AccountId: 011433970860
ContactId: f2d4b14b-eea5-4ba4-b475-69e83629fc49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 242179 ms
Total Talk Time (AGENT): 106616 ms
Total Talk Time (CUSTOMER): 112229 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/f2d4b14b-eea5-4ba4-b475-69e83629fc49_20250618T12:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name is [PII]. I'm trying to, um, I'm trying to verify, um, mil for a patient. I'm calling from Worldwide Pediatrics.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is gonna be 02221656 M as in mom, L as in Larry 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, child's name is [PII]. Date of birth is [PII]. It's gonna be a secondary.
[CUSTOMER][NEUTRAL] Uh, policy.
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active for [PII], it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I have a question and this this um policy uh cover office visits?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so we pay towards the copay, deductible and co-insurance of coverage charges after primary for outpatient, we'll, um, the policy will pay up to $3500 per calendar year.
[AGENT][NEUTRAL] Now the in-office setting in.
[CUSTOMER][POSITIVE] So it does correct the copays mhm.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] So it covers co-pays and and deductibles?
[AGENT][NEUTRAL] Yes, co-pay, deductible and co-insurance after primary.
[CUSTOMER][POSITIVE] So after the primary, OK, so it does OK perfect so it does OK.
[AGENT][NEUTRAL] So for the
[CUSTOMER][NEUTRAL] Um, may I have a, I'm sorry, go ahead, go ahead.
[AGENT][NEUTRAL] I'm trying to let you know for the in-office setting, there is no coverage on this policy. So if you bill for like a 9921499213, it will most likely be denied, but they do have the office treatment rider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the treatment
[CUSTOMER][NEUTRAL] Because that's the one that we build, that's the one that we use, that's the one that we use 9921499.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's not covered then.
[AGENT][NEUTRAL] Um, it depends. I was just trying to let you know if you use those codes, it's not covered, but they do have the office treatment rider, so the treatment in the office could be covered.
[CUSTOMER][NEUTRAL] A treatment meaning like, like for what?
[AGENT][NEUTRAL] Anything done in the office as long as it's not cosmetic.
[AGENT][NEUTRAL] X-rays, procedures.
[CUSTOMER][POSITIVE] Oh OK, OK, perfect, OK.
[CUSTOMER][NEUTRAL] The procedures are covered, but like an office visit, no.
[AGENT][NEUTRAL] If you're using the place of service code.
[CUSTOMER][NEGATIVE] Like, you know, sick visit.
[AGENT][POSITIVE] Go ahead, ma'am. I'm sorry.
[CUSTOMER][NEUTRAL] Like the code I got like the code like the 99214 office like in then got like like procedures are like procedures are covered but not like the the 99214 and the 99213 code is covered.
[AGENT][NEUTRAL] Right, treatment is covered, place of service is not.
[CUSTOMER][NEUTRAL] That's what you're trying to say, OK.
[CUSTOMER][NEUTRAL] Got it, got it. OK, perfect. May I have a reference number for this verification please?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much [PII] you have a nice day, OK? Take care.
[AGENT][NEUTRAL] You also [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] No thank you bye take care bye.
[AGENT][POSITIVE] Thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Uh