AccountId: 011433970860
ContactId: dfabdba8-d452-4215-9266-9e9fd406caf9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286809 ms
Total Talk Time (AGENT): 122182 ms
Total Talk Time (CUSTOMER): 89093 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/dfabdba8-d452-4215-9266-9e9fd406caf9_20250113T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I'm calling from a provider's office to verify benefits on a number.
[AGENT][NEUTRAL] OK Miss [PII], I can help you with the fits um you said [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], gosh, I was all off. Thank you, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is your callback number please ma'am just in case our call gets disconnected.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] His date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and his policy number please ma'am?
[CUSTOMER][NEUTRAL] His policy number I see here is for outpatient, which is what I need is 02465764 M as in Mary, L as in Laura number 8.
[AGENT][NEUTRAL] OK thank you let me pull that policy in real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and his effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify his coverage. It's not a guarantee of payment. He has a supplemental insurance policy that's billed secondary to the primary. This policy helps with deductible, co-pay or co-insurance, and he has an outpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] That's for outpatient, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 2500 for the year and would that cover um surgeries in office as well?
[AGENT][NEUTRAL] It covers, uh, deductible, co-pay or co-insurance. Uh, let me look and see if he has office visits covered.
[AGENT][NEUTRAL] He can go to an ER urgent care center, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] So it wouldn't be covered if he does a surgical procedure in an office setting.
[AGENT][NEUTRAL] I'm checking
[AGENT][NEUTRAL] According to let me, let me look one more place real quick.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And see
[AGENT][NEUTRAL] I'm gonna go ahead and pull in his policy and just read it and see what it says real quick.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It's gonna be just a moment while it pulls in for me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It's OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, he does have office visits.
[CUSTOMER][NEUTRAL] But it's not an office visit though. That's why I was, um, it's, uh, we, we, we're not gonna bill it a visit. It's just for the actual procedure in the office setting.
[AGENT][NEUTRAL] OK, so in the office setting this policy only covers deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Right, but it can be done in the office. That, that's my question, cause some policies don't cover procedures or surgeries done in an office, only at certain place of services.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, right. This policy does have office visits, so his deductible co-payer.
[CUSTOMER][NEUTRAL] So he does, he does have coverage in the office, OK.
[AGENT][NEUTRAL] Yes, he has an office visit writer. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect. That's what I needed. OK, and what is your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] OK [PII], perfect thank you so much have a good one.
[AGENT][POSITIVE] You have a good day too. Thank you for calling APL. We appreciate you calling.
[CUSTOMER][POSITIVE] Thank you, thank you, thank you, bye bye.
[AGENT][NEUTRAL] Bye bye Miss [PII].