AccountId: 011433970860
ContactId: e9787295-8a8c-4c38-b426-108ce00f1b22
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212970 ms
Total Talk Time (AGENT): 92235 ms
Total Talk Time (CUSTOMER): 87018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/e9787295-8a8c-4c38-b426-108ce00f1b22_20250217T18:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, good day. This is [PII] from provider's office. I'm just calling to check for benefits and eligibility.
[AGENT][NEUTRAL] I can verify benefits and eligibility. May I have a policy number?
[CUSTOMER][NEUTRAL] Um, for the policy number I have, it is
[CUSTOMER][NEUTRAL] 248-311-1.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Um, for my callback number, it is [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is for
[CUSTOMER][NEUTRAL] Um, it's a [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. This plan is effective for [PII] and it is active.
[AGENT][NEUTRAL] Which benefit can I provide for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just to check, um, are you checking by it by codes for the benefits?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh, um, are you checking the benefits for codes of the procedure?
[AGENT][NEUTRAL] No, ma'am. The place of service.
[CUSTOMER][NEUTRAL] Um, in office only, and office visits.
[AGENT][NEUTRAL] So, so an office visit or office treatment?
[CUSTOMER][NEUTRAL] Um, office visit.
[AGENT][NEUTRAL] OK, under this plan, office visit is not covered, but any treatment received in the office would be.
[AGENT][NEUTRAL] Do you have a code? I can pull up the code.
[CUSTOMER][NEUTRAL] Mhm. Um, the codes I have here is 31231.
[CUSTOMER][NEUTRAL] For endoscopy.
[AGENT][NEUTRAL] So that would be a treatment in the office that would fall under the outpatient benefit for office treatment. So anything in the office treatment wise would be 9100 per calendar year.
[CUSTOMER][NEUTRAL] Mhm. OK. And um, so I have here another code. Can you check if it falls to the application? Um, it's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment. It is 95,800.
[AGENT][NEUTRAL] That would be another treatment.
[CUSTOMER][NEUTRAL] Mm, OK. Got it. Thank you. So, this the office visit is not covered for this plan and all the outpatient, um, services will be covered. And can I have your name for my reference only? And do you have any reference number?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that last code, the 95,800, that's sleep study that is also allowed under this plan as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. OK, thank you very much for confirming. And I guess that would be all. Thank you, thanks again. You have a great day. Thank you.
[AGENT][POSITIVE] You're so welcome. Thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.