AccountId: 011433970860
ContactId: ec7e353a-2bc0-47b1-b1e0-0940e6158ae7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275329 ms
Total Talk Time (AGENT): 112627 ms
Total Talk Time (CUSTOMER): 124120 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/ec7e353a-2bc0-47b1-b1e0-0940e6158ae7_20250515T20:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. Um, my name is [PII] Last initial is [PII] I am calling for benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK, is this for service in an office, outpatient facility or inpatient?
[CUSTOMER][NEUTRAL] In in office.
[AGENT][NEUTRAL] In office, OK, what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's uh 01.
[CUSTOMER][NEUTRAL] 868-8799
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you. Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Alright, thanks for verifying the information. I'm showing an effective date of [PII]. This policy is active at this time, and let me get over to the benefit information.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK, so under this policy, the physician visit fee is not covered. Um, I do see an office treatment writer, so covered treatment in an office setting can be considered under the outpatient benefit. Would you like that benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, no, well, it's for an office specialist. I don't know if you want like a, uh, CPT and, uh, procedure code.
[AGENT][NEUTRAL] OK, so is it for the physician's visit, the 99 series code or is it for treatment?
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] It's uh like the procedure code it's 99204.
[CUSTOMER][NEUTRAL] Is there an office.
[AGENT][NEUTRAL] That's an office visit code that, yeah, so the, the physician office co-pay is not covered.
[CUSTOMER][NEUTRAL] Not covered, OK, and then procedures, it, it would be like a biopsy, so it'd be 11102, like uh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so that is considered.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Yeah, that's considered treatment in the office and uh that item can be considered under the outpatient benefit. Would you like that benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yes, please.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] And then, uh, information provided today is just verification. It doesn't guarantee payment of a claim. gonna pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] 45.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEGATIVE] I don't want to see it and stuff.
[AGENT][NEUTRAL] Alright, so the maximum outpatient benefit is up to $2550. That's per covered person per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2500 OK.
[AGENT][NEUTRAL] And it looks like an individual policy. Uh, let me see if that, any of that benefit has been used. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm and he hasn't.
[CUSTOMER][POSITIVE] Yes thank you.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] No you you you have a nice day.
[AGENT][NEUTRAL] So right now I'm showing uh $15.81 have been paid at this time of that maximum, and did you have any other questions?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Alrighty, well, follow me, thanks for calling AP.
[CUSTOMER][NEUTRAL] OK, um, just a reference number.
[AGENT][NEUTRAL] It's gonna be my name in today's date, [PII], first initial last is [PII]
[CUSTOMER][POSITIVE] I mean thank you.
[CUSTOMER][NEUTRAL] And you said [PII]?
[AGENT][NEUTRAL] Mhm. [PII], first initial last name is [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] And then [PII], OK, thank you, you have a good day.
[AGENT][POSITIVE] Uh, you're welcome. Thanks for calling ATL. Have a good day as well.
[CUSTOMER][NEUTRAL] Bye bye.