AccountId: 011433970860
ContactId: 1fd0294f-5d3b-428e-95b8-d3ae9e0b7e29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 710679 ms
Total Talk Time (AGENT): 176847 ms
Total Talk Time (CUSTOMER): 145868 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/1fd0294f-5d3b-428e-95b8-d3ae9e0b7e29_20250327T17:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. Um, I'm not sure if I'm speaking with the right department. Um, I have a patient, um, that he has the APL with you guys, so we want to know if, um, he's covered on our office, you know, like that he doesn't have to pay, um, a co-pay or anything, but I wanted to double check.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, I can get that policy pulled up. We'll see what kind of uh plan that is, um, was this for just an actual office visit, [PII]?
[CUSTOMER][NEUTRAL] Yeah, um, correct, it's uh an office visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, we'll get that pulled up and I'll see if that's going to be covered. um, first, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK. And then uh do you have that policy number?
[CUSTOMER][NEUTRAL] Of the patient?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hm hm.
[CUSTOMER][NEUTRAL] Do you mean the like the payer ID?
[AGENT][NEUTRAL] No, um, are you looking at a card?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Are you looking at the card?
[CUSTOMER][NEUTRAL] Um, yeah, I think I'm looking at the card.
[AGENT][NEUTRAL] Do you see um where it says in hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] Yeah, um, I do have the in hospitals benefits, sir, um, number and the outpatient benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, either one of those, please.
[CUSTOMER][NEUTRAL] OK, um, I have, um, 02.
[CUSTOMER][NEUTRAL] 505749 [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And then uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yes, so his name is [PII].
[CUSTOMER][NEUTRAL] And last name is [PII]. Um, date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that, [PII]. OK, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Give me just a moment, let me make sure that office visits are covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, um, do you need uh do you need the name of our office?
[AGENT][NEUTRAL] No, so this policy, it, it's not a uh, a part of any network. It's very dependent on um major medical. So as long as his major medical is willing to pay, this policy can.
[AGENT][NEUTRAL] All we would need is that uh primary EOB.
[CUSTOMER][NEUTRAL] OK, give me one second, hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what do you need on on our end?
[AGENT][NEUTRAL] Um, uh, there's nothing that I need, um, it just to file claims, all we need is the primary EOB, um, so this, this policy, it's not a part of a network or anything.
[CUSTOMER][NEUTRAL] Can you repeat that again?
[AGENT][NEUTRAL] So as this policy is dependent on whoever [PII] has as their major medical.
[AGENT][NEUTRAL] As long as they're willing to pay, this policy can.
[CUSTOMER][NEUTRAL] OK, one second, let me give me a second, hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, sorry, I'm gonna, uh, uh, she gave me the phone, so this patient is coming in for an axillary nodule for general surgery, and he has a co-pay, a co-payment of $60. We're calling to confirm if you guys cover that or if the patient pays for it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, so, um, of course I will let you know verification of coverage is not a guarantee of payment for claims. So office visits are covered under this policy as well as treatment received in office. Um, they're out outpatient, this is for outpatient, I'm sorry, right?
[CUSTOMER][NEUTRAL] This is um um sorry in oh my god, hold on, this is uh an office console.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, yes, um, so.
[CUSTOMER][NEUTRAL] But yes we're basically outpatient because we're we're specialist we mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, but that would fall under their outpatient benefits which is um $2500 max per calendar year and again that does go towards co-pay, deductible and co-insurance. If you give me one moment, I'll see if any of that has been used so far this year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so all that's been used for this year is $50 of that benefit.
[CUSTOMER][NEUTRAL] OK, so that you guys will cover that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, um, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sorry, just give me one more second, OK.
[AGENT][POSITIVE] No, you're perfectly fine.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, last thing, can I just have a reference number for the call?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. So my name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] No, so just [PII] That's it.
[AGENT][NEUTRAL] Yes, and then today's date.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect, thank you. So I'm just gonna put a reference number and then you guys will cover the copayment, OK.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely, um, again, all we really need is that primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, thanks for giving us a call and uh have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, [PII]ye bye.