AccountId: 011433970860
ContactId: 25c9a5af-e43e-4a1a-8b90-7f6f647b6c2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 792530 ms
Total Talk Time (AGENT): 243286 ms
Total Talk Time (CUSTOMER): 225837 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/25c9a5af-e43e-4a1a-8b90-7f6f647b6c2d_20250102T16:31_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, yes, I need to get benefits for infusion therapy done in an office setting, and I have codes.
[AGENT][NEUTRAL] OK. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, now on the card there are 2 numbers.
[CUSTOMER][NEUTRAL] There's a policy and then a medical ID number. Which one is the number you need?
[AGENT][NEUTRAL] It's the one starting with the 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said you need benefits for infusion therapy. What is the code?
[CUSTOMER][NEUTRAL] There I have a couple of them.
[CUSTOMER][NEUTRAL] The first one is J 2350.
[CUSTOMER][NEUTRAL] Then S as in Sam 9379.
[CUSTOMER][NEUTRAL] 99601
[CUSTOMER][NEUTRAL] 99602
[CUSTOMER][NEUTRAL] J 1200
[CUSTOMER][NEUTRAL] And J 2919.
[AGENT][NEUTRAL] OK. Let me uh look up this information. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure, no, that's fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good, thank you. Um, I have a question about a policy that I don't see the certificate and I'm a little confused. I went ahead and, you know, look into the, the information that we have, but I don't see anything for this type of service, so I just want to make sure. Um, the policy number is 2576376.
[CUSTOMER][NEUTRAL] OK, let's see what we got going on.
[CUSTOMER][NEUTRAL] I don't know if I can work my computer today, that might help.
[AGENT][POSITIVE] Happy [PII]
[CUSTOMER][NEUTRAL] It's the Monday Wednesday I've ever had.
[AGENT][NEUTRAL] Yeah, I know, right?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, what's your question?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I got a a provider calling for um infusion therapy in office which I don't see anything for infusion therapy under this one, but I'm not sure if it's something that is covered because I don't have a certificate and the certificate is not an on base.
[CUSTOMER][NEUTRAL] It's not for like um fertility fertility treatment or anything like that, is it?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, I did not ask. Uh, she gave me some codes.
[CUSTOMER][NEUTRAL] Uh, let's see here, what's that code?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, oh, I got several, um, but let me give you the one that maybe, maybe will give us that information, maybe 99601.
[AGENT][NEUTRAL] 99602.
[CUSTOMER][NEUTRAL] Uh, it's just a home and DJ.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Especially drug administration, is there another code 602 you said?
[AGENT][NEUTRAL] Um, 59379. I'm sorry, that's not 5, that's an S 9379.
[CUSTOMER][NEGATIVE] And it's not even pulling up in our system.
[AGENT][NEUTRAL] OK, and the rest are Jacodes, yeah, we still are, yeah, yeah, just the medication.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Jcode's just gonna be the medication. Um, what's the medication? Let me see that code.
[AGENT][NEUTRAL] Um, J 2350.
[AGENT][NEUTRAL] J 2919.
[CUSTOMER][NEUTRAL] Um, hold on, let me pull up this medication really quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, it's just uh.
[CUSTOMER][NEUTRAL] It's not scoliosis, it's something else, so it's not for fertility or anything like that. So on their policy, um, they have the outpatient accident and sickness rider.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so as long as it's billed as an accident or sickness with the diagnosis code, it's gonna completely be up to the provider on how they bill it. They get those 4 those 4 visits.
[AGENT][POSITIVE] So it's part of the office visit for visits. OK, got you. I wanna make sure, OK, because you know there's some that has infusion therapy separate, so all right, well I just wanna make sure, but thank you so much, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Yes, since you called me, I know you have someone on the line, but since you called me and you get off the phone, will you message me? I have a question about a policy that's not uploaded in the system and the master policy is not in there either.
[AGENT][NEUTRAL] Oh, OK. All right. I'll go ahead and send you a message.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I was gonna see if someone can help me. I didn't know if you could or not.
[AGENT][POSITIVE] OK. Yeah. I'll, I'll try my best.
[CUSTOMER][POSITIVE] Just whenever you get time, no rush.
[AGENT][POSITIVE] OK. OK. All right, I will. OK. You're welcome.
[CUSTOMER][POSITIVE] Alright thanks so.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][POSITIVE] Thank you for holding and being patient for me, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I went ahead and got some information on the claims department just to make sure. And they will, they, they were letting me know that um that's gonna be part of the accident and sickness treatment rider, which is the office visit rider um which there is um and this is not a guarantee of payment, just a verification of coverage. There are 4 visits per covered person per calendar year and that's $50 per visit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] That's all because this is a limited policy. Mmm. This is not a major medical. This is a limited hospital indemnity plan, limited policy.
[CUSTOMER][NEUTRAL] There's no deductible.
[CUSTOMER][NEUTRAL] So is this covered?
[AGENT][NEUTRAL] It is part of that benefit. So it, it will be considered under that accident and sickness treatment writer.
[CUSTOMER][NEUTRAL] After Cigna's what?
[AGENT][NEUTRAL] Accident and sickness treatment writer.
[CUSTOMER][NEUTRAL] Treatment.
[CUSTOMER][NEUTRAL] Writer, so the benefits are considered under that accident sick sickness treatment rider.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And all of those codes are covered with a $60 visit?
[AGENT][NEUTRAL] That is the maximum for that rider's uh $50 and that's 4 times per year. So it's $50 per day up to 4 days per year.
[CUSTOMER][NEUTRAL] OK, I guess I don't really understand because this is a um specialty um infusion that the patient's gonna be getting at our ambulatory infusion suite, and I guess it's every 6 months, once every 6 months.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I know that um the charges are gonna be way more than 50, but it only pays 50. So just an example, if um let's say the medicine, the J 2350 is more than 50, then it's just gonna pay for that one and the rest is gonna be denied stating that the um maximum has been exhausted.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, so it's only covered up to $50.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Only covered.
[CUSTOMER][NEUTRAL] Up to $50 and then the rest is the patient's responsibility.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I get a confirmation number for the call, please?
[AGENT][NEUTRAL] We don't have reference numbers, but you can use my name in today's date if you will, Mr. [PII]. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else?
[CUSTOMER][POSITIVE] 1225. Alright, thank you very much for breaking that down for me.
[AGENT][POSITIVE] You're welcome. No problem. Thank you for calling APA. You have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Bye-bye.