AccountId: 011433970860
ContactId: d09abfd8-9a12-4234-a3e7-9ad6ce0bbb15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437839 ms
Total Talk Time (AGENT): 141107 ms
Total Talk Time (CUSTOMER): 113673 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/d09abfd8-9a12-4234-a3e7-9ad6ce0bbb15_20250519T21:20_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII], and I'm calling from Cardiac and Weper Consultant MDPA. I'm so sorry, I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII], that's [PII], and may I have your name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you, Mr. [PII] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It is
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, it is 226-051-4.
[AGENT][NEUTRAL] OK, let me try that one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] How may I assist you today?
[CUSTOMER][NEUTRAL] Oh, I'm actually working on this patient account and I'm looking for eligibility and benefits information.
[AGENT][NEUTRAL] OK, outpatient or inpatient benefit or office?
[CUSTOMER][NEUTRAL] Uh, it is.
[CUSTOMER][NEUTRAL] It is office
[AGENT][NEUTRAL] Office setting? OK.
[AGENT][NEUTRAL] 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. We have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And this one doesn't have any office coverage. It's just for outpatient facilities, hospitals, urgent care, diagnostic centers or surgical centers.
[CUSTOMER][NEUTRAL] The patients don't have any office visits, surgical, and outpatient coverage.
[AGENT][NEUTRAL] It doesn't have any out it doesn't cover any office. It will only cover diagnostic centers, surgical centers, urgent care facilities, or ER so it doesn't have any office benefits.
[CUSTOMER][NEUTRAL] So can I uh give you the CPT and you let me know that whether this is covered or not?
[AGENT][NEUTRAL] Is it gonna be in an office setting?
[CUSTOMER][NEUTRAL] Yes, the POS is, uh, is office visit.
[AGENT][NEGATIVE] Not covered, not covered. Anything done in office or clinic is not covered.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Fine
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can I get the group number?
[AGENT][NEUTRAL] Um, sure, let me get that for you. One moment.
[AGENT][NEUTRAL] OK, so we have the group number 22486.
[CUSTOMER][NEUTRAL] OK. So, uh, office visit is not covered, but outpatient and inpatient is covered under the patient plan.
[AGENT][NEUTRAL] Office is not covered, procedures or office visits are not covered. This one only covers inpatient, which is hospitalization in the hospital or outpatient service in a hospital.
[CUSTOMER][NEUTRAL] Got it. And uh can I get the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, claim mailing address if there is any.
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um, can I get the pay ID as well?
[AGENT][NEUTRAL] Yes, payer ID is 60801.
[CUSTOMER][NEUTRAL] 801 and time parking limit?
[AGENT][NEGATIVE] No timely filing limits.
[CUSTOMER][NEUTRAL] So we can submit the claim at any time.
[AGENT][NEUTRAL] Yeah, there's no family time limits.
[CUSTOMER][NEUTRAL] Actually, why I'm asking this question because uh the patient has not given this information uh till uh uh date and he has some uh previous claims uh in the year [PII].
[CUSTOMER][NEUTRAL] So we can submit that claim.
[AGENT][NEUTRAL] You can submit any claims, um, there's no guarantee of payments, but you can always submit claims. There's no timely filing limits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thanks a lot, so. It was a great help. And can I get the call reference number if there is any?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you, sir. Uh, it is [PII].
[AGENT][NEUTRAL] SOL last initial [PII]
[CUSTOMER][POSITIVE] Thanks a lot, so it was a great help. Thank you and have a nice day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You too, bye, take your brother.