AccountId: 011433970860
ContactId: 32f0d57d-94c1-45f9-8e35-c5c86b2a6f1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376970 ms
Total Talk Time (AGENT): 135744 ms
Total Talk Time (CUSTOMER): 92680 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/32f0d57d-94c1-45f9-8e35-c5c86b2a6f1e_20250626T14:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hey [PII], this is [PII] with OU Medicine Central Insurance verification. I'm calling to see if some CPT because I have required authorization.
[AGENT][NEUTRAL] Uh, none of our policies require any pre-certs or pre-authorizations.
[CUSTOMER][NEUTRAL] OK, and can you tell me if this is um.
[CUSTOMER][NEUTRAL] Can you tell me if this insurance is still active then, please?
[AGENT][NEUTRAL] Of course, and [PII], what is your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] It is [PII], extension [PII]. And what is your name again, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course. My name is [PII]. My last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome. You're very welcome. And [PII], what's that policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is 00974225.
[AGENT][NEUTRAL] OK. I have that as 00974225. Let me just check here for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much. Give me one second, I can definitely check eligibility for you.
[CUSTOMER][POSITIVE] I appreciate it thank you.
[AGENT][NEUTRAL] Of course, you're welcome, you're welcome. And this member shows effective as of [PII], and this policy shows active as a supplemental or secondary.
[CUSTOMER][NEUTRAL] OK, so what kind of um benefits would it have then?
[AGENT][NEUTRAL] OK, would this be for inpatient, outpatient?
[CUSTOMER][NEUTRAL] It's outpatient diagnostic testing.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] Let me place you on a brief hold please [PII]. My computer is a little slow this morning. OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And [PII], thank you again for your patience. Now I have those benefits for you. I had to wait for that policy to populate. I apologize for that. Um, please note, thank you. Please note verification of benefits provided does not guarantee payment. For outpatient benefits, we pay up to $4000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] And there is a deductible of $250 per cover outpatient service.
[AGENT][NEUTRAL] So we pay up to $4000 for the calendar year for covered outpatient services and diagnostic is a covered um service as long as it's due to sickness or an injury. It cannot be related to preventative or sick or excuse me, wellness.
[CUSTOMER][NEUTRAL] OK, and it's $250 per service that they would pay?
[AGENT][POSITIVE] That, yes, the deductible, that is correct.
[CUSTOMER][NEUTRAL] OK, so they would, the deductibles 250. Have they used any of that deductible?
[AGENT][NEUTRAL] In regards to the member.
[CUSTOMER][NEUTRAL] And you said this is a supplemental policy.
[AGENT][NEUTRAL] Yes, it's a supplemental or secondary. And in regards to the deductible is $250 per cover outpatient service separated by 24 hours, so it has to be the same service, um, so the last date of service.
[CUSTOMER][NEUTRAL] OK, so if, so if one's a, if one's a CT, one's an echo, and then one's an ultrasound, it would be $250 for each service even though it's being done the same day.
[AGENT][NEUTRAL] Per services means far as the diagnosis, not the actual for the diagnosis, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK. And um do you have a call reference number for me please?
[AGENT][NEUTRAL] We do not use call reference numbers. You can use my name and today's date, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] I appreciate it.
[AGENT][NEUTRAL] You're welcome, [PII]. Anything else I can help you with, please?
[CUSTOMER][POSITIVE] Oh no, that would be it you answered all my questions and I so appreciate it. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm bye.