AccountId: 011433970860
ContactId: 2027aee7-7fb5-4c00-ad67-d0adad3beaad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228360 ms
Total Talk Time (AGENT): 132024 ms
Total Talk Time (CUSTOMER): 74712 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/2027aee7-7fb5-4c00-ad67-d0adad3beaad_20250303T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yes ma'am, I have a plan with you guys and I'm just wondering, I've got a colonoscopy coming up on the [PII] and my deductible is $5000. Is this plan, will this plan help cover that?
[AGENT][NEUTRAL] Is it a diagnostic colonoscopy or is it a preventative colonoscopy?
[CUSTOMER][NEUTRAL] Preventative.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Do you have the policy number, Mr. [PII]?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 02565183
[AGENT][NEUTRAL] Thank you. And I need to verify your date of birth, mailing address, and email address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] OK. Let me look at your benefits. And before I go over the benefits, I just need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see, so this is your secondary supplemental plan, Mr. [PII]. Um, this one usually, uh, this one doesn't pay preventative and the reason for that is because major medical usually pays 100%.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, now, if it's a diagnostic colonoscopy, then it will fall under the benefits of the policy. If it's a diagnostic colonoscopy and they're gonna do it in an outpatient facility, then you have up to $2000 per person per calendar year for outpatient facilities.
[CUSTOMER][NEUTRAL] Uh, so, wow, so it does, it's not gonna cover it.
[AGENT][NEUTRAL] If it's preventative, they, they usually, yeah, they usually cover 100% in your major medical. Have you checked with them?
[CUSTOMER][NEUTRAL] Because it's a preventative.
[CUSTOMER][NEUTRAL] Yeah, no, they're, they're, I got my out of pockets 50.
[AGENT][NEUTRAL] OK, but um did you explain to them that it was a preventative colonoscopy, not a diagnostic colonoscopy?
[CUSTOMER][NEUTRAL] No, I haven't called them yet. I just got the bill from the from the doctor's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you already performed the, the colonoscopy, or they're just prevailing?
[CUSTOMER][NEUTRAL] No, no, it's no, they, they sent it that, yeah, yeah, they're pre-billing me.
[AGENT][NEUTRAL] Pre-billing. OK. OK. So if it is a prevailing, um, yeah, you might wanna check with your major medical and see how much they will cover out of that bill that you're that they're prevailing. Just let them know that it's a preventative colonoscopy and see if it's fully paid by your major medical. But if it's not fully paid by your major medical, then this one, it doesn't have preventive service because usually it's paid 100%.
[AGENT][NEUTRAL] Um, so this one is just for diagnostic if you're having like stomach problems or something like that and they need to do like for a sickness and they need to do a colonoscopy because of that, then this one will take place, but if it's just preventative, it will not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] That's it thanks bye.
[AGENT][NEUTRAL] OK, you're