AccountId: 011433970860
ContactId: 36ae5da6-248e-488d-bde5-017e77eacf05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233899 ms
Total Talk Time (AGENT): 97052 ms
Total Talk Time (CUSTOMER): 104711 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/36ae5da6-248e-488d-bde5-017e77eacf05_20250311T22:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, I'm calling to verify benefits and eligibility on a patient.
[AGENT][POSITIVE] All right, I'm happy to verify eligibility and benefits today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Patient's policy number is 02576313.
[AGENT][POSITIVE] Alright, thank you for that. Let me pull this up here.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] That would be [PII]'s date of birth [PII].
[AGENT][POSITIVE] Thank you. So the
[CUSTOMER][NEUTRAL] Calling to verify bene oh go ahead.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I'm calling to verify benefits and eligibility. Patient will be having a medical colonoscopy and an ambulatory surgical center billing for the facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] 10
[AGENT][NEUTRAL] So the patient is active. The effective date is [PII].
[CUSTOMER][NEGATIVE] Oh sorry.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Do you have a termination date?
[AGENT][NEUTRAL] No termination, still active.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. So this is a limited benefit plan. So there's a surgical and anesthesia benefit. It looks like it's surgical is benefit up to $2000.
[AGENT][NEUTRAL] The anesthesia benefit on the plan is 25% of the surgical benefit.
[CUSTOMER][NEUTRAL] Or I'll try the the price on.
[AGENT][NEUTRAL] And it looks like the plan is gonna pay $100 per day as far as hospital confinement, and confinement is defined as 18 hours or longer.
[CUSTOMER][NEUTRAL] Well it's an outpatient, so that wouldn't apply because they go home the same day.
[AGENT][NEUTRAL] Well, let's see.
[AGENT][NEUTRAL] So the only other um outpatient benefit would be for like an office visit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 573.
[AGENT][NEUTRAL] And I don't think that would apply here, but that's $75 per visit.
[CUSTOMER][NEUTRAL] OK, but for ambulatory surgical center, the 2000 max supply?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] For the colonoscopy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and is this per procedure or if they have one procedure a year or is it per visit, the 2000 max?
[AGENT][NEUTRAL] Um, that would be per procedure, so there's not a limit of, yeah.
[CUSTOMER][NEUTRAL] Per procedure.
[CUSTOMER][NEUTRAL] So they came today and they come tomorrow it's [PII] today and [PII] tomorrow.
[AGENT][NEGATIVE] Yeah, that's the max it's gonna pay. It's not gonna pay any more than that.
[CUSTOMER][NEUTRAL] Per day, OK, per day per procedure.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Per procedure, not per day, per procedure.
[CUSTOMER][NEUTRAL] So if they were to have one procedure today.
[CUSTOMER][NEUTRAL] You guys would pay up to $2000 but if they needed to read you the colonoscopy tomorrow.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Then that would be another 2000 tomorrow correct?
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] OK, sounds good and can I have, I'm sorry, you say your name is [PII], correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Spoke to [PII].
[CUSTOMER][NEUTRAL] And can I have the last initial first initial of your last name?
[AGENT][NEUTRAL] It's [PII], and that's the call reference with today's date.
[CUSTOMER][POSITIVE] OK sir, thank you very much for your help.
[AGENT][POSITIVE] You're welcome have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.