AccountId: 011433970860
ContactId: 131d8c9b-c651-4b61-96f0-fc8c4ce6262b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389359 ms
Total Talk Time (AGENT): 209920 ms
Total Talk Time (CUSTOMER): 91603 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/131d8c9b-c651-4b61-96f0-fc8c4ce6262b_20250313T13:54_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, good morning. Um, I was just on the phone with American Public Life, asking if a mammogram was covered. They said I'd have to call medical benefits and a card. They said that I need to get the answer from you guys. So at this point, I need somebody to tell me.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] If it's gonna be covered or not. It shouldn't be that hard.
[AGENT][NEUTRAL] OK, uh, it depends on who is the one that is in charge of that particular product or the test. Is that mammogram a diagnostic? OK. If it's, uh, is this gonna be a diagnostic mammogram? It's a preventative. OK, so that's the clue. The clue that is a preventative. When it's a preventative, we do not cover preventative. Um, I can check on your policy and see who handles the preventative part of it.
[CUSTOMER][NEUTRAL] They said you guys were.
[CUSTOMER][NEUTRAL] It's a preventative.
[CUSTOMER][NEUTRAL] No, it's a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if it's um IMA I can go ahead and get you to IMA but um let me go ahead and look at your policy first, OK? Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, and may I have the policy number?
[CUSTOMER][NEUTRAL] It is um
[CUSTOMER][NEUTRAL] 0258
[CUSTOMER][NEUTRAL] 773-3
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, you say your card here. OK, so, so she had, um, let me just have the date of birth for security.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And let me pull the image of the card and see who handles the preventative. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now let me ask you a question too. Do I need to call the doctor and get her to write a script for the diagnostic to get it paid?
[AGENT][NEUTRAL] Um, whenever we do payments for diagnostic, um, usually what we do is we get the claim directly to us and we'll go ahead and pay directly to the provider of service. So usually what they do is they call us, they get verification or benefits or eligibility information, and then they'll go ahead and send the claim directly to us and that's after they do, they do the test, the diagnostic test. Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, afterwards?
[AGENT][NEUTRAL] Yes, it's afterwards. We don't do any pre-authorizations.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if I go and take my card um for this appointment.
[CUSTOMER][NEUTRAL] Then they'll just go ahead and get it done.
[AGENT][NEUTRAL] More than likely they will call us for benefits. Mhm.
[CUSTOMER][NEUTRAL] Or is it gonna come up that it
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I can check and see how much we cover for diagnostic. This, this is not a major medical. This is a limited policy, um, and it pays like a flat amount, but I can go ahead and tell you how much it is if it's a diagnostic testing.
[AGENT][NEUTRAL] OK. Um, so yes, you do have VIP, um, big plan which is uh through IMA. IMA is the one that handles preventative for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that will be that the number that you have on your medical ID on the card. There's a D number D45401. Yeah, that's gonna be your number for preventative, OK? Um, let me give you the number to IMA so you can call and get that and I can also transfer you. It's no problem. Let me give it to you for future. Um, see that number to IMA and that's gonna be option number one and it's gonna be 1-800-833.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4296. OK. And let me see how much we cover for you on the diagnostic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they'll be the one to tell me? Oh, you're looking at the coverage, OK.
[AGENT][NEUTRAL] Uh-huh. Yeah, for diagnostic, I can tell you, uh, for preventative, they're the ones that can tell you how much they cover for a mammogram if it's preventative, OK? Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And for diagnostic testing, we cover, let's see, $200 per day, maximum of 1 day per cover person per calendar year, but that is um the amount that we will cover if it's a diagnostic testing. Um, so let me go ahead and get you to IMA so they can give you your preventative coverage, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today before I transfer you?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Yeah, thank you for calling AP and I do apologize for the inconvenience, OK? One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card member. All agents are currently assisting other callers.
[CUSTOMER][NEUTRAL] Please remain on the line and your call will be answered by the next agent.
[CUSTOMER][POSITIVE] We appreciate your call.
[CUSTOMER][POSITIVE] We appreciate your patience.
[CUSTOMER][POSITIVE] Please remain on the line and we will be with you shortly.