AccountId: 011433970860
ContactId: 495301c6-2902-4ceb-bafb-537c1942cf9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207500 ms
Total Talk Time (AGENT): 80219 ms
Total Talk Time (CUSTOMER): 90294 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/495301c6-2902-4ceb-bafb-537c1942cf9e_20250327T12:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm sorry, your name is what? I can barely hear you.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], OK, my name is [PII]. I'm calling from Thrive Health and Wellness trying to verify if the patient's policy is active.
[AGENT][POSITIVE] OK, I can help you, [PII], with the policy number and a good phone number.
[CUSTOMER][NEUTRAL] The policy number is 60801. Our telephone number is [PII].
[AGENT][NEUTRAL] OK, that's the payer ID number that you provided. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Um, let me see if they have a copy.
[CUSTOMER][NEUTRAL] I'm just going by what the front desk put in here.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, looks like we do have one do you want the inpatient or I guess you want the outpatient benefit certification number?
[AGENT][NEUTRAL] The number should be the same for each. Give me the number before the letter M.
[CUSTOMER][NEUTRAL] It's not, it's different.
[AGENT][NEUTRAL] The letter be give me the numbers before the letter M, those should be the same.
[CUSTOMER][NEUTRAL] 01943.
[CUSTOMER][NEUTRAL] Yes, ma'am, I am. I, I am 01943300.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And we're just checking the eligibility dates?
[CUSTOMER][NEUTRAL] Uh, I mean if the policy is still active, I'll need primary care office benefits.
[AGENT][NEUTRAL] OK, so and office visit benefits, OK, we have that information. The policy effective date is [PII]. Uh, the policy is active at this time.
[AGENT][NEUTRAL] And the physician fee uh is not covered under this policy.
[CUSTOMER][NEUTRAL] So what does that mean? She needs to pay.
[CUSTOMER][NEUTRAL] For the visit.
[AGENT][NEUTRAL] Yeah, it's the office visit, yeah, the office visit is not covered under this particular policy.
[CUSTOMER][NEUTRAL] OK, so does it cover anything for outpatient office visits?
[AGENT][NEUTRAL] You know, treatment in the office or the physician visit fee is not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so nothing for this, for any type of medical procedure, office visit or anything in the office is covered for this policy is what you're saying, correct? Because this member has issues every time she comes in here, so that's why I just wanna make double sure.
[AGENT][POSITIVE] Correct, it covers in hospital and outpatient.
[AGENT][NEUTRAL] OK, so inpatient hospital is covered, outpatient, um, to us, outpatient is in a hospital, a diagnostic facility, emergency room, urgent care. So service in a physician's office, place of service 11 is not covered under this policy, whether it's the co-pay or the physician visit fee or treatment in the office.
[CUSTOMER][POSITIVE] OK, that's fine. I just wanted to double check that that's what you meant. So thank you for your help. You have a blessed day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] If no other questions, [PII], thanks for calling APL and you as well.