AccountId: 011433970860
ContactId: a42841a5-88ea-46fe-ad8c-7781744de6dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218320 ms
Total Talk Time (AGENT): 99325 ms
Total Talk Time (CUSTOMER): 58091 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/a42841a5-88ea-46fe-ad8c-7781744de6dc_20250203T20:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to gather eligibility and benefits for a patient please.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] 1869088
[AGENT][NEUTRAL] OK and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you repeat that a little louder and slower?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And is this service in a doctor's office?
[CUSTOMER][POSITIVE] Yes it is specialist.
[AGENT][NEUTRAL] OK. OK. And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Thanks for that information, [PII]. I'm showing an effective date of [PII].
[AGENT][NEUTRAL] The policy is active at this time.
[AGENT][NEUTRAL] And the physician visit, um, fee is not covered. There is a treatment rider under this policy, so if there's covered treatment during the course of the visit, um, covered items can be considered under the outpatient benefit. Would you like that benefit?
[CUSTOMER][NEUTRAL] OK, hold on a second. So this patient has Cross Blue Shield as a primary coverage. APR as the second, um, you guys, you said the co-payment is not covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the physician visit fee is not covered.
[CUSTOMER][NEUTRAL] Does that include diagnostics?
[AGENT][NEUTRAL] OK, that would be treatment.
[AGENT][NEUTRAL] So treatment in the office can be considered, you know what type of test it is?
[CUSTOMER][NEUTRAL] No, I do not since this patient has not come in yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so if you bill for a physician's visit and then a diagnostic test, uh, we can consider the diagnostic test. The the physician visit will be, but they're not, it's not covered by the policy.
[CUSTOMER][NEUTRAL] OK, is there a deductible?
[AGENT][NEUTRAL] No, because this policy is secondary to the major medical plan, it picks up uh the amount that the primary applies towards deductible, co-insurance and or co-pay amounts up to the policy benefit maximum.
[CUSTOMER][NEUTRAL] So do you guys coordinate with Blue Cross Blue Shield?
[AGENT][NEUTRAL] We are secondary to Blue Cross.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, is there a co-payment?
[AGENT][NEUTRAL] There isn't it just pays for treatment in the office up to $1 amount per calendar year.
[AGENT][NEGATIVE] So there's no copay for the physic I mean it's not covered under this policy.
[AGENT][NEUTRAL] Only treatment in the office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Do you have a reference number please?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. [PII] and first initial of last name is [PII]. Any other questions?
[CUSTOMER][POSITIVE] No, that's it thank you so much you have a good day.
[AGENT][POSITIVE] Alrighty, thank you for calling APL.