AccountId: 011433970860
ContactId: 5851883b-39d8-4a60-95bc-1bf263ea1eb8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304700 ms
Total Talk Time (AGENT): 168470 ms
Total Talk Time (CUSTOMER): 100013 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/5851883b-39d8-4a60-95bc-1bf263ea1eb8_20250313T12:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, this is [PII] with NGPG neurology. I was calling to find out benefits and of a prior office needed for diagnostic testing done in the office.
[AGENT][NEUTRAL] OK, [PII], so you're wanting to find out about eligibility benefits and I'm sorry, and benefits for diagnostic testing done in the office, is that correct? Yes, ma'am. [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] It's D as in dog, 463-069-04.
[AGENT][NEUTRAL] OK, thank you. Now [PII], that is not an APO policy number. That is a 90 degree benefit number. Some of these numbers also have uh coverage with APL. Do you know if they also have a policy with us?
[CUSTOMER][NEUTRAL] Um, this is the card that pulled up on his.
[CUSTOMER][NEUTRAL] Uh, on my website American Public Life.
[CUSTOMER][NEUTRAL] It says um limited ban.
[AGENT][NEUTRAL] OK, so there should be another number on his ID card in addition to the D number.
[CUSTOMER][NEUTRAL] Um, I'll, they somebody put the, yeah, [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] I don't know where they got that number from. I was looking on their chart.
[AGENT][NEUTRAL] They may have a policy with them also and that number would be probably on the bottom of the ID card as well.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so just one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hey this is [PII] how are you?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So it's still
[AGENT][NEUTRAL] OK, many information [PII] that I provide would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] What's the number on it?
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this limited benefit plan.
[AGENT][NEUTRAL] And this limited benefit plan is active with an effective date of [PII].
[AGENT][NEUTRAL] Now, on this policy, because it's not major medical, there is no prior authorization required.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Give you a call
[AGENT][NEGATIVE] Well, and I am all of a sudden having an issue with one of my screens getting a technical error.
[AGENT][NEUTRAL] Bear with me just a moment let me try that again.
[CUSTOMER][NEUTRAL] Well, that happens, yeah, I know all about that.
[AGENT][NEUTRAL] OK. So for, he has, he has a benefit on here for outpatient accident and sickness treatment for a physician's office that's $50 per day and a maximum of 4 days per calendar year. You said that he was having a diagnostic test, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and the EEG, yeah, it's a 2 hour test.
[AGENT][NEUTRAL] OK. Yes, ma'am. Let me see, I don't, no, ma'am, that's not gonna matter. I don't believe that is covered under this policy. Yes, ma'am. They have specific testing.
[CUSTOMER][NEUTRAL] I have codes
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Covered OK.
[AGENT][NEGATIVE] And yes, and the EEG is not covered.
[CUSTOMER][NEUTRAL] Mm, not covered, OK, so he'd be responsible.
[AGENT][NEUTRAL] Under the diagnostic. Yes, ma'am.
[CUSTOMER][NEUTRAL] Right, OK, do you have a uh reference number for the call?
[AGENT][NEUTRAL] So we
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then also, um, once the claim has been processed, [PII] there we do have a portal in which you should be able to check claim status by going to [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect alright alright I will uh put that in his chart and give him the estimate.
[AGENT][NEUTRAL] OK. And uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much, [PII].
[AGENT][POSITIVE] Well, you're very welcome and thank you again, [PII], for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you alright bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.