AccountId: 011433970860
ContactId: 046c2518-88bb-422b-8afe-be527a4197a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 189419 ms
Total Talk Time (AGENT): 97458 ms
Total Talk Time (CUSTOMER): 62062 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/046c2518-88bb-422b-8afe-be527a4197a4_20250523T12:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Gastro Health. I'd like to find out if you guys cover an upcoming procedure for a patient, please.
[AGENT][POSITIVE] I'm sure [PII] I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] It it's.
[CUSTOMER][NEUTRAL] Is it the certification number?
[AGENT][NEUTRAL] Yes, ma'am. The outpatient certificate number.
[CUSTOMER][NEUTRAL] OK, it's 02113858 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And where will the service take place, um, in the office or inpatient or outpatient facility?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's ambulatory outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. For outpatient services, we cover up to $250 per day and that's for the co-pay, the co-insurance, and the deductible. After the primary insurance processes the claim, um, in order for us to cover it, it has to be covered by the primary insurance and the um diagnosis codes have to be related to an illness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they're having an endoscopy.
[CUSTOMER][NEUTRAL] Do you know whetherless like that would be covered? It's a diagnostic endoscopy.
[AGENT][NEUTRAL] Um, yes, ma'am. Normally, that would be covered, um, as long as, like I said, it's related to an illness or an injury and it's not just for screening and the primary insurance carrier has to cover a portion of it, of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And you guys cover 250 every day.
[AGENT][NEUTRAL] Yes. Yes, ma'am. 250. Right.
[CUSTOMER][NEUTRAL] Up to 250.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right, thank you so much. Can I have a reference number to the call please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No that's all thank you so much ma'am.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great weekend. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.