AccountId: 011433970860
ContactId: b4face2a-6e8b-4d69-82dc-03b09db8ce25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317010 ms
Total Talk Time (AGENT): 95670 ms
Total Talk Time (CUSTOMER): 136701 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/b4face2a-6e8b-4d69-82dc-03b09db8ce25_20250618T13:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I want eligibility and benefits.
[AGENT][NEUTRAL] I can verify benefits and eligibility. May I have your name and a policy number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. Last name initial [PII]. Policy number is 025.
[CUSTOMER][NEUTRAL] 57208
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] L [PII].
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim.
[AGENT][POSITIVE] This plan is effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and it is active.
[AGENT][NEUTRAL] Which benefit can I provide for you?
[CUSTOMER][NEUTRAL] I have some CPT codes for that.
[AGENT][NEUTRAL] Where would the place of service be?
[CUSTOMER][NEUTRAL] Specialist office.
[AGENT][NEUTRAL] OK, and the CPT code?
[CUSTOMER][NEUTRAL] First is 70486.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which is for sleep oh sorry, which is for MRI and CT scan.
[CUSTOMER][NEUTRAL] Then 30,520.
[CUSTOMER][NEUTRAL] 30,140.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 31231.
[CUSTOMER][NEUTRAL] 31237.
[CUSTOMER][NEUTRAL] 31295.
[CUSTOMER][NEUTRAL] 31298
[CUSTOMER][NEUTRAL] 61782. All these codes are for surgery.
[CUSTOMER][NEUTRAL] Then 92557
[CUSTOMER][NEUTRAL] 92588. These both are for hearing.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] 95004.
[CUSTOMER][NEUTRAL] 951-65
[CUSTOMER][NEUTRAL] 963-72. These are for allergy testing, allergy serum, allergy injection.
[CUSTOMER][NEUTRAL] And the last code is 94,010, which is for pulmonary function test.
[AGENT][NEUTRAL] These codes fall under the office treatment rider, which falls under the outpatient calendar year benefit amount of 1500.
[CUSTOMER][NEUTRAL] Uh, so, what will the benefits? What were the benefits?
[AGENT][NEUTRAL] It will pick up the copays, the co-insurance, and our deductibles up to the 1500 under the office treatment benefit rider.
[CUSTOMER][NEUTRAL] OK, so just a moment.
[CUSTOMER][NEUTRAL] So the allowable amount is 1500, right?
[AGENT][POSITIVE] Calendar year, that is correct.
[CUSTOMER][NEUTRAL] And after that it is 100% covered or not?
[AGENT][NEUTRAL] It will cover up to 1500. After that, it becomes patient's responsibility.
[CUSTOMER][NEUTRAL] OK. So the plan will pay only $150.00 sorry, $1500.
[AGENT][NEUTRAL] Per year
[CUSTOMER][NEUTRAL] Per procedure or?
[AGENT][NEUTRAL] The treatment received in the office, this plan will pick up up to 1500 of the co-pays to co-insurance and or deductibles.
[CUSTOMER][NEUTRAL] OK, yeah, I understand.
[CUSTOMER][NEUTRAL] Is there any deductible or out of pocket max for this plan?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] Oh there is none.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any authorization required for any of the procedures?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] OK. And the claim mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII], OK. [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] [PII] Last initial is [PII]
[AGENT][NEUTRAL] Along with today's date.
[CUSTOMER][NEUTRAL] Can I get the caller reference number?
[AGENT][NEUTRAL] It will be my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for the details have a great rest of the day.
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.