AccountId: 011433970860
ContactId: 97249a4d-558a-4ad6-a4f2-e903539d6e71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193059 ms
Total Talk Time (AGENT): 99693 ms
Total Talk Time (CUSTOMER): 75324 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/97249a4d-558a-4ad6-a4f2-e903539d6e71_20250325T20:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I wanted to verify benefits for one of our patients.
[AGENT][POSITIVE] OK, I can help you with the benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01731805.
[CUSTOMER][NEUTRAL] And then let me see it looks like ML 7.
[AGENT][NEUTRAL] OK, here we go. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number that you provided turned on [PII], but there is an active policy. Let me get that for you.
[CUSTOMER][NEUTRAL] OK, so she should have a new card somewhere. OK, let me see turn.
[AGENT][NEUTRAL] Alright, so the new policy number is 258.
[AGENT][NEUTRAL] 9453.
[AGENT][NEUTRAL] And this policy has been active since [PII].
[CUSTOMER][NEUTRAL] [PII] OK and does she have any outpatient benefits for office visits?
[AGENT][NEUTRAL] OK, so for outpatient benefits, she does the um calendar day max is $4700.
[AGENT][NEUTRAL] Now, the policy itself doesn't have any coverage for like in office if you were to bill for facility, but she does have the office treatment rider in which any treatment in the office could be covered up to that $4700 per day as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] OK, so it's for treatments but not let's say actual copays and things like that. It would just be covering the treatments up to that amount.
[AGENT][NEUTRAL] Well, we pay towards the copay, deductible and co-insurance. If you have a facility or place of service, like if you bill us 99213, that might be denied because there's a place of service, but if you bill us for like a, I don't know, some type of treatment that you do in the office, it could be covered because of that rider.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] OK, yeah, because we just bill 99213 or 99214 as an office, um, not facility, mhm.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, so if you bill with those codes, it could be denied, but if you bill us for the treatment she receives, then it could be processed.
[CUSTOMER][POSITIVE] OK, OK, yeah, because we just, it's a consultation, it's not a treatment per se so OK so that definitely clarifies. OK, thank you so much for your help that's everything I needed.
[AGENT][NEUTRAL] Oh, yes, OK.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.
[CUSTOMER][POSITIVE] You're welcome bye bye.