AccountId: 011433970860
ContactId: 34703f26-95e7-4a45-8c78-cceea220d7ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234860 ms
Total Talk Time (AGENT): 94511 ms
Total Talk Time (CUSTOMER): 108429 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/34703f26-95e7-4a45-8c78-cceea220d7ac_20250102T16:37_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? This is [PII].
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I have a question about a policy that I don't see the certificate and I'm a little confused. I went ahead and, you know, look into the, the information that we have, but I don't see anything for this type of service, so I just wanna make sure. Um, the policy number is 2576376.
[AGENT][NEUTRAL] OK, let's see what we got going on.
[AGENT][NEUTRAL] Um if I could work my computer today, that might help.
[CUSTOMER][POSITIVE] Happy [PII]'s.
[AGENT][NEUTRAL] It's the Monday Wednesday I've ever had.
[CUSTOMER][NEUTRAL] Yeah, I know, right?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, what's your question?
[CUSTOMER][NEUTRAL] OK, so I got a a provider calling for um infusion therapy in office which I don't see anything for infusion therapy under this one, but I'm not sure if it's something that is covered because I don't have a certificate and the certificate is not an on base.
[AGENT][NEUTRAL] It's not for like um fertility fertility treatment or anything like that, is it?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm, I did not ask. Uh, she gave me some codes.
[AGENT][NEUTRAL] Uh, let's see here, what's that code?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, uh, I got several, um, but let me give you the one that maybe, maybe will give us that information, maybe 99601.
[CUSTOMER][NEUTRAL] 99602.
[AGENT][NEUTRAL] Uh, it's just a home invasion.
[AGENT][NEUTRAL] Specialty drug administration, is there another code 602?
[CUSTOMER][NEUTRAL] Um, 593-79. I'm sorry, that's not 5, that's an S 9379.
[AGENT][NEGATIVE] I it's not even pulling up in our system.
[CUSTOMER][NEUTRAL] OK, and the rest are Jacos, yeah, which those are just, yeah, yeah, just the medication.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Jcode is just gonna be the medication. Um, what's the medication? Let me see that code.
[CUSTOMER][NEUTRAL] Um, J 2350.
[CUSTOMER][NEUTRAL] J 2919.
[AGENT][NEUTRAL] Um, hold on, let me pull up this medication really quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, it's for scholar uh.
[AGENT][NEUTRAL] It's not scoliosis, it's something else, so it's not for fertility or anything like that. So on their policy, um, they have the outpatient accident and sickness rider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, so as long as it's billed as an accident or sickness with the diagnosis code, it's gonna completely be up to the provider on how they bill it. They get those 4 those 4 physical.
[CUSTOMER][POSITIVE] So it's part of the office visit for visits. OK, got you. I wanna make sure, OK, because you know there's some that has infusion therapy separate, so all right. I just wanna make sure, but thank you so much, [PII]. Have a good day.
[AGENT][NEUTRAL] Right, yeah.
[AGENT][NEUTRAL] Yes, since you called me I know you have someone on the line, but since you called me and you get off the phone, will you message me? I have a question about a policy that's not uploaded in the system and the master policy is not in there either.
[CUSTOMER][NEUTRAL] Oh, OK. All right. I'll go ahead and send you a message.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I was gonna see if someone can help me. I didn't know if you could or not.
[CUSTOMER][POSITIVE] OK. Yeah. Uh, I'll try my best
[AGENT][POSITIVE] Just whenever you get time, no rush.
[CUSTOMER][POSITIVE] OK. OK. All right. I will. OK. You're welcome.
[AGENT][POSITIVE] Alright thanks all.
[AGENT][NEUTRAL] All right, bye-bye.