AccountId: 011433970860
ContactId: 303a82d0-e7d5-4918-af90-d6eeb1b3882d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422690 ms
Total Talk Time (AGENT): 104876 ms
Total Talk Time (CUSTOMER): 96089 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/303a82d0-e7d5-4918-af90-d6eeb1b3882d_20250124T15:40_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I'm trying to um verify benefits on a patient.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with benefits today. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII] and what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII], and the policy number for the patient, please.
[CUSTOMER][NEUTRAL] 02503327
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to assist you with eligibility and benefits for [PII]. I'm showing his policy is active as a 6-17-2024.
[AGENT][NEUTRAL] And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] Um, cardiac rehab CPT code 93798.
[AGENT][NEUTRAL] OK, bear with me just one second.
[AGENT][NEUTRAL] I'm checking on that and it's for cardiac rehab facility?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's a good question. Let me just check real quick if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just wanna verify. I don't wanna tell you something wrong. So bear with me.
[CUSTOMER][POSITIVE] Oh, that's, yes, ma'am. Just take your time. I'm not in any hurry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm having to go through the policy, so bear with me.
[AGENT][NEUTRAL] Is that for a confinement rehabilitation center?
[CUSTOMER][NEUTRAL] Mm, I'm not sure. It, it's, it'll be outpatient hospital.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm not, I'm not encountered the consignment question before.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] We're learning all sorts of things today.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Just checking, bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it the, according to the policy, it states that the services would be covered while confined in a rehabilitation unit.
[AGENT][NEUTRAL] Or skilled nursing facility.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I'm checking for further.
[CUSTOMER][NEUTRAL] OK, so usually it's like a 36 visit limit.
[CUSTOMER][NEUTRAL] Um, they'll come in here to the hospital, to the cardiac rehab unit as an outpatient and.
[CUSTOMER][NEUTRAL] Come, you know, 2 or 3 times a week until they hit those 36 visits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I wouldn't say it's a nursing facility.
[AGENT][NEUTRAL] OK, so this would be covered if it is during the confinement as inpatient.
[CUSTOMER][NEUTRAL] OK, now this is outpatient.
[AGENT][NEGATIVE] So it would not be covered under the rehabilitation benefit.
[CUSTOMER][NEUTRAL] OK, so he doesn't qualify.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you able to say because they also have that he um.
[CUSTOMER][NEUTRAL] He has Medicare, but when I tried to check it online, nothing came up. Are you able to see if he has another insurance?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, not eligible.
[CUSTOMER][NEUTRAL] Through IPO.
[CUSTOMER][NEUTRAL] OK, and do you have a reference number for me?
[AGENT][NEUTRAL] Reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Alright, and today is the [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you, ma'am I appreciate it.
[AGENT][POSITIVE] It's been my pleasure to assist you with those benefits, [PII]. Thank you for your patience as I verified that coverage, and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too. Thank you. Mm bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.