AccountId: 011433970860
ContactId: 266263bc-3b19-497e-9134-023a9c2daf39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229229 ms
Total Talk Time (AGENT): 117826 ms
Total Talk Time (CUSTOMER): 89463 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/266263bc-3b19-497e-9134-023a9c2daf39_20250317T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. My name is [PII] calling from a provider's office.
[CUSTOMER][NEUTRAL] I would like to check eligibility and benefits for a patient.
[AGENT][POSITIVE] All right, I'm happy to check benefits and eligibility. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02.
[CUSTOMER][NEUTRAL] 338486
[AGENT][NEUTRAL] All right, thank you. And patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, by us uh here with date of birth [PII].
[AGENT][NEUTRAL] Alright, so the patient is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are they being seen for an office visit?
[CUSTOMER][NEUTRAL] Yes, office visit and this is uh a consult for a colonoscopy.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Patient has a limited benefit plan, so it's a hospital indemnity plan. It's just gonna pay a set amount depending upon what they're being seen for. No pre-authorization would be needed. Um, I'm just pulling up the policy here to see what it would pay out. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like the patient is allowed a total of 5 office visits in a calendar year. There's a benefit payment of $75 towards the office visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, any sort of diagnostic testing, it looks like the plan does have a benefit for that. It looks like the minimum would be 250 and then the max would be 500.
[CUSTOMER][NEUTRAL] OK, so is the max, uh, that we can bill is 500 you said?
[AGENT][NEUTRAL] Well, that's the most that the plan is gonna pay towards the service. So the most it would pay, yeah, would be $500 towards the colonoscopy. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] OK, and uh is this, I believe this is uh a screening which is a preventative. Does he have any benefits?
[AGENT][NEUTRAL] Oh yeah, let's see. There is a wellness um exam or test benefit. It looks like of $75 so it would pay $75 towards the wellness, yes.
[CUSTOMER][NEUTRAL] Preventative benefits or mhm.
[CUSTOMER][NEUTRAL] OK. It'll, it'll pay $75 only.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or or the patient has a 75 copay.
[AGENT][NEUTRAL] No, it just pays $75 towards that wellness exam.
[CUSTOMER][NEUTRAL] OK, so I only pay $75 towards the wellness exam, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In this case will be the colonoscopy.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um has the patient with this um benefit, does he have any, um, it's not like any other insurance where they have like deductibles or co-insurances?
[AGENT][NEUTRAL] Correct, yeah, there's no deductible, coinsurance, anything like that.
[CUSTOMER][NEUTRAL] Mhm. OK, no deductible, no coinsurance.
[CUSTOMER][NEUTRAL] And um so far, uh, has the patient reached those 5 office visits per year?
[AGENT][NEUTRAL] Uh, looks like the patient has used one visit for the year thus far.
[CUSTOMER][NEUTRAL] OK, sounds good. um, do I get a reference number for my call?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial, then today's date. My name again is [PII], that's [PII] My last initial is [PII] and then today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Have a great day. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] That'll be all for today. Mhm. Likewise, bye now.