AccountId: 011433970860
ContactId: bac71625-9e03-420a-915b-c988f3367853
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226139 ms
Total Talk Time (AGENT): 110711 ms
Total Talk Time (CUSTOMER): 77865 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/bac71625-9e03-420a-915b-c988f3367853_20250610T16:36_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] with um sorry Pecan Tree Pediatrics. I'm calling on, um, a patient of mine to see.
[CUSTOMER][NEUTRAL] Some other benefits and see if.
[CUSTOMER][NEUTRAL] Like what kind of plan they have.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Oh yes, it's the [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It's gonna be 02013247.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I guess outpatient.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum. I'm sorry?
[CUSTOMER][NEUTRAL] Uh, PCP.
[CUSTOMER][NEUTRAL] Uh, PCP.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum.
[AGENT][NEUTRAL] Is $7000. That includes treatment and procedures at the office visit. It does not include the co-pay associated with the physician's charges.
[CUSTOMER][NEUTRAL] OK, um, is this listed as a secondary?
[AGENT][NEUTRAL] Yes, we're the gap.
[CUSTOMER][NEUTRAL] OK, so do you guys cover sick visits once it comes to you?
[AGENT][NEUTRAL] Any treatment or procedures at the visit, it doesn't include the copay associated with the physician's charges.
[CUSTOMER][NEUTRAL] And you said it was 25?
[AGENT][NEUTRAL] West 25.
[CUSTOMER][NEUTRAL] Uh, sorry, $25 copay.
[AGENT][NEUTRAL] No, ma'am. I didn't say. I said.
[AGENT][NEUTRAL] The benefits include treatment and procedures at the visit. It does not include.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The copay associated with the physician's charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when you guys receive like let's just say um.
[CUSTOMER][NEUTRAL] A claim from us like, are you able to pull up previous ones?
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. I'm just curious um if y'all are.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Did you receive any of those or are, are y'all able to pay on any of those?
[AGENT][NEUTRAL] What's your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, we did receive a claim for data service [PII]. That claim denied because it is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the positions charges, the 99213, that's what's not covered now the JO 696, that would have been payable if there was something for us to pay, but the, it looks like there was no um copay coinsurance and attached to that, but that's payable, just like on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The 963-72 would have been payable if there was something to pay. It's just that 99213 and 99214, that is what's not covered.
[CUSTOMER][NEUTRAL] Right, [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I think thanks for the clarification. Can I have a reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Uh, no, that's it, thank you very much.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][NEUTRAL] You too.