AccountId: 011433970860
ContactId: 253a3320-6ae3-4619-8336-a1ecf4b9dda7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245289 ms
Total Talk Time (AGENT): 110993 ms
Total Talk Time (CUSTOMER): 127175 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/253a3320-6ae3-4619-8336-a1ecf4b9dda7_20250624T14:18_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, I'm calling from a provider's office and I need benefits for a member.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] It's [PII], it's [PII] and it's [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And what was the phone number? I apologize.
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] Thank you. [PII], what is the policy number of the member that you're calling to verify eligibility for?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, 02337174 MLA.
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. You're calling to verify benefits eligibility for what place of service?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, 11, so it's in an office setting.
[AGENT][NEGATIVE] This member's policy has been active since [PII] and is currently active, and unfortunately the policy does not provide benefits for office visits.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] No it's not an office visit, it's for what's it for? It's for an um MRI that's gonna be done in the um specialist office.
[AGENT][NEUTRAL] So is it a diagnostic center or is it a doctor's office?
[CUSTOMER][NEUTRAL] It's in the doctor's office. I know some of these plans do not have an office treatment writer, so I don't know if that's her case. I know it wouldn't cover.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, she doesn't have an office treatment rider either, so she don't have the office visit benefit nor the rider.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] But if it's considered as diagnostic testing, then she does have out she does have outpatient benefits.
[CUSTOMER][POSITIVE] OK, so alrighty.
[CUSTOMER][NEUTRAL] Yeah, I'll have to make.
[CUSTOMER][NEUTRAL] Yeah, it is diagnostic because it's an MRI, but the way we build it is in an office setting in the specialist.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So we're not considered like a facility we do it in the office, so I don't, I'm not sure that'll cover.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Hope for the best
[AGENT][NEUTRAL] Got you. It depends on how they, how it's being billed.
[CUSTOMER][NEUTRAL] Exactly and this is being billed as in as in the specialist office like not a facility.
[AGENT][NEUTRAL] Got you. So place for service 11, this is how it would be billed. What is the name of the facility though?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's neuroscience consultants.
[AGENT][NEUTRAL] Is it a
[AGENT][NEUTRAL] Is it a diagnostic?
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] No, it's not. We're, no, we're a group of uh neurologists and then we, the way, that's how we build it because usually the, usually the MRI's are performed in a, in a freestanding facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not in an office setting.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's why, that's the confusion all the time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, but it's not covered unfortunately. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, [PII], that'll be all, just a reference number.
[AGENT][NEUTRAL] We don't provide those, but you can use my name and today's date as a reference.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And what's your initial of your last name?
[CUSTOMER][NEGATIVE] I completely lost you there. I didn't hear you. Well, how do you spell your name?
[AGENT][NEUTRAL] [PII] for the first initial of my last name.
[CUSTOMER][POSITIVE] I completely changed your name. I, I called you [PII]. Thank you very much and you have.
[AGENT][NEUTRAL] It's OK. I change individuals' names all the time, so don't feel bad. It happens when you work with names all the time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] It definitely happens so.
[CUSTOMER][POSITIVE] Well, you have a great day, OK?
[AGENT][POSITIVE] You do the same. Thank you and have a good one. Thanks for calling ATL. Goodbye.
[CUSTOMER][NEUTRAL] Mhm you too bye bye.