AccountId: 011433970860
ContactId: 1bf9241d-d399-4b29-a858-ddacbb9354d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576280 ms
Total Talk Time (AGENT): 135848 ms
Total Talk Time (CUSTOMER): 114242 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/1bf9241d-d399-4b29-a858-ddacbb9354d5_20250529T17:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], I'm calling to, uh, I'm calling from a provider's office and I'm calling in regards to a mutual patient. I wanted to, uh, see in regards to pre-certs for a, um, sleep study.
[AGENT][NEUTRAL] For a sleep study? OK, um, I can help you with eligibility and benefits. Can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure. My name is [PII], initial to my last name is [PII].
[CUSTOMER][NEUTRAL] My number is [PII]. And can you spell me your first name?
[AGENT][NEUTRAL] Um [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is going to be.
[CUSTOMER][NEUTRAL] 02584929.
[AGENT][NEUTRAL] Let me look that up for you real quick.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I am showing that this is a hospital indemnity policy with an effective date of [PII]. It is active. Let me see what else you have going. You said it's for a sleep study, correct?
[CUSTOMER][NEUTRAL] Yes, I can provide you with the CPT code to make sure that we that it's covered because.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I'm going to go through their policy certificate, so I don't think that they have.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Um, let me, let me check and see real quick.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] It could possibly cover a sleep study. Um, I do want to say that this is just a verification of benefits and not a guarantee of payment and state.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. It's under their diagnostic testing benefits. So let me check and see what that is.
[AGENT][NEUTRAL] Right, it looks like for their diagnostic, oh, go ahead.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah, cause we do it here. We can provide the patient with a watch pack and then send them home or I, I'm just trying to clarify, or does it need to go, um, do we need to send it out to another facility? That's where I wanna make sure if we do give it to patient, will it be covered versus sending them out? Does it get covered? Mhm.
[AGENT][NEUTRAL] It looks like for this one it needs to be um an outpatient facility.
[CUSTOMER][NEUTRAL] OK, do you have the outpatient facility where I can send it to? Mhm.
[AGENT][NEUTRAL] I don't, we don't have we don't follow through with the network, a particular network, so as long as it's covered under their policy, we will um honor the amount of that they have on their benefit schedule.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Yeah, because we have numerous places, but I mean again, I don't.
[AGENT][NEUTRAL] Yeah, I don't know if giving it, it didn't say that they could take it home. Um, it looks like it needs to go under their outpatient.
[CUSTOMER][NEUTRAL] Right, and then what happens is they get it shipped to their house and they do the sleep study or they can go.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Let me check on that real quick.
[CUSTOMER][POSITIVE] Thank you, appreciate it.
[AGENT][NEUTRAL] Oh, here we go.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] All right, let me look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] I apologize, give me just one moment.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] It doesn't state specifically it does look like they might be able to.
[AGENT][NEUTRAL] Do it at home. I'm just not seeing.
[AGENT][NEUTRAL] Let me see. Give me just one more moment.
[CUSTOMER][NEGATIVE] Yeah, cause I don't wanna, you know.
[CUSTOMER][NEGATIVE] For us to give him a sleep study to take home and then his insurance doesn't provide it, I mean, um, pay for it.
[AGENT][NEUTRAL] It just says as long as it's under the recommendation of the physician.
[AGENT][NEUTRAL] So it looks like it could be done at home as under the diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK, is this one.
[CUSTOMER][NEUTRAL] OK, OK, I'll go ahead and let them know. mhm.
[CUSTOMER][POSITIVE] Mhm. All right, thank you. Mhm mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Mhm.
[AGENT][POSITIVE] Alright, thank you so much for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye bye