AccountId: 011433970860
ContactId: 45132d6c-9a09-401e-8a2c-b9d51882f6b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349040 ms
Total Talk Time (AGENT): 125330 ms
Total Talk Time (CUSTOMER): 149264 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/45132d6c-9a09-401e-8a2c-b9d51882f6b3_20250210T13:29_UTC.wav
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[AGENT][POSITIVE] This is easy.
[CUSTOMER][POSITIVE] I'm so sorry. Oh gosh, this is [PII] in customer service.
[AGENT][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] I have a provider's office on the line wanting to verify eligibility and um he gave me a CPT code he wanted to see if it was covered, but um the policy number is 2592475.
[AGENT][NEUTRAL] OK. For [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I do see the pay date is [PII], but I happen to know because I worked this one they have just completed we just completed their renewal so they have not received their bill. I'm just letting you know that that is going on, um, you know, just in case that makes a difference.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he, he's calling to see if a CPT code is covered.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He, he gave me 2777.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For an injection. OK, and what's his name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you can send them over, we'll figure it out.
[CUSTOMER][POSITIVE] All right, thank you. Here he comes.
[AGENT][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. Uh, my name is [PII] calling from Tenant Tech Assets Solutions at the request of, uh, Doctor, uh, [PII] on behalf of the patient, and this call may be monitored and recorded for quality training purposes, and I was calling for benefits and eligibility on the patient.
[AGENT][NEUTRAL] Um, yes, sir. Could you please verify the patient's name and date of birth one more time?
[CUSTOMER][NEUTRAL] Certainly it's uh [PII] and date of birth is [PII]. And for HIPAA verification, the ID would be 1200057.
[AGENT][NEUTRAL] OK. Thank you, [PII]. And yes, just let me advise you that verification of coverage does not guarantee payment of claims. I'm showing the effective date on this policy was [PII] and the policy is still active. And is this for inpatient or outpatient benefits or services provided in the doctor's office?
[CUSTOMER][NEUTRAL] Uh, this will be outpatient in the uh specialist office.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Actually, under
[CUSTOMER][NEUTRAL] And uh what type of plan is oh go ahead.
[AGENT][NEUTRAL] Um, this is a plan for secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible. After the primary insurance processes the claim for covered services, and I'm showing that actually under this policy services provided in office is not covered. I'm only showing coverage for inpatient hospital, outpatient hospital, and services provided in independent labs like Quest or LabCorp.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so no, no, um.
[CUSTOMER][NEGATIVE] No benefit for the, the.
[AGENT][NEUTRAL] For the office, in office.
[CUSTOMER][NEUTRAL] For the office.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Let's see. OK, I'll be uh outpatient in the specialist office, so it's not available. OK.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Um, OK, so this is a, what, what's the product? A supplement?
[AGENT][NEUTRAL] It, yes, sir, supplement.
[CUSTOMER][NEUTRAL] Medicare. Is it a Medicare supplemental?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] No, um, is it an indemnity?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] To indemnity, OK, OK, that makes sense, um, and this, so does this plan run on a calendar year?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK, and is it fully funded or self funded?
[AGENT][POSITIVE] Fully funded.
[CUSTOMER][NEUTRAL] Fully funded, OK, do you happen to have a group name for billing purposes?
[AGENT][POSITIVE] Um, yes, let me get that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is South Florida.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Gel, J A I L G Ministries.
[AGENT][NEUTRAL] DBA.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Agape Network.
[CUSTOMER][NEUTRAL] How do you spell that?
[AGENT][NEUTRAL] Um, Agape, A like apple, G like goat, A like apple, P like Paul, E like Edward, Network.
[CUSTOMER][POSITIVE] Network. OK, thank you very much.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] OK great
[CUSTOMER][NEUTRAL] All right, I think that should do it um and I'm sorry I didn't catch your first name and last initial.
[AGENT][NEUTRAL] My first name is [PII]. Um, it's spelled [PII] and my last initial is [PII], and my name and today's date will be your reference number. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That would be it. I do thank you for your help, easy. Enjoy the rest of your day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.