AccountId: 011433970860
ContactId: bad7a172-f750-4b60-a756-cf14e93b2dcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239199 ms
Total Talk Time (AGENT): 127010 ms
Total Talk Time (CUSTOMER): 78170 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/bad7a172-f750-4b60-a756-cf14e93b2dcf_20250616T12:05_UTC.wav
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[AGENT][NEUTRAL] Contacting you here. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm trying to verify benefits for the patient.
[AGENT][NEUTRAL] help with benefits. What is that policy number?
[CUSTOMER][NEUTRAL] Sorry but I'm not understanding what you're saying.
[AGENT][POSITIVE] Yes, um, yes, I can certainly help with benefits. Could you tell me the policy number, please, so that I can look it up?
[CUSTOMER][NEUTRAL] Yes, it's 02639903.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you very much. I do appreciate that. So the policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Now, the policy that [PII] has has both inpatient and outpatient benefits. Is there anything in particular that I can tell you about the secondary or gap insurance?
[CUSTOMER][NEUTRAL] Yes, do you cover for the specialist office visit copay?
[AGENT][NEUTRAL] No, we do not. We cover the uh treatment within the specialist office up to $6500 per calendar year, which is just a verification of the benefits, not a guarantee of payment, but the office visit co-pay is not covered.
[CUSTOMER][NEUTRAL] OK, so you covered, sorry, you said to 6500?
[AGENT][NEUTRAL] Yes, for the treatment, um, or, or procedures within the physician's office but not the other.
[CUSTOMER][NEUTRAL] OK, so for let's say a sleep study in the office, do you, you cover that?
[AGENT][NEUTRAL] Uh, the sleep study in the office, uh, she does have office benefits, so yeah, that, that could be covered, um.
[AGENT][NEUTRAL] It's just that it's uh that that would it would be the treatment that would be covered for that.
[CUSTOMER][NEUTRAL] That's not
[AGENT][NEUTRAL] Now is there anything else I can tell you about the policy? Do you want to know where to send the claims, or?
[AGENT][NEUTRAL] Is there anything in particular that
[CUSTOMER][NEUTRAL] No, no claims just benefits.
[AGENT][NEUTRAL] OK, OK. Well, that's the, the, the treatments, uh, will be covered but not the opposite of the copay.
[CUSTOMER][NEUTRAL] OK, um
[AGENT][NEGATIVE] And it doesn't look like she's used any.
[CUSTOMER][NEUTRAL] The can you check by the code because the patient is going to have a home sleep study, uh, but the insurance, the main insurance, uh, they applying the uh the copay, just the copay, so I'm not sure if that case you cover that copay or that copay is either not covered because it's a copay.
[AGENT][NEUTRAL] OK, are you talking about the copay for the office?
[CUSTOMER][NEUTRAL] No, for, uh, home sleep study, the code 958006.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, I'm sorry, what code number was that again?
[CUSTOMER][NEUTRAL] The code 958006.
[AGENT][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, let me check, give me just a moment please.
[AGENT][NEUTRAL] Um, of course, anything that I that we look at today is I can just tell you whether uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So
[AGENT][NEUTRAL] The sleep study itself, that's actually, we can consider that the treatment uh rather than the office visit, so it the treatment is covered. The treatment is covered. It's, it's the, it's the um uh opposite.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like the CPAP.
[AGENT][POSITIVE] Yes, the, yeah, the, OK, yes. Yes, that is in durable medical.
[CUSTOMER][MIXED] OK, but the actual story is not.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, may I have a reference number for the call?
[AGENT][NEUTRAL] My name is [PII]. The first [PII] last name is [PII]. We'll use that today's date as a reference. Is there anything else at all I may help you?
[CUSTOMER][POSITIVE] No, that was it. Thank you. Have a nice day.
[AGENT][POSITIVE] OK, thanks for thanks for contacting API.