AccountId: 011433970860
ContactId: c9d0cfa6-9dbe-4ee4-acda-bf80b8b7f14b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 672059 ms
Total Talk Time (AGENT): 246928 ms
Total Talk Time (CUSTOMER): 208692 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c9d0cfa6-9dbe-4ee4-acda-bf80b8b7f14b_20250424T13:48_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling ATL. This is how may I assist you?
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII] and my last initial is [PII], and I'm calling from a provider office to check on the eligibility and benefits.
[AGENT][NEUTRAL] OK, sure. I can assist you with eligibility and benefits, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, and may I have the name of the facility you're calling from from my location?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the name of the facility is Tapka Internal Medicine Clinic.
[AGENT][NEUTRAL] Yeah, what's the first name that you said? I didn't get that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the patient policy number is D as in Delta 43728801.
[AGENT][NEUTRAL] Mr. [PII], do you see another policy number that it doesn't start with a D, that's not our number. That's for IMA. Is there another number starting with a 0 followed by 7 digits?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, no, I have only this number and previously I have called on the number.
[CUSTOMER][NEUTRAL] [PII]. So they have stated for the 90 degree, you have to contact on the same number and it will be option 2. So I have selected option two, then it is connected to you. They stated there is a 90-degree plan. So then it again transferred to you. So where I have to connect for this patient benefit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct. Uh, the D number is IMA. So the ones that transfer you over here, that, that was the number for them, but it's not the number for us. Uh, and you should have a different number on that card that that's for us. Do you have the copy of the card, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I'm so sorry. I don't have the copy of the card.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you have the social of the member?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, just a, let me check.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's now the address I in.
[AGENT][NEUTRAL] No. OK, what's the spelling of the last name?
[CUSTOMER][NEUTRAL] Oh sorry, I don't have the social for the station.
[AGENT][NEUTRAL] It's OK. I just.
[CUSTOMER][NEUTRAL] OK. The patient's last name is [PII].
[AGENT][NEUTRAL] OK. OK. OK, and what is the spelling of the first name?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The first name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] OK, OK, thank you. One moment, let me see if I can find this.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And what is the date of birth for her?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, perfect. Um, what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] Yes, I need the PCP office visit benefits, and I have 6 CPT codes. I want to check their benefits. And also I want to check the in-office general diagnostic lab benefits.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] OK, um, Mr. [PII], uh, so you're trying to check for the benefits for diagnostic, you said?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] CPT codes, I have 6 CPT codes. I want to check their benefits and PCPC offices benefits also.
[AGENT][NEUTRAL] OK, I can give you a breakdown of benefits. I cannot tell you how much we pay for CPT. I can only give you the benefits based on the policy and a breakdown of the benefits on the policy. Is that OK?
[CUSTOMER][NEUTRAL] OK. So it's a limited plan?
[AGENT][NEUTRAL] Yes, it's a limited plan. Mhm.
[CUSTOMER][NEUTRAL] OK, it's a limited one. And what is the effective date?
[AGENT][NEUTRAL] OK, we have an effective date of [PII]. It is active at the moment. And again, this is a limited hospital indemnity plan.
[AGENT][NEUTRAL] Let me give you the benefits for the office visit.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And bear with me, I'm waiting on the documents, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] OK, so for this one, let's see. OK, so this one doesn't have any office visits.
[AGENT][NEUTRAL] So office visits are not covered.
[AGENT][NEUTRAL] This one does have medical imaging tests or advanced study follow-up tests. Uh, the medical imaging test is $100 per day, maximum of 2 days per calendar year.
[AGENT][NEUTRAL] And then the advance or follow-up test is $25 per day maximum of 1 day. And let me give you the list of what is covered, OK?
[CUSTOMER][NEUTRAL] I needed a
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] to the market. It is a daily to normal day.
[AGENT][NEUTRAL] OK. So the medical imaging test is MRI.
[CUSTOMER][NEUTRAL] Not
[AGENT][NEUTRAL] CT scan.
[AGENT][NEUTRAL] scan.
[AGENT][NEUTRAL] thyroid intake test.
[AGENT][NEUTRAL] Those are the ones covered under medical imaging. Those are the only ones covered under medical imaging.
[AGENT][NEUTRAL] And then the advanced study and follow-up test is going to be like for a sleep study, nuclear stress test.
[AGENT][NEUTRAL] Are the are the grams.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So for the offices, there is a 2 visits your state.
[AGENT][NEUTRAL] Upper GI.
[AGENT][NEUTRAL] No office visit benefit, no office visit benefit. Diagnostic medical imaging tests like a CT scan, MRI, thyroid intake, PET scan, those are the only ones that are covered under medical imaging test.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it will be a $100 fees.
[AGENT][NEUTRAL] It's 100 per day, maximum of 2.
[CUSTOMER][NEUTRAL] It's the $100 is paid by?
[AGENT][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] Yeah, it's paid by plane or the patient.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's a maximum benefit per plan, per member's plan.
[CUSTOMER][NEUTRAL] Individual $9000.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So it will be paid by you, not a member.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, if you are in.
[CUSTOMER][NEUTRAL] Yeah right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, and no offices in the.
[AGENT][NEUTRAL] No office message, no.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] No offices cover under the patient's plan.
[AGENT][NEUTRAL] OK OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And is it?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Telehealth, telemedicine is covered or not?
[AGENT][NEUTRAL] It will be the same as office visit, so it's not covered because office visits are not covered.
[CUSTOMER][NEUTRAL] It's the calendar year calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] So we have
[CUSTOMER][NEUTRAL] OK. And may I have your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][POSITIVE] Definite
[CUSTOMER][NEUTRAL] And the reference number for the song?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much and thank you so much for that.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[AGENT][NEUTRAL] Bye bye Mr. [PII].