AccountId: 011433970860
ContactId: 08ceaffd-e875-4bfe-aa5c-160346be8286
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328980 ms
Total Talk Time (AGENT): 117925 ms
Total Talk Time (CUSTOMER): 118181 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/08ceaffd-e875-4bfe-aa5c-160346be8286_20250410T17:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, sir. My name is [PII] and initial to my last name is [PII], calling from provider's office to check the eligibility and benefits certification for a member. Before that, I just want to inform you that this call is been recorded for quality and training purpose. I hope this is fine with you.
[AGENT][POSITIVE] That's fine. I'm happy to help and check eligibility and benefits. No. Can I get the policy number?
[CUSTOMER][NEUTRAL] Uh, sure. Give me a moment.
[CUSTOMER][NEUTRAL] So the policy number is 02563961.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] That is [PII] and the last name that is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date is [PII]. We are the members secondary insurance, so this will cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK. Could you please repeat it once?
[AGENT][NEUTRAL] We are the members secondary insurance.
[AGENT][NEUTRAL] So this, this will cover deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Co-pay
[AGENT][NEUTRAL] And co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, as you stated, uh, so the effective date is [PII] and the plan is secondary and there is no deductible co-pay and co-insurance. Is that correct?
[AGENT][NEUTRAL] Correct, because we are the secondary.
[CUSTOMER][NEUTRAL] OK. And could you please help me if the uh referral is required or not and the authoration is required or not for the uh procedures, colonoscopy, and you have to also check if it is covered or not.
[AGENT][NEUTRAL] No prior authorization is needed.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Under the member plan, their outpatient benefit max for the calendar year is $6000. This is a verification of benefits, not guarantee of payment. Member has not used anything as of date.
[CUSTOMER][NEUTRAL] So, uh, could you please repeat, is, is the out of pocket here as you stated?
[AGENT][NEUTRAL] I apologize. What was your question again?
[CUSTOMER][NEUTRAL] OK, could you please repeat?
[AGENT][NEUTRAL] On the member plan, the outpatient benefit max for the calendar year.
[AGENT][NEUTRAL] It's $6000.
[CUSTOMER][NEUTRAL] OK. Outpatient benefit max, that is $6000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And could you please tell me if any referral is needed?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And could you please check if the procedure uh code 45378 colonoscopy is covered under the member's plan?
[AGENT][NEUTRAL] We're unable to check procedure codes. It follows the primary, so we're gonna pick up whatever the primary doesn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So it's uh all the benefits and the courses will be uh uh uh depend on the primary. Is that correct?
[AGENT][NEUTRAL] Correct. And then we pick up the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, sorry, could you please repeat? Uh.
[AGENT][NEUTRAL] We pick up the co-pay, deductible, and co-insurance.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. From the primary insurance.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Could you please help me, uh, [PII], could you please spell your name and last name initial?
[AGENT][NEUTRAL] My name is spelled [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] My last name initial is [PII]. The call reference is my name.
[AGENT][NEUTRAL] With today's date.
[CUSTOMER][NEUTRAL] And [PII], there is no term date. Is that correct for the member's plan?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thank you, sir. Thank you for assisting me. Have a great day.
[AGENT][POSITIVE] You're welcome. Have a good day. Bye-bye.