AccountId: 011433970860
ContactId: 338f3ed5-02c4-475a-90b9-c7e24378a393
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228940 ms
Total Talk Time (AGENT): 94938 ms
Total Talk Time (CUSTOMER): 107557 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/338f3ed5-02c4-475a-90b9-c7e24378a393_20250619T15:15_UTC.wav
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[CUSTOMER][NEUTRAL] You're just
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling from uh Doctor [PII]'s office. I need eligibility and benefits for this member's plan.
[CUSTOMER][NEUTRAL] And to see if we're if if it's in network or participating.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, I can help you with both the eligibility and benefits and the network. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. The number here is [PII].
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Oh, payer, no, payer ID number? No.
[AGENT][NEUTRAL] Um, not payer ID, it should say in hospital or outpatient policy cert number.
[CUSTOMER][NEUTRAL] Oh, outpatient benefit certification number. This is not a hospital, so I guess it's this 1, 02580222 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] may I help you?
[AGENT][NEUTRAL] And what type of benefits did you want to go over today, outpatient?
[CUSTOMER][NEUTRAL] Uh, office visit, PCP office visit, um, 6.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Uh, so the policy for outpatient will pay up to $500 per calendar day. Now, the office visit like facility 9921399214, if you if you're billing for those codes, it most likely will not be covered because they don't have an office setting.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But they do have an office treatment rider which the treatment in the office could be covered because of that additional rider.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, so this is actually basically more for like hospital?
[AGENT][NEUTRAL] No, um, it's no, it's a secondary insurance. They do have inpatient benefits, but they have outpatients separately.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I cannot bill a 99213, so what do we bill?
[AGENT][NEUTRAL] What's being done at the service, if they're testing, I mean, you know, the treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, the treatment only.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Not the vision.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] American public life, so this will be the secondary.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I I think because I know there's some.
[AGENT][NEUTRAL] And we pay towards the copay, deductible and co-insurance of coverage charges after primary, which I'm showing as United Healthcare.
[CUSTOMER][NEUTRAL] Yeah, and he has a deductible on United or you don't know that part.
[AGENT][NEUTRAL] Uh, we don't have their, their, uh, like policy or benefit breakdown, but yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right. OK, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No bye bye.
[AGENT][POSITIVE] Alright, well thanks for calling APL
[CUSTOMER][NEUTRAL] Yeah.