AccountId: 011433970860
ContactId: 94eee46d-21fb-4ea6-b1d7-21e27a117ee1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411109 ms
Total Talk Time (AGENT): 117202 ms
Total Talk Time (CUSTOMER): 67977 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/94eee46d-21fb-4ea6-b1d7-21e27a117ee1_20241230T14:16_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from MUSC Marion and I have a patient on the CSS.
[AGENT][NEUTRAL] OK, I can't hear you.
[CUSTOMER][NEUTRAL] me, I'm calling from [PII].
[AGENT][NEUTRAL] OK, and I missed your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. And how can I help you, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I have a patient that is here for her screening mammogram and I'm trying to find out if APL would cover that.
[AGENT][NEUTRAL] OK, I can help you. What's the policy number?
[CUSTOMER][NEUTRAL] OK, the policy number is 01813684.
[AGENT][POSITIVE] And a good phone number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Ms. [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. So I'm showing an effective date of [PII]. Policy is active at this time, and you said this is for a screening mammogram?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] She she's still checking OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this policy does have a routine health screening benefit.
[AGENT][NEUTRAL] And you said for a mammogram, so I'm looking at the covert tests.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, mammogram is listed. One moment.
[AGENT][NEUTRAL] And so
[AGENT][POSITIVE] The benefit for that.
[AGENT][NEUTRAL] It's $100 per day.
[AGENT][NEUTRAL] Maximum of one day per calendar year.
[AGENT][NEUTRAL] And let me verify if they've had uh this done any other time this year.
[CUSTOMER][NEUTRAL] So this payment go to the facility or does it go to the patient?
[AGENT][NEUTRAL] So if it's submitted by the provider and there's an assignment of benefits on file.
[AGENT][NEUTRAL] Uh, the payment will be issued to the provider.
[AGENT][NEUTRAL] And so I don't show where she's had one this year.
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] Um, the benefit is $100 per day for that test.
[CUSTOMER][NEUTRAL] OK, hold on just one second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] So if we submit this to the [PII].
[AGENT][NEUTRAL] Yeah, I can't hear you. I don't know if you have me on speaker.
[CUSTOMER][NEUTRAL] No, I don't. The [PII], is that the correct address?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's not. The claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then we can you can fax it or submit it electronically as well if you need that information I can give that to you.
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] So the payer ID number is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claims fax number is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942-3 and make it to the attention of claims.
[AGENT][NEUTRAL] Information provided is verification, not a guarantee of payment. And did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] That is it [PII]. Thank you for your help you have a great day.
[AGENT][POSITIVE] OK, you, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Uh huh bye bye.