AccountId: 011433970860
ContactId: d97dd1b8-84a1-4c31-bf13-d8e76b808c52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174300 ms
Total Talk Time (AGENT): 91066 ms
Total Talk Time (CUSTOMER): 51980 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/d97dd1b8-84a1-4c31-bf13-d8e76b808c52_20250609T17:45_UTC.wav
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[AGENT][NEUTRAL] Calling API. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Oh yeah, my name is [PII] I'm calling from Sleep Life Center. Um, we have a patient who just called and gave me your guys' information and her ID number, uh, to see if you'll cover the copay that she, that her primary insurance says she's responsible for.
[AGENT][NEUTRAL] Hey yeah
[AGENT][POSITIVE] OK, I'd be happy to assist with benefits today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, the number she gave me is 02505742 and then the letters MLB.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. Now is this gonna be an office visit?
[CUSTOMER][NEUTRAL] Uh, it's for a sleep study. She's subject to a co-pay of $60.
[CUSTOMER][NEUTRAL] Through the primary?
[AGENT][NEUTRAL] Oh, now this that's gonna depend on how how are you billing because.
[AGENT][NEUTRAL] Is this a home
[AGENT][NEUTRAL] Are you billing as office place of service 11 or place of service 22?
[CUSTOMER][NEUTRAL] 11.
[AGENT][NEUTRAL] 11? OK, so for $11 for special for specialist visits, the um co-pay for the specialist visit will be covered at $50 and then.
[AGENT][NEUTRAL] But can you, what's the CPT code because it's gonna depend on what the procedure code is.
[AGENT][NEUTRAL] Is the procedure called
[CUSTOMER][NEUTRAL] 958006.
[AGENT][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] 958006.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Place the service 11. OK, so that's gonna be covered at 100% up to her.
[AGENT][NEUTRAL] Calendar year for outpatient maximum of $2500.
[AGENT][NEUTRAL] Uh, let me just check and she hasn't used.
[CUSTOMER][NEUTRAL] OK, so her max is 2500.
[AGENT][NEUTRAL] Yes, her outpatient max is $2500. Um, she hasn't used any benefits so far this year, so she, um, she has the full amount available, so we will cover 100% of that.
[AGENT][NEUTRAL] Of that cost up to her $2500 maximum.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Wonderful. That's all I needed to know. um, if I could just get a reference number, please?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] All right awesome well thanks for your help. I hope you have a great rest of your day.
[AGENT][NEUTRAL] You do the same thank you for calling APO.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.