AccountId: 011433970860
ContactId: 465acf4c-0f78-435b-883e-c7c1e0de9e99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313519 ms
Total Talk Time (AGENT): 109791 ms
Total Talk Time (CUSTOMER): 98309 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/465acf4c-0f78-435b-883e-c7c1e0de9e99_20250217T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Hi, good morning. My name is Ca[PII]I'm calling from the rendering facility Atrium Health. I was wanting to verify eligibility and benefits on the member.
[AGENT][NEUTRAL] Uh, yes, ma'am. I can verify benefits for you. And Ms. Ca[PII]what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, I have a policy number um.
[CUSTOMER][NEUTRAL] 683-934-762.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Yeah, the patient's name, date of birth?
[CUSTOMER][NEUTRAL] I could have that wrong. Yes, I do. I have patient uh San TVs, S A [PII] T like Tom, E [PII].
[AGENT][NEUTRAL] [PII]K.
[CUSTOMER][NEUTRAL] Last name Jo[PII].
[CUSTOMER][NEUTRAL] Ma[PII].
[AGENT][NEUTRAL] You said last name is Jo[PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let's see. And Miss. Ca[PII]do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] I do. That'll be 47[PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you. Give me one.
[CUSTOMER][NEUTRAL] And that's a direct line.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] And I'm sorry, your name again?
[AGENT][NEUTRAL] Ki[PII].
[AGENT][NEUTRAL] [PII]eah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Uh, Ms. Ca[PII]when you're ready, I can give you the policy number with our company.
[CUSTOMER][POSITIVE] Oh I'm ready.
[AGENT][NEUTRAL] OK, it is 259-2902.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh oh, I'm sorry, one more time, 259.
[AGENT][NEUTRAL] 259-2902.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the effective date of this patient is Ja[PII]and they are active.
[AGENT][NEUTRAL] And what benefits we're needing?
[CUSTOMER][NEUTRAL] Um, looks like, uh, outpatient diagnostic.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Give me one moment I do see diagnostic benefits, but give me one moment, please.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. Do you sure they have diagnostic benefits, but it depends on the type of test, or how much is paid or if it's covered. Uh, do you know what type of, um, imaging or diagnostic test is gonna be performed?
[CUSTOMER][NEUTRAL] Uh it looks like it's going to be a um let's see.
[CUSTOMER][NEUTRAL] The test is a barium swallow, so I have a procedure code if that would be more, more helpful it's 74,230.
[AGENT][NEUTRAL] 74,230. OK. So I do show that under the diagnostic benefit, they do have a bar swallow or upper GI series as an advanced test under the plan and not a guarantee of payment, just a verification coverage. The max payable.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's up to $25.
[AGENT][NEUTRAL] And it's once per calendar year.
[CUSTOMER][NEUTRAL] Max pay is $25.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, and they're allowed what, uh, I'm sorry, say that one last time what one annually.
[AGENT][NEUTRAL] Uh, just once a year. It just only shows one time, so yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well, that's actually all that I needed. Um, is there a reference number for the call or would I just use your name today's date and time?
[AGENT][NEUTRAL] Uh, you can just use my name at today's date if you like.
[CUSTOMER][POSITIVE] OK, sounds good, Ms. Ke[PII]Thank you so much for your time. You have a great Monday.
[AGENT][POSITIVE] Oh, you too, Ms. Ca[PII]and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.