AccountId: 011433970860
ContactId: 573731c4-6b36-49b6-9e37-55709f608a17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351730 ms
Total Talk Time (AGENT): 163083 ms
Total Talk Time (CUSTOMER): 134416 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/573731c4-6b36-49b6-9e37-55709f608a17_20250205T18:54_UTC.wav
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[CUSTOMER][NEUTRAL] That for you and then would you like.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office, uh, just looking to get benefits for a patient.
[AGENT][POSITIVE] OK, yeah, I can check on benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, that's.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, I do. It is 02289403.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, it is [PII] in [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and uh let's see, so the policy is active. Effective date was [PII], and if you'd like I can send you a copy of the fax box that shows all covered procedures and benefit information.
[CUSTOMER][NEUTRAL] OK and then are you able to tell me um like their past preventative history?
[AGENT][NEUTRAL] Oh sure, yeah, give me just a moment let me get that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and this just was for [PII] correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so I.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Are we looking for specific codes [PII]?
[CUSTOMER][NEUTRAL] Um, yes, you want me to give you all the, um, at once?
[AGENT][POSITIVE] Um, please, that'd be great.
[CUSTOMER][NEUTRAL] Yeah, uh, so the first one's going to be D0120.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] D1120.
[CUSTOMER][NEUTRAL] D 1206 DZ 20272.
[CUSTOMER][NEUTRAL] D0330.
[CUSTOMER][NEUTRAL] And then let me see what else I need.
[CUSTOMER][NEUTRAL] Um, the 1354.
[CUSTOMER][NEUTRAL] And the.
[CUSTOMER][NEUTRAL] 2930.
[CUSTOMER][NEUTRAL] And that should be it.
[AGENT][NEUTRAL] OK, OK, thank you, let's take a look here so the last item that I have for Cooper was from [PII] and that was.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 1120 and 0120.
[AGENT][NEUTRAL] Those were the only um items for that visit.
[AGENT][NEUTRAL] And then from there it goes to [PII].
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] 23 OK.
[AGENT][NEUTRAL] So for that visit that was.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm trying to find the code that you mentioned, let's see.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, so for [PII] there was also the 1120 0272.
[AGENT][NEUTRAL] Um, oh, that's OK. That's all the history I've got. OK.
[CUSTOMER][NEUTRAL] OK, and then, um, is uh the 1206, is that a covered benefit on the plan?
[AGENT][NEUTRAL] Uh, let me check. Give me just a moment. I can go ahead and check all of those codes that you gave me to make sure that they are covered.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Of course.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and so they paid the secondary fee 465, but the write-off is taking care of it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm mm, no, there wasn't
[CUSTOMER][NEUTRAL] OK, so this is, I mean they might, but
[AGENT][NEUTRAL] OK. Um, so the, uh, 1206, um, is not a covered procedure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] I still look and give me just a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the 1354 is not a covered procedure either.
[AGENT][NEUTRAL] And neither is the 29:30.
[CUSTOMER][NEUTRAL] And then 29:30.
[AGENT][NEUTRAL] The others are covered.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] In short, OK, in short, this plan, um, just so that you're aware, uh, it only has preventative and basic expenses there is no major coverage did you still want me to.
[CUSTOMER][POSITIVE] Already I believe that's all I needed.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] No major OK and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, could you fax over something?
[AGENT][POSITIVE] Absolutely, yes, what was that fax number for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back, make sure I heard that correctly, uh, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alrighty, I will get this sent to you now. I should get it here in maybe 10-15 minutes depending on how busy your machine is. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, actually, yes, um, is the annual maximum for a patient, is it $500 still?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that is correct, um, and I do apologize. I think I gave you an incorrect effective date. Um, Cooper's is different. Did you want me to give you that? I mean, it will be on the fax back, but I can go ahead and give that to you. Um, it is, uh, [PII]. Sorry about that.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] OK, but sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's OK. Alrighty, got it. I'm all set, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right sounds good thank you I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye-bye.