AccountId: 011433970860
ContactId: d6591ca3-f91b-4fca-a4b1-32a7411bd681
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453910 ms
Total Talk Time (AGENT): 210869 ms
Total Talk Time (CUSTOMER): 174845 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/d6591ca3-f91b-4fca-a4b1-32a7411bd681_20250321T15:07_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. My name is [PII] calling from the doctor's office, and I called you to verify the benefits of the patient.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with benefits. What is the callback number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, sure, my call back number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yes, [PII], it is 02158770. M as in Mexico, L as in London, 8.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] I felt like I was traveling from [PII] to [PII]. I like that, [PII].
[AGENT][NEUTRAL] And what is, what is the patient's name and date of birth, please?
[CUSTOMER][POSITIVE] It's a good one.
[CUSTOMER][NEUTRAL] Yeah, first and last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And I can help you with eligibility for [PII]. Now, actually, [PII], the policy number that you gave me is no longer active as of [PII]. [PII] does have active coverage with us, but it's under another policy number. Can I give you her active policy information?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, definitely, please.
[AGENT][NEUTRAL] It would be my pleasure. As of [PII], the active policy number is 259.
[AGENT][NEUTRAL] 5821.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it is current.
[CUSTOMER][NEUTRAL] And it is active from [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a secondary policy to her primary insurance, [PII].
[CUSTOMER][NEUTRAL] And uh,
[CUSTOMER][NEUTRAL] Oh, OK. Uh, can you please provide me what is the primary payout for this patient?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The premier insurance.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, let me get that information for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing her primary insurance to be through AvMed.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, I missed you. Can you please repeat that once again?
[AGENT][NEUTRAL] Sure, it's Amed, A V M E D Healthcare.
[CUSTOMER][NEUTRAL] Um, oh, I, OK. Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I have Healthcare. And uh can I have the effective dates of the um healthcare and also, uh, can you please provide me the uh co-payment or co-insurance for the uh visits?
[AGENT][NEUTRAL] So you would need to, sure, you would need to contact the insured for the AMed policy information.
[CUSTOMER][NEUTRAL] For the specialist.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't have that policy number or information.
[CUSTOMER][NEUTRAL] 00 I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I got it, I got it. And also, uh, actually, can you please confirm uh what is the uh coverage providing to this visit with the American public life?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it is for a doctor's offices in?
[CUSTOMER][NEUTRAL] Does the patient have any co-payment or coins?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. [PII], for the office visit, there is no coverage on this policy.
[AGENT][NEUTRAL] We do have benefits for procedures or treatments in office for sickness or injury, but no benefits for the office visit co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, well, but, uh.
[CUSTOMER][NEUTRAL] I can provide you the CPT codes, but this, uh, procedure is done with office visit only. So can you please check for this CPT course? Does patient apply any coverage or not? Or else, uh, the patient needs any requests your authorization or else.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, I can help you. What's the first code?
[CUSTOMER][NEUTRAL] Uh yeah. The postcode is [PII].
[AGENT][NEUTRAL] Now, that is considered a procedure. Um, diagnostic testing is covered in the doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And no prior authorization is required, and that benefit amount for any diagnostic testings or procedures or treatments in office, the benefit amount that we can pay.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is a maximum of $500 per calendar day. Now, that is what we paid to her deductible copay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh, so you confirm that this is the procedure CPT code and it is happening in the office, uh, visit through the specialist. So this patient needs to pay any co-payment or co-insurance for this procedure.
[AGENT][NEUTRAL] And now we can pay a maximum of $500 for that procedure.
[AGENT][NEUTRAL] Um, we don't determine patient's responsibility. Once that claim is processed with the primary insurance and you get that EOB back, then you can file with APL and if benefits are available for that data service, we can provide that benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] OK, and, uh, I do have 3 more CPD codes. Can you please, uh, check whether the your authorization is required or not?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] And this policy being secondary, there is no authorization required.
[CUSTOMER][NEUTRAL] OK, OK, I got it.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and uh.
[CUSTOMER][NEUTRAL] Got it. No, nothing. And do you have any uh Ahmed Healthcare number policy number?
[AGENT][NEUTRAL] I have, um, I do not. I'm sorry. You would need to contact the patient.
[CUSTOMER][NEUTRAL] Do you know the number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh sure, no problem, that's good. And uh can I have the reference to this call?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] The reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII], it was a pleasure to assist you with that eligibility and benefit. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, at least, yeah, uh, just give me one second. Let me, uh, try to recall whether any information needed or not. Just allow me one minute.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, no problem at all.
[CUSTOMER][POSITIVE] Yeah, uh, thank you so much for holding the line. Uh, that's it, uh, [PII], and thank you so much for providing this information and wish you have a good day.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII] [PII], it was my pleasure to assist you and thank you for calling APL and have a great weekend.
[CUSTOMER][POSITIVE] You too. Have a great weekend. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.