AccountId: 011433970860
ContactId: d683bf5e-4098-4ffc-9458-c4c06fd5477f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 135130 ms
Total Talk Time (AGENT): 72929 ms
Total Talk Time (CUSTOMER): 48559 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/d683bf5e-4098-4ffc-9458-c4c06fd5477f_20250204T21:03_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from GI Consultants of Augusta. I'm calling to verify I will check up patients eligibility with you all.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Could you provide me with the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII]
[CUSTOMER][NEUTRAL] And then a callback number [PII].
[AGENT][NEUTRAL] Thank you, and what is the policy number of the member that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] Um, the policy number, which is based off of his card is 23 I'm sorry 023.
[CUSTOMER][NEUTRAL] 56084.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and you're calling to verify inpatient, outpatient?
[AGENT][NEUTRAL] What benefits or place of service are you inquiring about?
[AGENT][NEUTRAL] And I'll be able to assist you. So inpatient is 18 hours or more. OK, outpatient is considered as under 18 hours. This member's policy has outpatient benefits of $1500 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage. However, the office visit itself is not covered under the policy, but the treatment received in the policy is covered under the treatment received in the office is covered under the policy.
[CUSTOMER][NEUTRAL] Inpatient?
[CUSTOMER][NEUTRAL] Well, outpatient, I'm sorry, outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer on the policy's coverage, and the member's policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] OK, do you need the provider's API number?
[AGENT][NEUTRAL] Is there anything else that I can assist you with, [PII]? No, this is a gap insurance. We don't.
[AGENT][NEUTRAL] We pay whatever the primary pay towards deductible, co-pay and co-insurance for services that's covered under the policy. So when the, when the claim is submitted here, it has to have the primary EOB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh OK all right well thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too.