AccountId: 011433970860
ContactId: 7b133fa5-0dd2-4ba9-b867-3d4302eb0eab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257750 ms
Total Talk Time (AGENT): 121431 ms
Total Talk Time (CUSTOMER): 114738 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/7b133fa5-0dd2-4ba9-b867-3d4302eb0eab_20250604T19:03_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 [PII], my name is [PII]. I'm just calling to get uh benefits for a patient that's coming into the office.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[CUSTOMER][NEUTRAL] And her policy number would be 02538044ML8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So 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] Um, she is coming in for a procedure, I guess. I does she, how does it work? Because I think you guys are her secondary so I don't know if you cover anything or.
[CUSTOMER][NEUTRAL] Aren't you going to the
[AGENT][NEUTRAL] So y'all are considered outpatient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, so we pay towards the copay, deductible and co-insurance of covered charges after primary. For outpatient, the policy will pay up to $250 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, up to 250.
[CUSTOMER][NEUTRAL] OK, so any, so any co-pay that she has or deductible co-insurance, right? You said?
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] As long as it's up, so up to 250.
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] Per, yes, per day.
[CUSTOMER][POSITIVE] OK, awesome. Um, can I get, and then that's office visits, like in office procedures, ultrasound, it's the same regardless, up to 250 per day for the visit.
[AGENT][NEUTRAL] Now, in office works a little bit well, so the policy itself doesn't have any coverage for the office setting. It's only like inpatient after admission and then outpatient like ER emergent um urgent care, outpatient surgeries, but they do have the office.
[CUSTOMER][NEUTRAL] Oh, so this is just hospital stuff?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are, are you in, are you like a specialist office, physician office, or this is an outpatient? OK. So, so it'll be a in-office procedure. So that would be the office treatment rider. So the if you bill us for like a 99, this is just an example, like a 99213 like place a service code, then that would most likely be denied because there's no in-office setting.
[CUSTOMER][NEUTRAL] Yeah, yes, a specialist office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Coverage, but because she has this office treatment rider, anything that's done in the office as long as it's not cosmetic could be covered up to that $250 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, oh, I get it. OK, so the office doesn't know, but the, the procedure would fall under that too, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The treatment, right.
[CUSTOMER][NEUTRAL] Got it, got it. Is that the same if she were to come in because most likely what they come, uh, what they would be coming to us for would be like that, like office visits, uh, a procedure or, or ultrasounds. So would, would her ultrasound benefits be the same or?
[CUSTOMER][NEUTRAL] Like a 768 0 my god.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything you do in the office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just not the visit.
[AGENT][NEUTRAL] Um, just not the physical visit itself, cold, I should say.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Perfect and uh can I get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Alright, thanks for calling APO [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.