AccountId: 011433970860
ContactId: 64cd4cc7-2231-4702-ba15-a2916c37ded3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 161880 ms
Total Talk Time (AGENT): 91519 ms
Total Talk Time (CUSTOMER): 57923 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/64cd4cc7-2231-4702-ba15-a2916c37ded3_20250402T15:21_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] Good morning [PII]. My name is [PII]. I'm calling from Baptist Health of South Florida, and I would like to know if this patient is active.
[AGENT][POSITIVE] OK, I can definitely help you with the eligibility. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] and the policy number is 02145414ML and the number 8.
[AGENT][NEUTRAL] Thank you. Hold on one moment. And can you verify the member's first? You're welcome. Can you verify the member's first and last name and date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] said [PII] is [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, um, a question, does it cover the, um, specialist office?
[AGENT][NEUTRAL] Let's see, hold on one second.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[AGENT][NEUTRAL] OK, so for outpatient, the benefit is up to $8000 per calendar year.
[AGENT][NEUTRAL] If you all bill a facility charge, like using 99213 or 99214, that claim could be denied because they don't have any in-office coverage for the setting.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But she does have the office treatment rider, so any treatment in the office could be covered up to that $8000 per year.
[CUSTOMER][NEUTRAL] OK, if, but if it's a facility if it's office.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, do they call office?
[AGENT][NEUTRAL] If it's a, if it's a, you know how you you can bill for the facility and bill for the treatment, if you're billing us just for the facility, it could be denied. What has the treatment.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEGATIVE] Then it could be denied.
[AGENT][NEUTRAL] Could be covered under that office treatment rider.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um, can I get a reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial of my last name is [PII].
[CUSTOMER][POSITIVE] [PII]. OK. Thank you and have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. You also, was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you very much.
[AGENT][POSITIVE] Alright, thanks for calling APO. You're welcome. Have a great week. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.