AccountId: 011433970860
ContactId: a8145e78-79c7-4640-a97d-3373257d91fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274420 ms
Total Talk Time (AGENT): 121322 ms
Total Talk Time (CUSTOMER): 85746 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/a8145e78-79c7-4640-a97d-3373257d91fa_20250307T17:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. I'm calling from Alameda Surgery Center on behalf of a patient. I just wanna see their in and out of network benefits, um, and if they're covered for our facility.
[AGENT][NEUTRAL] OK, so you're just looking for network um.
[AGENT][NEUTRAL] If the patient would be in network, is that correct?
[CUSTOMER][NEUTRAL] Um, no, we are not in network.
[AGENT][NEUTRAL] And inpatient and outpatient.
[CUSTOMER][NEUTRAL] No, it's gonna be, it's gonna be an outpatient facility. It's gonna be under ambulatory surgical center. Um, I have a CPT code that I would like you to run.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK. All right, Ms. [PII]. Can I please get the name of the facility again? I, I think I heard Alameda Surgery Center. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and then what is your phone number, ma'am? Just in case our call gets disconnected.
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, name is [PII], and then the date of birth is [PII] and then the member ID is 02553332.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. His effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment. He has uh outpatient per.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][POSITIVE] He has an outpatient benefit.
[AGENT][NEUTRAL] Per occurrence of
[AGENT][NEUTRAL] $250.
[CUSTOMER][NEUTRAL] So you guys would, uh, you guys would cover $250.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, this will go towards the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, and what is the deductible?
[AGENT][NEGATIVE] He does not have a deductible.
[AGENT][POSITIVE] This helps with deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK. And does he have an out of pocket?
[AGENT][NEUTRAL] Ma'am?
[CUSTOMER][NEUTRAL] Oh, he doesn't have a deductible hello?
[AGENT][NEUTRAL] Yes ma'am, I can hear you.
[CUSTOMER][NEUTRAL] OK, does he have um an out of pocket?
[AGENT][NEUTRAL] No, ma'am, this helps with the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, uh, OK, and so this is for an upper endoscopy, correct? Were you able to put the CPC code in?
[AGENT][NEUTRAL] We don't go by CPT code, we go by facility and he is covered under an ambulatory center.
[CUSTOMER][NEUTRAL] He is covered?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And OK, so he said he's covered at $250.
[AGENT][NEUTRAL] For deductible or coinsurance.
[CUSTOMER][NEUTRAL] OK and then um can I have your name please?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] OK, and then, oh, does this patient have any out of network benefits?
[AGENT][NEUTRAL] And that's just to verify.
[AGENT][NEUTRAL] Uh, and this is just to verify his coverage is not a guarantee of payment. There is no network because we're not the primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK, I understand you. um, OK, can I have a reference number please?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] I'm OK thank you so much.
[AGENT][POSITIVE] Alright you have a good weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.