AccountId: 011433970860
ContactId: 605ecb05-2ba2-4b91-836d-6ac607e81aba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184320 ms
Total Talk Time (AGENT): 107656 ms
Total Talk Time (CUSTOMER): 39358 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/605ecb05-2ba2-4b91-836d-6ac607e81aba_20250213T17:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Prisma Health and want to verify patients benefits eligibility.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the eligibility and benefits. And can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII]. It's spelled [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] 8645229002. No extension.
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] 021 37806
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am um showing the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Ta office visit for PCP.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. So for outpatient, the policy would pay up to $500 per calendar day. Now for office, um, I'm sorry?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, go ahead. I didn't say anything.
[AGENT][NEUTRAL] For, OK, um, for office, like the facility charges, it would most likely be denied because there's no coverage for the in-office setting, but there is office treatment rider in which the treatment in the office could be covered up to that $500 per day.
[CUSTOMER][NEUTRAL] OK. So the, in uh uh sick office visit is not covered?
[AGENT][NEUTRAL] OK, so if you bill for the facility charge, you know how you bill for facility charges. If you bill for facility or place of service, it most likely will be denied because the policy doesn't have in-office coverage. They have an additional rider which are additional benefits that could cover any treatment done in the office as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Up to $500 a day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the, the facility, no, but the treatment, yes, could be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I just need your name and call reference number, please.
[AGENT][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And there's no call reference number, but you can use my name in today's date. You're welcome.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome