AccountId: 011433970860
ContactId: 607bdc54-3a15-439d-9991-94885fe36093
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377589 ms
Total Talk Time (AGENT): 194059 ms
Total Talk Time (CUSTOMER): 113585 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/607bdc54-3a15-439d-9991-94885fe36093_20250314T18:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was wondering, could you verify if I gave you a CPT code if it would be covered?
[AGENT][NEUTRAL] No, we don't use the CPT code. It's more a place of service, but I can let you know the coverage.
[CUSTOMER][NEUTRAL] OK. So, um, because my, um, my regular insurance, it would be for like the NIP test, which tests for like Down syndrome and all those things, um, when you're pregnant, and I have to meet my deductible first before they will cover it. So then it sounds like, well, and I know I haven't met my deductible, so then I didn't know from you guys what would be covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, well, I can look into the policy for you, but just in general, if the, so if the deductible is being required for service, um, you would either have to pay that upfront and then on the back end be reimbursed from because we don't come in until the back end after primary. But also keep in mind if primary doesn't apply, then we can't apply either, but I can definitely let you know your coverage for your policy with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, primary would, it's just I would be paying it, it would go towards my deductible since I haven't met it.
[CUSTOMER][NEGATIVE] So they would, they, it's it's a covered service, but I would just be paying full for it so then I wasn't sure if you guys would pick up what my out of pocket cost is.
[AGENT][NEUTRAL] So you
[AGENT][NEUTRAL] Right, we pay towards the copay, deductible and co-insurance. So like on the back end, if you do have to pay what you're saying, then we could possibly reimburse you or um if something still owed to the provider, you know, pay them. I would have to look at your policy, but usually there's like a calendar year max and then it will be up to that max for your secondary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Um, 5402714547, and then let me get out my card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, they said once I met my deductible, then it would be a 20% um co-insurance, but I know I haven't met my deductible.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, um, policy number is 02475819.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you um verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Um, [PII], [PII], and you said phone number or email?
[AGENT][NEUTRAL] Um, email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you and all the information provided is a verification of benefits, not a guarantee of payment. So I'm just waiting for your um policy benefits to populate here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just scroll.
[AGENT][NEUTRAL] Here we go. So, um, let me ask you this, where the test is done, is it like in the office or is it like a hospital outpatient facility or?
[CUSTOMER][NEUTRAL] It's in the office, but the office is associated with a hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I don't know if that makes it murkier.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that would go under, um, so your, your policy with us is broken down into inhospital and outpatient. So once you're admitted, you know, you're in labor, then we'll use all your in-hospital benefits, which is $4000 per calendar year.
[AGENT][NEUTRAL] And then for outpatient, it's 4000 per calendar year as well. Um, so if they bill
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How can I? So if they bill, you know how some places bill like a facility charge and then they bill for the treatment?
[AGENT][NEUTRAL] And then some places bill everything altogether. So if they break their treatment up, or sorry, if they break their billing up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your policy with us doesn't have like any in-office.
[AGENT][NEUTRAL] Coverage, so like you were trying to give the CPT code. If it's a CPT code for an office visit, it wouldn't be covered because you don't have any coverage for the facility, but you do have the office treatment writer, so any treatment in the office, as long as it's not cosmetic, could be covered up to that $4000 per calendar year. So it depends on how they code their uh services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so they didn't give me like a facility code, they only gave me the like test code.
[CUSTOMER][NEUTRAL] So it sounds.
[AGENT][NEUTRAL] Oh, they're trying to see if the treatment itself is covered, but we go by a place of service, not so much was done. The best thing for you to do, um, would be to give them, like if you have a contact there at the facility, just give them our phone number and have them call us to verify benefits and providers call us all the time. Um, they'll just need your policy number and your first and last name and date of birth, so, you know, to verify.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh huh OK perfect thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Nope, that should do it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL and congratulations.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.