AccountId: 011433970860
ContactId: 5a328dd0-f34d-4a27-8cbd-a9cd05e487bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200309 ms
Total Talk Time (AGENT): 75724 ms
Total Talk Time (CUSTOMER): 53420 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/5a328dd0-f34d-4a27-8cbd-a9cd05e487bf_20250513T20:36_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling for benefits on a patient.
[AGENT][POSITIVE] OK, I can help you with benefits. Do you have a good callback number and can I get your name?
[CUSTOMER][NEUTRAL] It's [PII] callback number [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Uh, do you have the policy number of that patient?
[CUSTOMER][NEUTRAL] 262-242-5
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] The policy is effective [PII], and this is not a guarantee of payment. It's a basic outline of the policy. Do you need benefits for office visit or outpatient or?
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The office office visit for sick visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get that pulled up. One moment.
[AGENT][NEUTRAL] Uh, so for this policy, it pays a maximum of $50 per day to a max of 4 days per calendar year for office visits.
[CUSTOMER][NEUTRAL] And for laboratory or anything procedures?
[CUSTOMER][NEUTRAL] Does it cover?
[AGENT][NEUTRAL] Um, so they do have a diagnostic testing benefit, um, for medical imaging tests, it covers $100 per day for a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] Um, let me see if that's defined. Sometimes it defines what that is, it will allow.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Um, so diagnostic testings can include MRIs, CAT scans, and PET scans, and radioactive iodine thyroid uptake tests.
[CUSTOMER][NEUTRAL] So no X-rays, basically.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, what about laboratory?
[AGENT][NEGATIVE] I don't show any coverage for labs.
[CUSTOMER][NEUTRAL] It doesn't
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, my question is, do, uh, do we providers spell out the claim or is it the patient?
[AGENT][NEUTRAL] Um, we accept assignment of benefits, so if you file the claim we would pay you.
[CUSTOMER][NEUTRAL] OK, and then we file it as paper claim or electronic?
[AGENT][NEUTRAL] Uh, either one. We've got an old payer ID if you'd like that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Pay ID is 60801.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK bye.