AccountId: 011433970860
ContactId: 2bded251-9a4d-4d79-98f9-ea8b25a0c7b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277670 ms
Total Talk Time (AGENT): 115794 ms
Total Talk Time (CUSTOMER): 76008 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/2bded251-9a4d-4d79-98f9-ea8b25a0c7b7_20250224T16:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Acumen. I'm trying to get benefits on a patient. They're here and presented this card as secondary.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, Miss [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Callback number is [PII] direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 1422277 ML8
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, patients here for a mammogram and a breast ultrasound.
[AGENT][NEUTRAL] Is this preventative or diagnostics?
[CUSTOMER][NEUTRAL] Um, the mammogram is, let me see something, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the mammogram is routine, so it's a screening and the breast ultrasound is routine as well.
[AGENT][NEUTRAL] OK. Um, Ms. [PII], this particular policy is a secondary supplemental plan to the major medical and we do not cover um preventative testing.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, that's usually covered 100% by the major medical, so it doesn't cover under secondary.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] OK, so you guys won't cover the ultrasound either, even with um let me see if there's a diagnosis on, hold on.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the ultrasound has a diagnosis of R 92.9.
[AGENT][NEUTRAL] And the ultrasound is gonna take place in the office or outpatient facility?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK, bear with me just a second, let me pull that code.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] You said it's R as in Robert 92.9?
[CUSTOMER][NEUTRAL] 92.2.
[AGENT][NEUTRAL] 32.2.
[CUSTOMER][NEUTRAL] Is it 9? Hold on, let me hold on, let me go back. Hold on.
[AGENT][NEUTRAL] Yeah, now I'm just not pulling anything up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] R 92.2 inconclusive mammogram.
[AGENT][NEUTRAL] This mammogram mhm.
[AGENT][NEUTRAL] Yeah, um,
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. Um, it sounds like it's gonna be a um diagnostic ultrasound, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So uh let me check and see if it's covered.
[AGENT][NEUTRAL] OK, this one doesn't have any office treatment either, so no, it's not gonna be payable in the office.
[AGENT][NEUTRAL] So this one only has like hospital benefit, outpatient facility benefits. So if it was done in an outpatient facility, is it, so you charged as an office or outpatient?
[CUSTOMER][NEUTRAL] This is an outpatient facility.
[CUSTOMER][NEUTRAL] This is an outpatient but we charge as an office because we're free standing.
[AGENT][NEGATIVE] Yeah, if you charge, yeah, if you charge us in office, then it's not gonna be covered.
[CUSTOMER][NEUTRAL] Alright, can I have a reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. You need the spelling of my name or any other information, Ms. [PII]?
[CUSTOMER][POSITIVE] Thank you. Nope, that's it.
[AGENT][POSITIVE] You're welcome and thank you for calling ATO. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][POSITIVE] Thank you bye bye.