AccountId: 011433970860
ContactId: 4f5bc448-3670-4ba1-a009-656a0ed47c2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297519 ms
Total Talk Time (AGENT): 138400 ms
Total Talk Time (CUSTOMER): 134977 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/4f5bc448-3670-4ba1-a009-656a0ed47c2b_20250314T14:29_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I was just calling to get benefits on a patient or regarding claims.
[AGENT][POSITIVE] Oh, I'd love to help you with benefits. OK, perfect.
[AGENT][NEUTRAL] Alright, so we're wanting benefits regarding um claims and then do you mind if I snag your name and a good call back number pretty please?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Sure, my name is [PII], callback number [PII].
[AGENT][NEUTRAL] [PII] thank you and the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number I have is 02149498.
[AGENT][POSITIVE] Perfect, give me just a moment to get that pulled up for you. Are you having a great day so far?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I am it's Friday.
[AGENT][POSITIVE] I know. I'm feeling it. And it's [PII] day.
[CUSTOMER][POSITIVE] Thank God.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank God.
[AGENT][NEUTRAL] All right. And would you be able to verify for me, pretty please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][POSITIVE] Perfect. And I'm gonna go ahead and get those benefits loaded now for you. I do wanna let you know that any benefit information given over the phone is just a verification of coverage and not a guarantee of payment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Perfect and are you looking at the inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Um, this is, is this a policy only for hospital?
[AGENT][NEUTRAL] Um, no, this is like a gap insurance.
[CUSTOMER][NEUTRAL] Because this is for office visits.
[AGENT][NEUTRAL] It she has um a rider on it for office treatment.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] OK, because I have multiple claims, um, so I came across, uh, an explanation of benefits for data service [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see, do you have that claim number handy on the, the explanation of benefits I can look at?
[CUSTOMER][NEUTRAL] Um, yes, let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, claim number 348.
[CUSTOMER][NEUTRAL] 2762.
[AGENT][NEUTRAL] OK, um, so I'm looking at that one with you. So it covers this for this particular policy, it covers treatment in an office setting, but not the administrative charges. So like those 99 charges are like administrative.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like the office is in [PII].
[AGENT][NEUTRAL] Mhm. Yeah, but like if there was treatment done, um, like to be treated, that would be covered in an office setting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh I see, yeah, uh it seems like they never received treatment. um, they were only in for office visits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] All the claims that we have are just often visits so that it wouldn't be covered.
[AGENT][NEUTRAL] No, I'm sorry. Yeah. That's um the, the way it's particularly worded is treatment in that, in that rider.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I see, OK, so.
[CUSTOMER][NEUTRAL] Mm, I'm wondering.
[CUSTOMER][NEUTRAL] If we should even have this in there.
[CUSTOMER][NEUTRAL] Because it seems like they yeah they're not receiving treatment. I'll make a note so um.
[CUSTOMER][NEUTRAL] Only treatment is covered and um what would be covered like the administration and the drug in case they do receive treatment.
[AGENT][NEUTRAL] So I actually don't process claims so I can't tell you like exactly we always have to have that um the primary EOB and then your claim form that you submit with it um but I can tell you that like for their outpatient um they have that office treatment writer I see they have coverage for labs and diagnostics, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] It looks like it as long as it's something that's not just the administrative charge you might have you should maybe send it in and give us a chance to process it.
[CUSTOMER][NEUTRAL] Just not the
[CUSTOMER][NEUTRAL] OK, let me see um.
[CUSTOMER][NEUTRAL] They did have labs before. Let me just see if I don't think they probably had any responsibility on the labs.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, because the primary covered.
[AGENT][NEUTRAL] It involve, mhm.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] I'll make a note of that on the patient's account.
[CUSTOMER][NEUTRAL] And this would be our patient responsibility then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, I just wanted to verify that um if I can get a reference number?
[AGENT][NEUTRAL] Oh yeah, you betcha. It's just my name [PII] and then today, oh, my last initial will be like boy in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Is there anything else I can do, Miss [PII]? Oh well, my pleasure. Thank you.
[CUSTOMER][POSITIVE] Alright thank you so much [PII].
[CUSTOMER][POSITIVE] No, I think that's all for now bye bye have a good day.
[AGENT][POSITIVE] Take care, have a great day bye bye.