AccountId: 011433970860
ContactId: ac06e95f-d1d6-4d5e-b327-95aa76f8ef03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342309 ms
Total Talk Time (AGENT): 126626 ms
Total Talk Time (CUSTOMER): 106834 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/ac06e95f-d1d6-4d5e-b327-95aa76f8ef03_20250128T15:10_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], this is [PII] calling from Doctor [PII]'s tourist office. I would, I was hoping you could help me with benefits for patients.
[AGENT][NEUTRAL] OK, I can help you spell your name.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] And you said that you needed assistance with eligibility and benefits?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02483111.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and you can ask for extension [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] please.
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm showing an effective date of [PII].
[AGENT][NEUTRAL] Uh, the policy is active at this time, and [PII], did you say this is for in an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] This is an ambulatory surgical center, so outpatient.
[AGENT][NEUTRAL] OK. Outpatient. OK.
[AGENT][NEUTRAL] Alright, so I have that information for you. I'm showing the maximum outpatient benefit and actually the outpatient and inpatient benefit, uh, there is a combined maximum of up to $9100 per covered person per calendar year.
[AGENT][NEUTRAL] And let me see how many.
[AGENT][NEUTRAL] Dependents we have, yeah, so this is a family coverage and then the family maximum is up to 27,300 per calendar year for all covered persons combined.
[CUSTOMER][NEUTRAL] You said 2700?
[AGENT][NEUTRAL] 27,300.
[AGENT][NEUTRAL] For the family.
[CUSTOMER][NEUTRAL] Got it. And do you have any accumulators for that or anything?
[AGENT][NEUTRAL] Mhm, I'll verify if any of that benefit has been used for 2025. 1 moment.
[AGENT][NEGATIVE] I do not show any benefits used at this time.
[CUSTOMER][NEUTRAL] Got it. Um, does the, this benefit cover deductible and co-insurance, both, neither, just one of them?
[AGENT][NEUTRAL] Uh, deductible co-insurance and or co-pay amounts of covered charges, and of course information provided is verification, not a guarantee of payment. And any other questions, [PII]?
[CUSTOMER][NEUTRAL] Um, I just wanna make sure this doesn't depend on the like if I give you a CPT code, you're not able to tell me whether or not it's covered.
[AGENT][NEUTRAL] What's, just give me the description of the service. It's in an ambulatory surgical center. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, correct. And um it's going to be a combined tonsillectomy and palate expansion procedure.
[AGENT][NEUTRAL] OK. So if neither of those are elective surgery, I don't believe a tonsillectomy is. I'm not sure what the other one is.
[AGENT][NEUTRAL] Can you explain?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, let me see here. So I can tell you the patient's diagnosis is obstructive sleep apnea and hypertrophy of tonsils.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so those items can be considered under the outpatient benefit provided.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Keeping in mind there's no guarantee because we have to receive the actual documentation for review.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] I'm just writing down what you're saying. Give me one moment.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Perfect. Um, I believe that is all the information I need, [PII]. Thank you so much. Would I be able to get a reference number for this call?
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. [PII]
[AGENT][NEUTRAL] First initial of my last name is [PII] and anything else?
[CUSTOMER][NEUTRAL] And it's gonna be today's date and time or just today's date?
[AGENT][NEUTRAL] My name and today's date. You can add the time if you choose to, it's up to you.
[CUSTOMER][POSITIVE] Got it. Thank you so much, [PII]. Um, you've been very helpful today.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.