AccountId: 011433970860
ContactId: 99c8c726-0001-4220-989b-ecb6d325c156
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290239 ms
Total Talk Time (AGENT): 80226 ms
Total Talk Time (CUSTOMER): 48958 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/99c8c726-0001-4220-989b-ecb6d325c156_20250606T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Piedmont Healthcare. I'm calling to get benefits and eligibility for pulmonary rehab. I do have CPT codes as well as the diagnosis code.
[AGENT][NEUTRAL] OK [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 02356134.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[AGENT][NEUTRAL] Give me just a moment to pull up the policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was for um what was it for again?
[CUSTOMER][NEUTRAL] Pulmonary rehab for outpatient hospital facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me just a moment, let me see.
[AGENT][NEUTRAL] And just so you know this is secondary gap insurance so we will need the primary EOB when filing a claim, um, and this is just a verification of benefits, not a guarantee of payment. I am showing that there is an outpatient benefit maximum of up to $1500 per calendar year.
[AGENT][NEUTRAL] And let me see, you were wanting pulmonary rehab, correct? Give me a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing that as a covered service, but let me check real quick one more thing.
[AGENT][NEUTRAL] Yeah, I'm only showing surgery or diagnostic testing, um, and physical therapy.
[AGENT][NEUTRAL] Not necessarily pulmonary rehab.
[CUSTOMER][NEUTRAL] Diagnostic testing, so it's not covered.
[AGENT][NEUTRAL] Diagnostic testing is covered in a hospital.
[CUSTOMER][NEUTRAL] Now you said surgery and diagnostic testing, so it's not covered. OK. Can I get the first initial to your last name and a call reference number, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date which is [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much for all of your help. You have a great weekend. Thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. You have a great weekend as well, OK?
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.