AccountId: 011433970860
ContactId: d2230c74-27d3-46d7-884b-dad0e54656f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390100 ms
Total Talk Time (AGENT): 119711 ms
Total Talk Time (CUSTOMER): 168136 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/d2230c74-27d3-46d7-884b-dad0e54656f4_20250321T20:51_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. I was wondering if uh this insurance company is the kind that the doctor sends claims to as like a secondary, uh, and the payment goes to the patient or does the payment go to the doctor?
[AGENT][NEUTRAL] Um, so are you with a provider's office?
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, um, it just depends on which policy we're talking about. Do you have a patient that you'd like to check the policy for?
[CUSTOMER][NEUTRAL] Uh, yeah, let me see if I have her.
[CUSTOMER][NEUTRAL] I'm actually not at the office right now, so I don't know if I, do you need her date of birth?
[AGENT][NEUTRAL] Uh, but what about the last thing?
[CUSTOMER][NEUTRAL] OK. Last name is [PII]. [PII], I'm sorry, [PII], I. First name is [PII].
[AGENT][NEUTRAL] And that was [PII].
[AGENT][NEUTRAL] Oh, [PII], or was that [PII], I?
[CUSTOMER][NEUTRAL] Uh, it's [PII] and [PII]. So the last, uh, the last two N's are like [PII]. So [PII] and then [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have a uh let's see.
[CUSTOMER][NEUTRAL] Yeah, because she's got two different numbers. One of them is for hospital inpatient or outpatient. Which one do you want?
[AGENT][NEUTRAL] Policy number?
[AGENT][NEUTRAL] Uh, uh, just give me, which one, give me one of them and we'll see if it pulls something up.
[CUSTOMER][NEUTRAL] OK. OK. So 0236.
[AGENT][NEUTRAL] Don't matter which one.
[CUSTOMER][NEUTRAL] 389
[CUSTOMER][NEUTRAL] 3 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK thank you and what was.
[AGENT][NEUTRAL] Your name and a good callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] and the call back is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's the one I don't have hold on because I'm not at the office. Let me, let me log into the system.
[AGENT][NEUTRAL] OK. Oh.
[AGENT][NEUTRAL] OK, sorry, yeah, I just need that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, it's OK. No, I know you need it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I thought I had this document that she had emailed me. I thought it would be on it. It'll just take me a second.
[AGENT][POSITIVE] Yeah, that's fine, no worries, just take your time.
[CUSTOMER][NEUTRAL] When I, when I go to lunch, I, I sometimes, uh, do some of my, you know, things I need to do when I get back to the office, so.
[AGENT][POSITIVE] Totally understand.
[CUSTOMER][NEUTRAL] Anyway,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It'll just take me probably a minute just to log in.
[AGENT][NEUTRAL] Oh, yeah, that's fine.
[CUSTOMER][NEUTRAL] What kind of insurance is it? Is it like a supplemental for like a secondary or is it different from a secondary? OK.
[AGENT][NEUTRAL] It is, yes, yeah, it's like a supplemental policy um we it does work in conjunction with the primary um major medical so basically we can potentially cover deductibles, co-pays or co-insurance based on what the primary process is and what the, what you know how they process so.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Good to know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then as for who it would pay would depend on when you submit the claim, the assignment of benefits if if that's completed so we would either pay the patient or the.
[AGENT][NEUTRAL] Provider based on that assignment of benefits so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so I'm supposed to put down, I'm not accepting or I am accepting?
[AGENT][NEUTRAL] So, um.
[AGENT][NEUTRAL] Do you, do you have like, is this for an outpatient benefit or?
[CUSTOMER][NEUTRAL] It's an office visit actually. um, she came in for her annual and the insurance covered a portion of it and there's a CPT code 99459.
[CUSTOMER][NEUTRAL] And that was applied to her co-pay.
[CUSTOMER][NEUTRAL] Um, which is $22.07 so I don't know if that's something you guys would cover. Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you for that. um, let's see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let's see if so it was an office visit wellness exam.
[AGENT][NEUTRAL] Um, let me pull up and see specifically.
[CUSTOMER][NEUTRAL] Yeah, it's a CPT code.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just checking if you'll just bear with me.
[CUSTOMER][POSITIVE] No, no worries, I'm, I'm here.
[AGENT][NEUTRAL] I don't see any coverage for routine physicals or preventative services.
[CUSTOMER][NEUTRAL] OK, all right, so I'll let the patient know. um, can I get a reference number for this call, please?
[AGENT][NEUTRAL] Um, it's my first name, [PII], last initial [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Then it's today's date. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's all. Thank you so much. You've been most helpful.
[AGENT][POSITIVE] OK, thank you and have a great weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye, bye.