AccountId: 011433970860
ContactId: 7fa71fb4-689a-4a8f-bde8-aac4f321d040
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261480 ms
Total Talk Time (AGENT): 143027 ms
Total Talk Time (CUSTOMER): 131533 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/7fa71fb4-689a-4a8f-bde8-aac4f321d040_20250129T19:26_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Possible like a time.
[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 calling from an OBGYN office about one of our patients that's here today, um, just calling to get benefits on her.
[AGENT][NEUTRAL] OK, well, I can definitely 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, so [PII] and then her number is [PII] ML8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] is her first name. [PII] is her last name and 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 So I'm actually showing that the policy number you gave is no longer active. So that policy was effective from [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] So as of right now we're gonna start off with.
[AGENT][NEUTRAL] But she does have an active policy. Um, let me know when you're ready for that number.
[CUSTOMER][POSITIVE] I'm ready for it, please.
[AGENT][NEUTRAL] OK, so it's 230-1203.
[CUSTOMER][NEUTRAL] the beginning
[CUSTOMER][NEGATIVE] Probably not more than 10.
[AGENT][NEUTRAL] And this has been active since [PII] and it's still active.
[CUSTOMER][NEUTRAL] OK, so that's probably why we didn't use it.
[CUSTOMER][NEGATIVE] We have the wrong number.
[CUSTOMER][NEUTRAL] OK, I'll update that.
[AGENT][NEUTRAL] And then you said you wanted benefits as well?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] What type of benefits, like outpatient or inpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Outpatient I guess is what we would be.
[AGENT][NEUTRAL] Is she being admitted?
[CUSTOMER][NEUTRAL] Like for office visit?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, that would be um outpatient. So for outpatient, the policy will pay up to $500 per calendar day. Um, now the policy itself doesn't have like any in-office setting coverage, like if you were to build a facility charge, but she does have the office treatment rider in which any um treatment in the office as long as it's not cosmetic, um, could be covered up to that $500 per day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, $500 per day. So let me see what, so for like just the, the regular office visit code, is it easier if I give you a code? Can you run like the CPT code or?
[AGENT][NEUTRAL] No, our policies don't go by the service, it's the uh place of service.
[CUSTOMER][NEUTRAL] No? OK, oh OK, OK.
[CUSTOMER][NEUTRAL] OK, I just wanna see because her other insurance left with the $40 copay, but so what you, you, if we go through you guys, she would be covered for today's visit, is that how what I'm understanding or?
[AGENT][NEUTRAL] So, so you'll bill primary first and then if, if she does have a co-pay and you all require her to pay it to be seen, then she'll have to pay that co-pay and then on the back end once you bill primary and you bill us, we'll see because we'll ask for the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If you guys covered enough, OK, so she does have to pay the copay.
[AGENT][NEUTRAL] No, no, no, no, no, no, no, hold on. Not see if we cover it or not. We'll see what she's paid and she can be reimbursed for that co-pay. We pay towards the copay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Or, or we could pay you all if you know, if primary has applied, what they're gonna pay and there's still something left over, we can reimburse her for her co-pay and then pay you all, but up to that 500 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so you guys pay towards that.
[CUSTOMER][NEUTRAL] Got it. I will let her know that because we are collecting her co-pay now, so she would have to pay it and then what what.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On the back end when you file that claim, she can be reimbursed.
[CUSTOMER][NEUTRAL] Yeah, OK, I will let her know that.
[AGENT][POSITIVE] Alrighty. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Send
[CUSTOMER][POSITIVE] No, that's it thank you so much, [PII]. Can I get a reference number?
[AGENT][NEUTRAL] Yes, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much [PII] have a good rest of your day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye.