AccountId: 011433970860
ContactId: 863307e4-6bcc-49dc-89aa-958ee57f08ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 160509 ms
Total Talk Time (AGENT): 54728 ms
Total Talk Time (CUSTOMER): 86252 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/863307e4-6bcc-49dc-89aa-958ee57f08ab_20250521T18:29_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. I'm calling Doctor [PII]'s office. I just called, um, but I forgot to ask a question regarding a patient's gap plan.
[AGENT][POSITIVE] OK, I'll be happy to assist. May I have your first name please?
[CUSTOMER][NEUTRAL] Yes, it's [PII], that's [PII]
[AGENT][POSITIVE] And [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 01845857 ML8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. And how can I assist today?
[CUSTOMER][NEUTRAL] OK, so, um, the patient, this is this gap plan has a deductible with, with the primary plan, so any procedures rendered in the office will be subject to the patient's deductible. So, um, the patient states that this that this gap plan will cover procedures that are rendered in the doctor's office, but I was told that it only covers for procedures rendered in a hospital.
[CUSTOMER][NEUTRAL] So, um, I just wanted to double check on that because he's telling me that it does cover.
[AGENT][NEUTRAL] No, it does not. He does not have benefits for treatment in an office or clinic setting unless the diagnosis is for cancer.
[CUSTOMER][NEUTRAL] Oh, I see. OK, so then if he just had a to remove a.
[CUSTOMER][NEUTRAL] if you had a biopsy but it had nothing to do with cancer, then it would not be covered.
[AGENT][NEUTRAL] If the diagnosis is not cancer, it would not be covered.
[AGENT][NEUTRAL] Unless he, unless it is billed, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, so if he has mhm.
[CUSTOMER][NEUTRAL] No, no, what you're saying?
[AGENT][NEUTRAL] Unless it is billed as place of service 22, if it's billed as place of service 11 which is office or clinic, it's going to deny.
[CUSTOMER][NEUTRAL] I see. OK, so then it is, um, so it, this is just for hospital, anything in the office if it was if it's due to cancer, then it would be covered if that's only would be covered in the office setting.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] That is the only way it would be um benefits are covered in an office or clinic setting, the diagnosis would have to be cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright then, may I have a reference number? Would it be your name [PII]?
[AGENT][NEUTRAL] Yes, just my name and today's date and time. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that was all. OK, I'll let him know thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.