AccountId: 011433970860
ContactId: 659402f7-cf6c-44ff-bf4f-c6c5a3b23581
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 150300 ms
Total Talk Time (AGENT): 89885 ms
Total Talk Time (CUSTOMER): 56147 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/659402f7-cf6c-44ff-bf4f-c6c5a3b23581_20250313T18:45_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, I'm calling because I'm trying to get benefits for a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits. And may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII]. Call back number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] There it says 2 sorry 02365652 and [PII].
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [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 showing the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Do you cover copays or deductible for uh office?
[AGENT][NEUTRAL] So our policy, our policies pay towards the copay, deductible and co-insurance of covered charges after primary.
[AGENT][NEUTRAL] Now, as a secondary, the policy doesn't have like facility or place of service.
[AGENT][NEUTRAL] Coverage for the for the facility, but it does have the office treatment rider, so any treatment done in the office as long as it's not cosmetic, could be covered up to that $750 per day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so if you just a regular office visit you wouldn't cover it or an ultrasound.
[CUSTOMER][NEUTRAL] Only for procedures.
[AGENT][NEUTRAL] No, so if you bill us for 99213, like a procedure office place of service, it will most likely be denied as office visits not covered. But if you bill us for
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Something treatment done in the office, um, then the office treatment writer would come into play and we could pay up to that $750 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, got it. Can I have a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. So that's [PII] to my last [PII].
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][POSITIVE] OK perfect thank you very much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that's gonna be all.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.