AccountId: 011433970860
ContactId: babb3c8a-0934-4a0a-a1a4-9fbd5d4d1318
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263339 ms
Total Talk Time (AGENT): 104305 ms
Total Talk Time (CUSTOMER): 66719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/babb3c8a-0934-4a0a-a1a4-9fbd5d4d1318_20250401T12:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I have a patient presenting this card is secondary. I just wanted to check the benefits and what it would cover.
[AGENT][NEUTRAL] OK, and is this for service in a doctor's office?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, so they're not providing me the insurance card, but the number they're giving me is 60801.
[AGENT][NEUTRAL] That's the payer ID number spell the patient's first and last name or if you have the social I'll take that.
[CUSTOMER][NEUTRAL] Um, I'll do first name and last name. So I have [PII] Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] What is your callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And what state does [PII] reside?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII]'s date of birth is [PII]?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so the policy number is 0255.
[AGENT][NEUTRAL] 5889.
[AGENT][NEUTRAL] Uh, this policy became effective [PII]. It is active at this time.
[AGENT][NEUTRAL] And I'll check to see if there's an office visit benefit under this plan. Um, office visits are not covered under this policy, it covers inpatient and then outpatient, outpatient such as emergency room, urgent care service in a hospital.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] Yeah, patients coming in and to get an MRI so we're a radiology center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That bills as an office.
[AGENT][NEUTRAL] You build it with place a service 11?
[AGENT][NEUTRAL] Or 22.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] 11.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it covers place of service 22, which is outpatient and then inpatient.
[CUSTOMER][NEUTRAL] Only covers inpatient.
[CUSTOMER][NEUTRAL] So it only covers inpatient services and you said one more thing I'm sorry I just needed to take notes.
[AGENT][NEUTRAL] Outpatient, such as emergency room, urgent care?
[AGENT][NEUTRAL] Surgery in the hospital, freestanding facility?
[CUSTOMER][NEUTRAL] So we are a freestanding facility.
[AGENT][NEUTRAL] OK, I thought you said in the office.
[AGENT][NEUTRAL] And your billing with place of service 11.
[CUSTOMER][NEUTRAL] Correct, so we, we, we bill as place service 11, but we're a free standing facility.
[AGENT][NEUTRAL] OK, so we'll provide the outpatient benefit. any information provided is verification, not a guarantee of payment. That benefit is up to $6600 that is per calendar year, and I'll check to see if any of that amount has been used. I don't show any claims on file for [PII], so the amount is available at this, uh, at this time, and then we'll review the claim.
[AGENT][NEUTRAL] And the primary EOB upon receipt.
[CUSTOMER][POSITIVE] Perfect, can I have a reference number for the call?
[AGENT][NEUTRAL] My name in today's date, [PII], first initial [PII] name [PII], and any other questions, [PII], I can help with today?
[CUSTOMER][POSITIVE] That's it, thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] I still show that you're connected [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] I'm sorry, bye.