AccountId: 011433970860
ContactId: 7d1c2cc8-7b72-4f54-b973-37ee8a0d85a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280929 ms
Total Talk Time (AGENT): 125780 ms
Total Talk Time (CUSTOMER): 107157 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/7d1c2cc8-7b72-4f54-b973-37ee8a0d85a3_20250523T15:49_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good morning. This is [PII] calling from AdventHealth Imaging Center. Um, I'm calling to get benefits and eligibility information for a patient that's here for outpatient service.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] OK, well I can definitely help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's [PII] and the policy number for outpatient benefits is 01336688M as in L as in Lamb 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. First name is let me this song because it's [PII].
[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] for [PII]. And what type of benefits, you said outpatient?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Outpatient ultrasound.
[CUSTOMER][NEUTRAL] It's a CPT code 76815.
[AGENT][NEUTRAL] We can't really use the codes. Let me see if um this policy is specific for if they specifically list the diagnostic testing. Hold on one second, OK?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But just in general for the outpatient um benefits is up to $6000 per calendar year. There is no deductible.
[AGENT][NEUTRAL] Did you want me to see if she's used any of the 6000 for the year? OK, hold on one moment.
[CUSTOMER][POSITIVE] Yes, yes please.
[AGENT][NEUTRAL] Mm just the last one, hold on one moment, yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so so far for [PII], um, they have not used any of their benefits, and let me check on that. I'm waiting for the benefit, the policy to populate.
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] And that's the out of pocket?
[AGENT][NEUTRAL] Um, that's the max that would be, that could be applied towards their expenses. There's no out of pocket. This is her secondary.
[CUSTOMER][NEUTRAL] No deduct
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so this one doesn't specify, so, um,
[AGENT][NEUTRAL] Some of them have like particular test, but I don't see it on here. So it'll just be that calendar year max.
[CUSTOMER][NEUTRAL] OK, so and this does not, OK, so it doesn't cover co-payments.
[AGENT][NEUTRAL] That we could pay up to.
[AGENT][POSITIVE] It covers it, so we pay towards the copay, the deductible and co-insurance after primary. We don't charge it, we help pay it.
[CUSTOMER][NEUTRAL] OK, OK, because, alright, so she has your her United and so today's payment is 31288, so that's what she would have to pay it's the 31288 before this plan kicks in or does they have to submit if she make a co-pay?
[CUSTOMER][NEUTRAL] That's what we're not trying we can't we're trying to figure out.
[AGENT][NEUTRAL] So it'll kind of be like a reimbursement if she pay, if there's something that's required for them to pay to be seen, then they're gonna have to pay it to be seen and then when you file the claim, they can be reimbursed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then they have to submit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you all are to file the claim after you file with her primary, then file to us.
[CUSTOMER][POSITIVE] However it works.
[CUSTOMER][NEUTRAL] OK there alright, is there a confirmation number for this call?
[AGENT][NEUTRAL] So there's no confirmation, but you can use my name on today's date, which is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much and you have a great day.
[AGENT][POSITIVE] You also, and thanks for calling [PII]. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too love alright bye bye bye.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.