AccountId: 011433970860
ContactId: 861501a9-655d-4e3b-8f12-f2ff38a0ecac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257040 ms
Total Talk Time (AGENT): 123516 ms
Total Talk Time (CUSTOMER): 82424 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/861501a9-655d-4e3b-8f12-f2ff38a0ecac_20250327T15:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, good morning, [PII]. I'm calling from a provider's office to get eligibility and benefits on a mutual patient.
[AGENT][NEUTRAL] OK, I can help you with both eligibility and benefits. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] My name is [PII], first initial [PII] and call back number is.
[CUSTOMER][NEUTRAL] [PII], I'm sorry. [PII].
[AGENT][POSITIVE] Thank you very much, Ms. [PII]. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] The facility is called
[CUSTOMER][NEUTRAL] On-site imaging.
[AGENT][NEUTRAL] OK, and can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number is 6.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] OK, that is our payer ID number. Do you see another number there? It might say inpatient or outpatient cert number.
[CUSTOMER][NEUTRAL] It says in hospital benefits cert number, but I wanted to know if she was covered within the office.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so if you can.
[CUSTOMER][NEUTRAL] OK, so that number is 0.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02462876. [PII] the [PII].
[AGENT][POSITIVE] OK, thank you very much. Let me pull up the policy for us.
[AGENT][NEUTRAL] OK, I do show that she does have an active policy. The effective date of the policy is [PII].
[AGENT][NEUTRAL] Uh, let me check your benefits here real quick.
[AGENT][NEUTRAL] She has, um, and this is a supplemental insurance policy, it's billed secondary to the primary. It helps with deductible copay or co-insurance. She has an inpatient benefit amount of $2000 and then she also has an outpatient per calendar day benefit of $2000.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, let me check about office visits for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To see if she has office visits if they're covered or not. It can be a real quick hold while I'm searching.
[CUSTOMER][POSITIVE] Not a problem. Thank you so much.
[AGENT][NEUTRAL] For her policy certificate.
[AGENT][NEUTRAL] And I'm gonna read that and see if it has office visits.
[AGENT][NEUTRAL] I'm on the line. I'm just letting you know it's gonna be just a moment so the computer can pull it up.
[CUSTOMER][NEUTRAL] No, no. I, I understand, yeah. No, I, I understand.
[AGENT][NEUTRAL] OK, she does not have office visits on her policy.
[CUSTOMER][NEUTRAL] OK. So, um, this morning she's coming in for an ultrasound visit at the office. She's not covered for office visits. She's only covered for hospital visits, correct?
[AGENT][NEUTRAL] Now the ultrasound if it's done in an ER urgent care center, MRI imaging center or an ambulatory center.
[AGENT][NEUTRAL] It would be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Not a problem. Can I get a reference number for this call, [PII]?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your help. Have a lovely afternoon.
[AGENT][POSITIVE] You too, thank you for calling APL you guys have a great day too. There's.
[CUSTOMER][NEUTRAL] Likewise.
[AGENT][NEUTRAL] Alright