AccountId: 011433970860
ContactId: d8df3872-6c86-4666-bb4a-b79f64d154a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263109 ms
Total Talk Time (AGENT): 98437 ms
Total Talk Time (CUSTOMER): 142778 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/d8df3872-6c86-4666-bb4a-b79f64d154a9_20250311T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] at Downtown Tulsa Eye Care, and I just need to see if the patient still has their coverage and if they do, I've got a couple of questions please.
[AGENT][NEUTRAL] OK, [PII]. Happy to check eligibility today. What's the policy number?
[CUSTOMER][NEUTRAL] It's 01822341.
[AGENT][NEUTRAL] OK, let me pull that up here.
[AGENT][NEUTRAL] And if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like the member does have an active plan with us. It is a different policy number. Would you like to take that down?
[CUSTOMER][POSITIVE] Oh yes please.
[AGENT][NEUTRAL] OK. The active policy is going to be 024628.
[AGENT][NEUTRAL] 80.
[AGENT][NEUTRAL] And the effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK, so is this new this new um policy number is it still, it's still a secondary plan though, correct? Secondary to OK and then is this plan I know in the future when she had it, the secondary wouldn't cover any exam codes, but, but my question is she came into our office, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And we're filing her Blue Cross Blue Shield sheet, one of the codes is an exam code and then the other two codes are special testing codes. If, if they're, can we still submit that claim as secondary and you would deny the exam but possibly pay uh help pay on the special testing codes? Is that how this policy works?
[AGENT][NEUTRAL] Yeah, absolutely, [PII]. I always say go ahead and submit it um to see if it's covered and then if it's denied not covered, you know, there's no harm in obviously filing it. Um, it, yeah, I mean, it is meant to cover within certain parameters like the deductible, co-pay, and the co-insurance of their primary does not, it does carry like you had said though, restrictions, it doesn't cover everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, that's what I wanted to make sure of because I knew in the past we were denied any secondary and it was because she it was only for an exam code and so they explained that to me but I didn't know if anything had changed and I wasn't even sure if she still had the secondary or not so I'll go ahead and submit it. Do we still submit it? Is the best address still um the [PII]?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It actually has changed [PII], so let me give you the updated one.
[CUSTOMER][POSITIVE] OK, yeah, perfect. OK.
[AGENT][NEUTRAL] Uh, it's gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII] City, Oklahoma.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh city OK.
[AGENT][NEUTRAL] And zip is [PII].
[CUSTOMER][POSITIVE] OK, perfect. I'm glad I asked about that then. OK, perfect. Now does back to when you gave me her updated ID number, is there a new group number?
[AGENT][NEUTRAL] Uh, let's see, let me see what the group is on this one.
[CUSTOMER][NEUTRAL] 02462.
[AGENT][NEUTRAL] Uh, group number on this is 237959.
[CUSTOMER][NEUTRAL] 959. OK, 237959.
[AGENT][NEUTRAL] 2323759.
[CUSTOMER][NEUTRAL] OK, so that's the same as what it was. OK, perfect. OK, that's what, but the ID number I show is 02462880.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for all your help. I really appreciate you.
[AGENT][POSITIVE] My pleasure. You have a good day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Hi.