AccountId: 011433970860
ContactId: d6426710-c0c7-44d0-b60c-fc240c53db3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219559 ms
Total Talk Time (AGENT): 121849 ms
Total Talk Time (CUSTOMER): 94858 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/d6426710-c0c7-44d0-b60c-fc240c53db3b_20250203T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII] with Auctioner Health, and I need to verify that a patient has his insurance and the effective date, please.
[AGENT][NEUTRAL] OK, sure. I can assist you with eligibility, Ms. [PII], um, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And what was your name? I'm sorry.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. That's initial [PII], and um you're welcome. What's the name of the facility you're calling from?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's Oxer Health. It's O C H S N E R.
[AGENT][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. Thank you. All right, and may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Yes ma'am, it's 126-5678.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Like there's a $40 something.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. We have an effective date of [PII]. It's active at the moment and this is one of our secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK, so once we file with our major medical, well it goes to y'all correct?
[AGENT][NEUTRAL] Correct, yes. We are the secondary. We have with the co-payments, coinsurance and deductibles from the major medical. Um, um, is this for an office or is it an outpatient facility?
[CUSTOMER][NEUTRAL] Um, I think it was, um, it was for an office visit.
[AGENT][NEUTRAL] Office visit. OK, let me check and see if we cover office visit on this one because they're all different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. Um, this one doesn't have an office visit coverage. It, it only covers if there's procedures or treatment in the office. That's what we will cover.
[CUSTOMER][NEUTRAL] OK, so let, let me get this straight, no office visits?
[AGENT][NEUTRAL] Mhm. Correct. Only office procedures or treatments are covered.
[CUSTOMER][NEUTRAL] Only office.
[AGENT][NEUTRAL] Procedures or treatments.
[CUSTOMER][NEUTRAL] Procedures.
[CUSTOMER][NEUTRAL] And what do you mean by treatments?
[AGENT][NEUTRAL] Um, treatments, um, like any type of treatment, infusion treatment or something, any treatment.
[CUSTOMER][NEUTRAL] Uh, I mean, procedures and I guess, I mean, procedures would be like a little surgery or something. I guess treatments for like maybe warts and stuff like that, maybe.
[AGENT][NEUTRAL] Yeah, something that it has consecutive that they need to go more than once to get um.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yeah, like.
[CUSTOMER][NEGATIVE] But if they just come in for a general office visit, annual visit, whatever y'all don't cover those.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, I mean, and if it gets filed it'll just be denied correct?
[AGENT][NEUTRAL] Correct. I if you send in the claim, if you need to send in the claim, you can, and we'll go ahead and send you a denial stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, I appreciate that. Is there a reference number for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you would like to receive it. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Um, no, ma'am, that's it for today. I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good week, Mr.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.