AccountId: 011433970860
ContactId: 45a3535c-3200-4c2c-9f03-fb73a1da7ee1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 166639 ms
Total Talk Time (AGENT): 93577 ms
Total Talk Time (CUSTOMER): 51756 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/45a3535c-3200-4c2c-9f03-fb73a1da7ee1_20250131T19:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. 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 you from Acumen. I have a patient coming in tomorrow. I need your help with benefits.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with benefits today. What is the callback number for you?
[CUSTOMER][NEUTRAL] [PII], that is correct.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] I have policy number 02465362.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right. Thank you, [PII].
[AGENT][NEUTRAL] And [PII], I am showing that [PII] policy is active. The effective date is [PII].
[AGENT][NEUTRAL] This is a secondary policy to her primary insurance.
[AGENT][NEUTRAL] And are you needing specific benefits?
[CUSTOMER][NEUTRAL] Yes, this patient is coming in.
[CUSTOMER][NEUTRAL] Um, for a CAT scan, uh, we bill out an office to code 11 with no office visit. Just wanna see if you guys can pick up that primary responsibility.
[AGENT][NEUTRAL] Now, a diagnostic testing is covered, but it would have to be performed in an outpatient facility to be eligible for benefits under her APL policy.
[CUSTOMER][NEUTRAL] OK, so we, we are considered an outpatient diagnostic.
[AGENT][NEUTRAL] If it is a a freestanding diagnostic center MRI facility or outpatient hospital, she is eligible for diagnostic benefits up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] Perfect. And is there a reference number for our call?
[AGENT][NEUTRAL] The reference number would be my name and today's date, and I spell my name [PII].
[AGENT][NEUTRAL] And again, all benefits given over the phone is a verification of coverage, not a guarantee of payment.
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with those benefits. Anything else I can help you with today?
[CUSTOMER][POSITIVE] That is all. Thank you so much.
[AGENT][POSITIVE] And [PII], thank you for calling APL. I hope you have a wonderful day and happy weekend. Thank you, [PII].
[CUSTOMER][NEUTRAL] You do the same.
[CUSTOMER][POSITIVE] Have a great one thank you so much, stay safe.
[AGENT][POSITIVE] Thank you. You too, bye bye.