AccountId: 011433970860
ContactId: aa18fe5a-254c-47dd-8161-16a464f48b2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352989 ms
Total Talk Time (AGENT): 115307 ms
Total Talk Time (CUSTOMER): 131399 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/aa18fe5a-254c-47dd-8161-16a464f48b2d_20250514T19:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. It is spelled as [PII] I'm from Integris Southwest Medical Center. May you please help me verify the eligibility and benefits?
[AGENT][POSITIVE] OK, sure, I can assist you with the eligibility and benefits. And may I have a callback number just in case we get disconnected, Eline?
[CUSTOMER][NEUTRAL] Sure, my direct line is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 60801.
[AGENT][NEUTRAL] Um, that's the payer ID. Do you see a policy certificate number? It's gonna start with the 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um, no. Um, will you happen to check if I give you the patient's name instead and the date of birth?
[AGENT][NEUTRAL] OK, what is the spelling of the last name?
[CUSTOMER][NEUTRAL] It's [PII], [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the spelling of the first name?
[CUSTOMER][NEUTRAL] It's [PII], [PII]
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you happen to have an address for Ms. [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The address is
[CUSTOMER][NEUTRAL] It's located in.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] City, and the ZIP code is [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] What is her date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and you say you need eligibility and benefits and what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] Um, it's for bone density. I have here the CPD code. It's 77,080 and it's for outpatient hospital.
[AGENT][NEUTRAL] OK. And is this diagnostic, it's gonna be due to diagnostic to sickness. What's the diagnosis called?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's M as in Mary 81.0.
[AGENT][NEUTRAL] OK, let me just a second.
[AGENT][NEUTRAL] OK, can you repeat that diagnosis code one more time?
[CUSTOMER][NEUTRAL] It's M as in Mary 81.0.
[AGENT][NEUTRAL] OK. Right, and this is not a guarantee of payment, just a verification of coverage. This is one of our secondary supplemental plans to the major medical and um with this one, we have an outpatient maximum of 5000 per cover person per calendar year.
[AGENT][NEUTRAL] Now, if this is considered preventative, it's not covered because we do not cover preventative. If, if it's a diagnostic testing, then yes, it's gonna be considered um the benefits.
[CUSTOMER][NEUTRAL] Mhm. So that means the, the insurance is a secondary to, um, it has a primary insurance, uh, in Blue Blue Cross.
[AGENT][POSITIVE] Yes, we're the secondary to Blue Blue Cross. That's correct.
[CUSTOMER][NEUTRAL] Mhm. All right. Got it. And the amount is 5000, right? The maximum amount?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Correct. That's a 5000 calendar year maximum.
[CUSTOMER][NEUTRAL] OK. Um, I think I already have all the details that I needed for this patient. May you please spell out your first name for me? and may you please also provide the reference number?
[AGENT][NEUTRAL] My name is [PII]. That's S [PII]. Last initial [PII].
[AGENT][NEUTRAL] And we don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh, OK, got it. Thank you so much so for assisting me today. That's all that they needed for now.
[AGENT][POSITIVE] Mhm. OK. Well, thank you for calling APL. Have a good day, honey.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.