AccountId: 011433970860
ContactId: 50c261bc-5231-4735-9791-dcbd5589b8eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293299 ms
Total Talk Time (AGENT): 109497 ms
Total Talk Time (CUSTOMER): 149788 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/50c261bc-5231-4735-9791-dcbd5589b8eb_20250217T18:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you calling APL. This speaking. May I help you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII] and I'm calling from uh doctor's office, and I need to check to see if you guys, um, so we have a patient that had came in and I just need to make sure you guys are in network and if you would cover, um, she had a test done.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you, Ms. [PII]. Uh, what's the policy number, please?
[CUSTOMER][NEUTRAL] OK, it's 02369723 M as in Michael, L as in Linda 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII] and I'm at [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, uh.
[AGENT][NEUTRAL] Well, I show she had a policy with us. Uh, it is a secondary supplemental, um, effective [PII], and the policy terminate [PII]. Give me a moment. Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, I do show she has a current policy with us and I can give you that number when you're ready.
[CUSTOMER][NEUTRAL] I, I can't
[CUSTOMER][NEUTRAL] OK, what is that number?
[AGENT][NEUTRAL] OK, it's 251.
[AGENT][NEUTRAL] 8170.
[CUSTOMER][NEUTRAL] Mhm. Alright, so it's 251-817-0 is the new policy number.
[AGENT][POSITIVE] Yes, ma'am, and it became effective [PII] and it's active.
[CUSTOMER][NEUTRAL] Alright, hang on.
[CUSTOMER][NEUTRAL] And it would cover um so she had a test would it cover what um the Cigna didn't pick up or?
[AGENT][NEUTRAL] Was this test in the outpatient facility?
[CUSTOMER][NEUTRAL] No, it's in a um a doctor's office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was for a test only though.
[CUSTOMER][NEUTRAL] And I can give you the CPT codes if um.
[AGENT][NEUTRAL] Give me one moment. And was this for a sickness or an injury or is this for wellness screening?
[CUSTOMER][NEUTRAL] No, um, it was for she had a test that was like to see if she had carpal tunnel, nerve or anything like that. I can give you the CPT codes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, give me one moment. It's mainly based on if it's in a facility and if it's for a sickness or an injury, but give me one moment. Let me see if.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Procedures and offices covered.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] I'm sorry. I apologize. Thank you for being, trying to make sure if it's covered.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the office.
[AGENT][NEUTRAL] OK, there you go.
[CUSTOMER][NEUTRAL] I have a question for you. You sent me over an off request on a patient, um.
[CUSTOMER][NEUTRAL] And I'm a little confused because Pacare normally gets the authorization for our office.
[CUSTOMER][NEUTRAL] So I was and then I had noticed.
[AGENT][NEUTRAL] Uh, so I do show service in a in a physician's office is covered on the policy as outpatient, um, not a guarantee of payment, just a verification of coverage. The max payable is up to $2,025 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, alrighty, and do you have a reference number for me?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] Um, can I make sure I have the correct claim address that way just in case, uh, is it the [PII] and then it's [PII] [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, well thank you very much I greatly appreciate you. You too thank you alright bye bye.
[AGENT][POSITIVE] Uh, you're welcome. Thank you for calling APL. You have a great day, Ms. [PII].
[AGENT][NEUTRAL] Bye.