AccountId: 011433970860
ContactId: 7adebe40-9242-4881-a150-9a78a487853f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263529 ms
Total Talk Time (AGENT): 104382 ms
Total Talk Time (CUSTOMER): 85299 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/7adebe40-9242-4881-a150-9a78a487853f_20250609T16:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is. Can I help you?
[CUSTOMER][NEUTRAL] Um, yeah, I need to go over some benefits for a patient to see who files the claim as well.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And your name is?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It is 1381794.
[AGENT][NEUTRAL] OK, wait.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh huh it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is um [PII].
[AGENT][NEUTRAL] OK. Um, showing the effective date of [PII], she is active on the policy and what benefits are needed for the patient?
[CUSTOMER][NEUTRAL] So this is gonna be outpatient surgery at a surgical center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification of coverage with the policy as secondary. It helps with primary insurance deductible copay or co-insurance, and it shows she has an outpatient benefit max up to $750 per calendar year.
[CUSTOMER][NEUTRAL] There's an [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi doctor.
[CUSTOMER][NEUTRAL] Alright, so they have a deductible, co-pay, and what was the last one? Co-insurance? OK.
[AGENT][NEUTRAL] Coinsurance.
[CUSTOMER][NEUTRAL] That's the one I cut off and then you said she has 750 for the year for.
[AGENT][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] Outpatient, OK, and then next question um.
[CUSTOMER][NEUTRAL] Is she responsible for filing her own claim?
[AGENT][NEUTRAL] Uh, she can, or we do take assignment from providers so providers can also process the claim.
[AGENT][NEUTRAL] Or submit the claim information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and then if I give you a CPT can you tell me if her insurance is gonna pay anything to it?
[AGENT][NEUTRAL] What is the procedure code? I can verify if it's.
[AGENT][NEUTRAL] Covered or it's, um, considered a covered procedure.
[CUSTOMER][NEUTRAL] It's um 42975.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Well, if it's covered by primary and it's performed in an outpatient facility, it could be covered under the policy. We can't give a guarantee. We can only verify with this policy procedures in an outpatient facility could be covered, especially if it's covered by primary as well.
[AGENT][NEUTRAL] But it's not a procedure that is just flat out, not covered by the policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and is there.
[CUSTOMER][NEUTRAL] Well, that's pretty much the only.
[CUSTOMER][NEUTRAL] No, that was just yeah, um, can I have a reference number?
[AGENT][NEUTRAL] Uh, you may use my name in today's date if you like.
[CUSTOMER][NEUTRAL] Yeah, go ahead. What's your, what did you say your name was?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APO Ms. [PII]. Have a great day.