for the sleep test that the patient has with the primary, you know, if that covers.
[CUSTOMER][NEUTRAL] For the co-payment?
[AGENT][NEUTRAL] Is this done within an office setting?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I give you the patient information?
[AGENT][NEUTRAL] May I have a callback number please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02405479 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um [PII].
[AGENT][NEUTRAL] OK. So you're calling to see if the sleep study performed within an office setting is covered under the under the member's policy?
[CUSTOMER][NEUTRAL] I mean, the prime on the primary, basically it's uh he has coverage for the primary insurance.
[CUSTOMER][NEUTRAL] He's gonna have a sleep test, and with the primary insurance that he has, he will have to pay.
[CUSTOMER][NEUTRAL] So, since he has this secondary, I would like to know if that.
[CUSTOMER][NEUTRAL] You know, he has coverage for that for the copay, deductibles and all of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So my question is, is this going to be done within an office setting or an outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, well, it's outpatient facility, but we build with number 11 as office setting. There is not office visit involved.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And for this member verification of coverage does not guarantee the payment of the claim. You're calling in for office setting benefits for this member it shows that the member does not have the office procedure benefit writer.
[CUSTOMER][NEUTRAL] OK, so what about the facility?
[AGENT][NEGATIVE] The member does not have the office procedure if it's done within an office setting. They do not have that benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, all right, so he, he's not covered.
[AGENT][NEUTRAL] For that procedure that you're, you're questioning, that member does not have that.
[CUSTOMER][NEUTRAL] Basically.
[AGENT][NEUTRAL] Benefit
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] All right, but I mean he's gonna be covered by his primary insurance. OK, I would like to know if the patient has, I don't know how the, like the secondary um insurances work.
[CUSTOMER][NEGATIVE] You know, I mean, you usually cover for the primary because we're not gonna be with you.
[AGENT][NEUTRAL] If the member does not have that benefit, we can't cover it, so the member does not have the benefit coverage.
[CUSTOMER][NEUTRAL] I mean, on the first place.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So not benefit coverage, OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yes. Can I have your name again and a reference number, please?
[AGENT][NEUTRAL] The call reference would be my first name [PII], which is spelled [PII] last [PII] and today's date.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So [PII], that's your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right? So [PII], OK. [PII], but ends with [PII].
[AGENT][NEUTRAL] No, I stated IA.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. So, T Tango, [PII], K Kilo, [PII]. Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, got it. Thank you so much, OK, for your help and assistance.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Have a good one.