AccountId: 011433970860
ContactId: d09a70dd-e73d-48ff-b61e-4fe5daaae257
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283170 ms
Total Talk Time (AGENT): 117035 ms
Total Talk Time (CUSTOMER): 137520 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d09a70dd-e73d-48ff-b61e-4fe5daaae257_20250205T17:05_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] from Sleep Center of [PII]. Um, I have a patient that I need to get eligibility and benefits for an office visit.
[AGENT][POSITIVE] that it would be a pleasure to assist you with those benefits. What is a good callback number please, ma'am?
[CUSTOMER][NEUTRAL] [PII]. No extension.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] 232-0079
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], I am showing that [PII]'s policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] This is a secondary policy to his primary insurance.
[AGENT][NEUTRAL] And you are needing benefits for a sleep study. Is that, will that be in a clinic or a doctor's office?
[CUSTOMER][NEUTRAL] Oh no, it's not a sleep study, just a consultation or visit, an office visit. And also if there's any telehealth coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. Yeah, I'm showing that his policy does cover, does not cover the office visit.
[AGENT][NEUTRAL] Co-pay and that would be either in person or telehealth.
[AGENT][NEUTRAL] Now, he does have benefits for any procedures or treatments in the office, but not for the visit co-pay.
[CUSTOMER][NEUTRAL] Um, I'm, I'm sorry. If I understood it, um, so yeah, there is no coverage for an office visit or consultation, only for
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A procedure.
[CUSTOMER][NEUTRAL] Any procedure done in the office?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's correct. Any procedure or treatment in office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So no telehealth um coverage too, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. All right. Um, I'll just get if, uh, I just wanna know if there's any future termination date for this plan.
[AGENT][NEUTRAL] There's no future termination date on file.
[CUSTOMER][NEUTRAL] OK. Um, by the way, um, cause we had this patient last year, when we checked the eligibility, we were informed that
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The patient is covered up to 6000 per calendar year for an office visit.
[CUSTOMER][NEUTRAL] But not telehealth.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yeah, the office visit.
[CUSTOMER][NEUTRAL] So when did the plan changed? Uh-huh.
[AGENT][NEUTRAL] Yeah, as of [PII], the office says it is not a covered benefit.
[CUSTOMER][NEUTRAL] OK. As of, let me just take note of that. Thank you. As of [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So it includes last year too. Mm.
[CUSTOMER][NEUTRAL] Let me just see. Anyways, um, you don't, since it's not covered, you don't pick up the patient's uh responsibility from primary, right?
[AGENT][NEUTRAL] Not for an office visit. That is correct.
[CUSTOMER][NEUTRAL] Uh, OK. Um, may I know if on your record, um, if the patient's primary shows as United Healthcare?
[AGENT][POSITIVE] I can certainly get that information for you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. We do have United Healthcare on file as the primary insurance carrier.
[CUSTOMER][POSITIVE] Perfect. And is, uh, when was, by the way, the coordination of benefits updated?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Same as the start date then. All right. And I'm sorry, if I heard it right, your name is [PII] or [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And if you need a reference for it, it would be my name in today's date, and I'm sorry, I didn't mean to interrupt you.
[CUSTOMER][POSITIVE] Thank you. Um, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Uh, no, no, no. I was about to ask for the reference number, but anyway, you have already provided it. But yeah, this is all I need. Thank you so much, [PII], for your help. Have a good day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] My, my pleasure to help you with those benefits, [PII]. Thank you for calling APL. You have a great day as well. Take care. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. All right. Bye-bye. Thank you. Goodbye.