AccountId: 011433970860
ContactId: 0748da14-60ba-4cc6-aee3-b9ce9c87765b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461799 ms
Total Talk Time (AGENT): 235579 ms
Total Talk Time (CUSTOMER): 126339 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/0748da14-60ba-4cc6-aee3-b9ce9c87765b_20250414T20:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm just calling to find out.
[CUSTOMER][NEUTRAL] The insurance that I have through my job, do you guys cover anything for a colonoscopy?
[AGENT][NEUTRAL] OK, I can look at your policy and give you your benefits. Uh, can you please give me your name and your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. My name is [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your policy number?
[CUSTOMER][NEUTRAL] Um, my policy number.
[CUSTOMER][NEUTRAL] Do you mean group number?
[AGENT][NEUTRAL] No, it might say uh member ID or inpatient or outpatient certification number.
[CUSTOMER][NEUTRAL] Uh, it says outpatient benefits certified number.
[AGENT][NEUTRAL] Yes, ma'am. If you can give me that number.
[CUSTOMER][NEUTRAL] And in hospital
[CUSTOMER][NEUTRAL] OK. Uh 02497497 ML 8.
[AGENT][NEUTRAL] OK, let me look it up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please um verify your policy for me? I'll need for you to give me your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, the phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, my address is [PII]. My phone number is [PII], and my email is [PII].
[AGENT][NEUTRAL] OK, thank you. I appreciate you verifying that information for me, Ms. [PII]. All right, so we're looking to see if you can get a colonoscopy.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look at your benefits real quick.
[AGENT][NEUTRAL] I'm going to need to pull up your policy and read it as far as what it says it's going to be a little bit so the computer can pull it in for us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let's look and see. I've got it pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's going to be outpatient, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not showing that you have diagnostic coverage on this policy and this is just to verify your benefits. It's not a guarantee of payment. Um, well, that was inpatient, let me look outpatient.
[AGENT][NEUTRAL] Let me see what it says for outpatient.
[AGENT][NEUTRAL] And you're, are you going to have it done at a outpatient free standing facility or is it gonna be?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. You do have a diagnostic testing in a hospital outpatient facility. Is that, does that sound like it's
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, I, I don't think it will be in a hospital.
[AGENT][NEUTRAL] What you're gonna be doing.
[AGENT][NEUTRAL] It's uh an ambulatory center or urgent care center, um.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Uh, I, I don't really know yet. I just
[CUSTOMER][NEUTRAL] I don't, it's, it's not the hospital. It's.
[CUSTOMER][NEUTRAL] I'm, I think it's just a building.
[AGENT][NEUTRAL] But is it
[AGENT][NEUTRAL] Just a building? OK.
[CUSTOMER][NEUTRAL] It's just an outpatient building, I think.
[AGENT][NEUTRAL] OK. All right, let's look real quick.
[AGENT][NEUTRAL] I'm gonna see what it says as far as diagnostic testing for you.
[AGENT][NEUTRAL] OK, yes. It says that um these facilities may not be at the hospital. They may be elsewhere if it's a formal agreement in their use. So if it's um
[AGENT][NEUTRAL] A free standing
[AGENT][NEUTRAL] Outpatient facility, that'll be fine. Uh, and let me tell you what your benefits are going to be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For outpatient and again this is just to verify your benefits, it's not a guarantee of payment. You, this is a supplemental insurance policy that helps with deductible, co-pay, and co-insurance and you have an outpatient per calendar day benefit of $3000 to go towards your deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So now,
[CUSTOMER][NEUTRAL] Like, my insurance told me that if I go in and it's just routine, it won't cost anything. If they have to remove polyps, it'll cost me $1500. So do you guys help me pay that $1500?
[AGENT][NEUTRAL] Yes, um, now, the procedures, if it's done in a physician's office, the procedure that you have done will will, is covered. Now the physician's office visit fee is not covered under this policy.
[AGENT][NEUTRAL] So the office visit fee is not covered, but the procedure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That you have done.
[CUSTOMER][NEUTRAL] would be covered.
[AGENT][NEUTRAL] Right, for deductible, co-pay or co-insurance and the way it works is your primary insurance is billed first and depending on what they pay is what we pay. So after the primary is billed and the claim is sent in.
[AGENT][NEUTRAL] Uh, you can have the office make sure that they send in the explanation of benefits from your primary insurance so that the claims examiners can examine what the primary paid first.
[CUSTOMER][POSITIVE] OK, all right, um, OK, thank you very much.
[AGENT][NEUTRAL] You're welcome. Is there anything else, Miss [PII], I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh, no, I think I'm OK. I might have to call back again tomorrow just to refresh myself, but I think right now I'm OK.
[AGENT][NEUTRAL] OK, well,
[AGENT][NEUTRAL] That's fine.
[AGENT][POSITIVE] OK, that is very fine. You're welcome and I hope your procedure goes well for you, Ms. [PII]. Thank you for calling APL. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Me too.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye-bye.