AccountId: 011433970860
ContactId: caa7d289-d45a-42a5-8c20-2fe610fa6839
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 731979 ms
Total Talk Time (AGENT): 154039 ms
Total Talk Time (CUSTOMER): 97454 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/caa7d289-d45a-42a5-8c20-2fe610fa6839_20250610T19:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi, um, I'm calling to get hearing aid benefits for a member.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. So may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Our phone number is [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] ENT and allergy Associates of Florida.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] The policy number is 022632 sorry I said that wrong 02262371 M like Mary L like Lima 8.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. All right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] OK. He does have DME. Let me check and see if that falls under the DME benefits. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for medical equipment on the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me one more minute. I'm looking at the limitations.
[AGENT][NEUTRAL] Because usually hearing aids is not covered, but I wanna make sure, OK.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold, OK?
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Miss [PII].
[CUSTOMER][NEUTRAL] Yes, hello.
[AGENT][NEUTRAL] OK. I'm so sorry. I had to ask an examiner because it, it wasn't clear on the um documents. It looks like it is covered. She's asking for the code just to be 100% sure.
[CUSTOMER][NEUTRAL] Um, yeah, give me one moment, let me find the code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The code is V like Victor 5261.
[AGENT][NEUTRAL] 5261, you said Z or V, V like Victor 65261. OK.
[CUSTOMER][NEUTRAL] Yeah, V like Victor [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. All right, I went ahead and send that over to her see what she says.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage, but it looks like it's gonna be considered under the outpatient maximum which is 1000 per covered person per calendar year.
[AGENT][NEUTRAL] And it has to be approved by the major medical, OK?
[CUSTOMER][NEUTRAL] OK, um, I have a question about that. So his, his primary is Aetna.
[CUSTOMER][NEUTRAL] And they for for this code they have them go through a vendor so how would that work?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, when you said they go to a vendor, are they approving the charge and just applying the amounts towards the deductible co-payment or co-insurance or they're denying the charges?
[CUSTOMER][NEUTRAL] That I'm not sure. Is that what would.
[CUSTOMER][NEUTRAL] Like, so if they do, if it does go towards their deductible or out of pocket, then would it be covered under you guys?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. Um, how we work is if the major medical pay and apply towards the deductible co-payment and co-insurance, we go ahead and pay. If uh the major medical denied, then we will deny.
[CUSTOMER][NEUTRAL] OK, I got you, so I would have to confirm that with them.
[AGENT][NEUTRAL] So we'll follow major medical.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, perfect, that's all I needed then would I just, would I be able to get a reference?
[AGENT][NEGATIVE] No right.
[AGENT][NEUTRAL] We do have reference numbers now you can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]? And I do apologize for the long wait.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] No, it's OK. Uh, you said it's so, [PII]?
[AGENT][NEUTRAL] Yes, last initial [PII]
[CUSTOMER][POSITIVE] OK perfect all right that's all I needed thank you for your help then.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good afternoon, [PII].
[CUSTOMER][NEUTRAL] You as well bye.