AccountId: 011433970860
ContactId: 3cd48367-ed0c-4b14-9837-2d566c1ef7d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233820 ms
Total Talk Time (AGENT): 100657 ms
Total Talk Time (CUSTOMER): 74680 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/3cd48367-ed0c-4b14-9837-2d566c1ef7d7_20250107T19:27_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for calling APL. This is Sa[PII]How can I help you?
[CUSTOMER][NEUTRAL] Hi Sa[PII]this is Ta[PII]I'm calling from Children's Skin Center in order to get the eligibility and benefits of the patient that I had in the office today.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It'll be 02580177 M as in Mary, L as in long 8.
[AGENT][POSITIVE] All right, thank you so much for that. Let me pull this up one moment.
[AGENT][NEUTRAL] Can I get the patient name and date of birth?
[CUSTOMER][NEUTRAL] First name will be Ag[PII]Last name De[PII]Date of birth would be 4t[PII].
[AGENT][POSITIVE] Thank you so much. So patient plan is active. Effective date is 12[PII]This is a secondary insurance, so this is gonna cover deductible, co-pay, co-insurance if the primary does not.
[CUSTOMER][NEUTRAL] OK, do you guys cover regular office visit for specialists or just procedures that are done?
[AGENT][NEUTRAL] Uh, let me double check this and see if it covers the office visit fee. One second.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] N
[AGENT][NEUTRAL] OK, so it looks like the member's plan is going to cover treatment in a physician's office. It will not cover the physician office fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then one more question, um, the patient did a shape biopsy in the office, so.
[CUSTOMER][NEUTRAL] This insurance will cover that procedure, however, would it cover the the fees for it to be sent to the, the lab to have that tested and get the results back, or is that gonna go through the primary?
[AGENT][NEUTRAL] Yeah, so I mean, anything will go through the primary first and then this would pick up any residual. Um, as far as that's concerned, like a biopsy, let's see what the
[AGENT][NEUTRAL] Um, yes, so it looks like it would be covered under outpatient treatment. It looks like the benefit maximum is $500 per calendar day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 500 per calendar?
[AGENT][NEUTRAL] Per calendar day. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 500 per calendar day OK.
[AGENT][NEUTRAL] And it does.
[CUSTOMER][NEUTRAL] And does there is there a ending sorry, go ahead.
[AGENT][NEUTRAL] No, there's no end date at this time. Policy is still active. I was gonna say under the outpatient benefits, it does state surgery and hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] OK, all right perfect and then can I get a reference number for this call please?
[AGENT][NEUTRAL] Yeah, absolutely. So call references my name with my last initial than today's date. My name again is Sa[PII]that is spelled S [PII]y last initial to my name is T [PII].
[CUSTOMER][NEUTRAL] And then today's day with 2 digits, 2 digit numbers? OK.
[AGENT][NEUTRAL] Yes, uh huh.
[CUSTOMER][POSITIVE] Perfect, I really appreciate it.
[AGENT][POSITIVE] You're welcome. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Um bye.