AccountId: 011433970860
ContactId: 602f00cf-cc38-4a96-9282-b1e2cd6cc5a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196899 ms
Total Talk Time (AGENT): 93833 ms
Total Talk Time (CUSTOMER): 60654 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/602f00cf-cc38-4a96-9282-b1e2cd6cc5a3_20250422T17:43_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Good afternoon, Ms. [PII]. My name is [PII] calling from your provider's office. I'm trying to verify uh benefits for a patient again for outpatient mental health in the office.
[AGENT][POSITIVE] I'll be happy to assist with benefits today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 785132.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, I do show the outpatient calendar year maximum is $4000. Customer does have a $100 deductible.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It doesn't look like he's met his deductible yet.
[CUSTOMER][NEUTRAL] Alright, is there a visit limit on the policy?
[AGENT][NEUTRAL] No, just that dollar amount.
[CUSTOMER][NEUTRAL] OK, um, well, I guess with that being said, I have a claim. Can you check a claim for me?
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, I'm showing that that claim denied because the copay associated with the physician's charges is not covered under the policy, only the treatment and procedures at the visit is covered under the policy.
[CUSTOMER][NEUTRAL] So when you say only the visit and treatment.
[CUSTOMER][NEUTRAL] Meaning what?
[AGENT][NEUTRAL] Treatment and procedures.
[AGENT][NEGATIVE] Meaning he goes to the office, y'all charge him for the, to see the provider and then y'all charge him for any, say y'all drew blood or
[AGENT][NEUTRAL] Something or ran a test.
[AGENT][NEUTRAL] We're gonna deny that 99213 because that is the charge for the physician, but we're gonna pay for whatever tests you did at the visit. So only treatment and procedures at the visit will be covered. The copay, which is normally associated with the physician's charges, is not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I guess the policy has changed, OK.
[CUSTOMER][NEUTRAL] Alright, and you have a reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] No ma'am, that is it for today. Thank you very much.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Right