AccountId: 011433970860
ContactId: f004b3d6-533d-4aad-865f-5b20de0ffdc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378420 ms
Total Talk Time (AGENT): 115179 ms
Total Talk Time (CUSTOMER): 145567 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/f004b3d6-533d-4aad-865f-5b20de0ffdc5_20250520T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from NYU Langone Hospital. Um, I just have some questions on a patient's plan, please.
[AGENT][POSITIVE] All right. Happy to check on the policy for you, [PII]. What's the policy number?
[CUSTOMER][POSITIVE] Um, I have, oops, I'm sorry.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It is 15185.
[AGENT][NEUTRAL] Let me pull this up here.
[AGENT][NEUTRAL] All right, that doesn't come up as a valid policy number. Do you have their name or social? I can check that way.
[CUSTOMER][NEUTRAL] Oh wait, you know what? I did have a copy of a card. That's the ID the patient gave me, but I do have the card. I'm sorry, um, it's 016.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 163.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 82 ML8. Sorry about that.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] All right. And then what is the patient name and date of birth, please?
[CUSTOMER][NEUTRAL] This is [PII] and um date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] Is there a future termination date for this plan?
[AGENT][NEUTRAL] There is not, no.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, I called there a little while ago and I spoke to somebody named [PII] in your office. She was trying to explain the plan to me, but um I just had some additional questions. She mentioned that this first, if you can just double check, I don't know if I explained it to her properly, that the patient's getting a sleep study done and it is going to be billed by the hospital.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you tell me if that's something, I have a CPT code and a diagnostic code if you need it.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Right. So do you know, are they gonna, they are gonna be, you said in a hospital having the sleep study done, is that correct?
[CUSTOMER][NEUTRAL] No, it's actually a home sleep study, but the hospital bills it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's an outpatient service.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just reading. So the plan itself is a secondary plan. Um, it picks up any deductible, co-pay, co-insurance from the primary. I don't see anything under the exclusions, um, that lends to that it wouldn't be covered under their outpatient benefits.
[CUSTOMER][NEUTRAL] OK. Now they also um.
[CUSTOMER][NEUTRAL] What was I gonna say? [PII] had also mentioned that it covers up to $1500 per calendar year, is that right?
[AGENT][NEUTRAL] Mhm. That's the Benefit Max under their outpatient, yes.
[CUSTOMER][NEUTRAL] What I did not ask was if the patient has used it.
[AGENT][NEUTRAL] OK, yeah, let's take a look.
[CUSTOMER][NEUTRAL] Any of the 1500?
[AGENT][NEGATIVE] Yeah, this sucks.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it looks like they have the full amount remaining.
[CUSTOMER][NEUTRAL] OK, very good. And can I have your name and the reference number?
[AGENT][NEUTRAL] Absolutely. My name is [PII], which is uh
[CUSTOMER][NEUTRAL] Oh wait, I'm sorry. There was another question, sorry. Um, so when we, you guys reimburse the insurance company or the hospital, if we put a claim into you guys.
[AGENT][NEUTRAL] Yes, ma'am. No, it's OK.
[AGENT][NEUTRAL] So if you're submitting the claim then payment would be remitted to you.
[CUSTOMER][NEUTRAL] OK, so even though the back of the card mentions about a limited benefit plan.
[CUSTOMER][NEUTRAL] I guess it depends on the benefit, and in this case her sleep study is something that you guys cover.
[AGENT][NEUTRAL] Yeah, I don't see anything under outpatient. Yeah, I don't see that it would be denied.
[CUSTOMER][NEUTRAL] When build outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much. And I just need your name again. I'm sorry.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] That's OK. My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] And [PII], what's your last initial?
[AGENT][NEUTRAL] It is [PII], and you can use my name with today's date as a call reference.
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your help, sir. Have a good day.
[AGENT][POSITIVE] My pleasure. You too.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.