AccountId: 011433970860
ContactId: 8f433fda-7309-4881-93f5-02c58f4fb861
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169630 ms
Total Talk Time (AGENT): 88731 ms
Total Talk Time (CUSTOMER): 57387 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/8f433fda-7309-4881-93f5-02c58f4fb861_20250423T15:28_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. It's [PII] last initial [PII] Just calling to verify eligibility and benefits for patients.
[AGENT][POSITIVE] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] It is 256-453-7.
[CUSTOMER][NEUTRAL] I'll check I'll.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] 42257.
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's for an office visit, uh, an outpatient PET scan.
[AGENT][NEUTRAL] OK, for services provided in office, we cover up to $750 per day and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So, um, you guys don't cover copays for the primary insurance?
[AGENT][NEUTRAL] That not for office visits, um, for other outpatient services, um, it is covered under the outpatient benefit, but not for office visits. The copay is not covered.
[CUSTOMER][NEUTRAL] Now, we are an outpatient radiology center. Not, not, not like a doctor's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, if you're an MRI facility, then yes, the co-pay would be covered. So yes, it'd be 750 per day. Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. That sound for the day after the primary process is active, um, no authorization or predetermination required.
[AGENT][NEUTRAL] No, ma'am, because we're secondary coverage, we go by the primary insurance guidelines.
[CUSTOMER][POSITIVE] OK, got it. All right, thank you so much and I'm sorry, may I have your name again and the reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, ma'am, that's all. Thank you so much. Have a good day.
[AGENT][POSITIVE] You do the same, [PII]. Thank you for calling APO. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.