AccountId: 011433970860
ContactId: 1e5d3be4-d2c5-4863-b420-81ccbae16407
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268959 ms
Total Talk Time (AGENT): 125675 ms
Total Talk Time (CUSTOMER): 144098 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/1e5d3be4-d2c5-4863-b420-81ccbae16407_20250618T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with Harris Dermatology. I have a potential new patient, but I'm just calling to see if uh we're in network or how this insurance actually works or, you know, all that good stuff.
[AGENT][NEUTRAL] OK. Yeah, absolutely. What's the policy number?
[CUSTOMER][NEUTRAL] Here let me pull up the stuff and he sent me like 4 different emails with the different pictures alright, uh, here we go policy er number 01682087.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] The name let me pull up that other email.
[CUSTOMER][NEUTRAL] Um, [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, patient is active. It looks like the effective date on here is gonna be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a limited benefit plan, so it pays a set amount, yeah, just depending upon what they're being seen for so let's see here.
[CUSTOMER][NEUTRAL] Mhm that's what he did say.
[CUSTOMER][NEUTRAL] It would just be like a new patient office visit I think initially um I think he's potentially coming for a skin cancer surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'll let you know that the physician office visit, uh, patient is allowed 6 visits in a calendar year.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the plan pays $75 towards the visit.
[CUSTOMER][NEUTRAL] OK, alright, and then a $75 and then does this require authorization for procedures like for um any kind of like biopsies or cancer surgery?
[AGENT][NEUTRAL] It does not require pre-authorization. I can give you the surgery benefits if you would like them.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you need the CPT codes because I don't even have the pathology. I don't even know what it would be, what site.
[AGENT][NEUTRAL] No, I mean, it's pretty much just surgery in a hospital, outpatient, yeah, facility. It's a, yeah.
[CUSTOMER][NEUTRAL] Yes, surgery.
[CUSTOMER][NEUTRAL] It'll be outpatient surgery, yeah.
[AGENT][NEUTRAL] So it pays $1000.
[CUSTOMER][NEUTRAL] Performed in an office, OK.
[AGENT][NEUTRAL] Uh, per day, and it's a maximum of 2 days per year.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] so 2 separate surgery days a year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is that calendar year?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] So February to January whatever OK and let's see, is there, uh no is there a co-pay or it's just the $75 and then he's responsible for the rest?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah it just pays at 75 and then what the responsibility is, yeah, would be then whatever you guys decide.
[CUSTOMER][NEUTRAL] OK and uh how many visits does he have remaining?
[AGENT][NEUTRAL] Looks like he has 5 remaining used 1 so far this year.
[CUSTOMER][NEUTRAL] 5 remaining alright, perfect, and I think that's it that'll be it. um, where do we let me just double check the mailing address or the claims address for this.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, is it [PII]?
[AGENT][NEUTRAL] No, ma'am. Let me give you the corrected one.
[CUSTOMER][NEUTRAL] OK, please.
[AGENT][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is gonna be [PII].
[CUSTOMER][NEUTRAL] OK, is there.
[AGENT][NEUTRAL] And we also have a fax or payer ID if you want it.
[CUSTOMER][NEUTRAL] Uh, yes, yeah, I'll take both.
[AGENT][NEUTRAL] OK, uh, fax number is going to be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 99423.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801 right and that would just be American Public Life?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am, correct.
[CUSTOMER][POSITIVE] All right wonderful is there a reference number for this call?
[AGENT][NEUTRAL] Call reference would be my name with today's date. My name again is [PII] and that's [PII] is my last initial with today's date.
[CUSTOMER][POSITIVE] Wonderful thank you so much for your help. I hope you have a great day.
[AGENT][POSITIVE] You're welcome you too bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.