AccountId: 011433970860
ContactId: ab03c504-c7db-470a-956e-626e9f8e234a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288179 ms
Total Talk Time (AGENT): 131174 ms
Total Talk Time (CUSTOMER): 80986 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ab03c504-c7db-470a-956e-626e9f8e234a_20250219T21:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling with Augusta Oncology Associates. I'm calling to get the benefits and eligibility on a member.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It's gonna be 02596401.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII], sorry, she is active on the policy and what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] I need to make sure that this policy is in network with my facility and with the provider.
[AGENT][NEUTRAL] Well, with our company, we don't have a network, uh, but she could go to a multi-plan provider.
[AGENT][NEUTRAL] So claims can be repriced. Uh, you can contact Multiplan by phone or I can give you their email address.
[CUSTOMER][NEUTRAL] How do I know?
[CUSTOMER][NEGATIVE] Multiplay just told me they couldn't give me that information.
[AGENT][NEUTRAL] Really? Well.
[CUSTOMER][NEUTRAL] Yeah, I just need to know if her if her visit today is gonna be covered or not. I just need some basic information on whether her claims are gonna get paid on if I can see it's a limited benefit plan. I just need to know what y'all are gonna pay for so I can let her know what her responsibility is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is she coming in for for an office visit?
[CUSTOMER][NEUTRAL] She's here today for an exam and blood work.
[AGENT][NEUTRAL] OK. Well, under the plan, it doesn't cover life charges, uh, but she does have benefits for sick office visits, um, not a guarantee of payment, just verification coverage. The max we pay is $75 per day, and she has a total of 5 visits per year.
[CUSTOMER][NEUTRAL] So 75 per day, 5 per year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can go ahead and assume you're not gonna cover any chemo injection, CT scans, and you don't have buy and bill coverage, correct?
[AGENT][NEUTRAL] Uh, she does have diagnostic benefits, but she's not covered for chemo. Uh, the diagnostic pays up to 700, I'm sorry, up to, oh Lord, I forgot. Give me one moment to pull up this plan.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] OK, as far as the diagnostic, it pays up to
[AGENT][NEUTRAL] 500 per uh per calendar year.
[CUSTOMER][NEUTRAL] For diagnostic?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then the injections and CT scans.
[AGENT][NEUTRAL] I'm sorry, up to 250, but injections are not covered. A CT scan will fall under the diagnostic benefit, and it pays up to $250 per year. I apologize.
[AGENT][NEUTRAL] Up to 500 total for all combined.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a preferred outside lab you'd like us to send our blood work today?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] What was your name again?
[AGENT][NEUTRAL] Uh, my name is [PII] [PII].
[CUSTOMER][NEUTRAL] Alright, um.
[CUSTOMER][NEUTRAL] Can I get a call reference number please?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Is there a specific payer ID?
[AGENT][NEUTRAL] Um, pay ID is 64556.
[CUSTOMER][NEUTRAL] Claims address.
[AGENT][NEUTRAL] It's [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, 55.
[CUSTOMER][NEUTRAL] [PII] is that what you said?
[AGENT][NEUTRAL] Uh, the zip code [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Let me make sure I don't need to ask you anything else.
[CUSTOMER][POSITIVE] Alright, [PII], thank you so much have a good day.
[AGENT][POSITIVE] Alright, you too, Ms. [PII], thanks for calling APL. Bye.
[CUSTOMER][POSITIVE] Thanks, of course bye bye.