AccountId: 011433970860
ContactId: 22a4195d-a7a7-4bfa-87cf-e70dcc2b066f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313339 ms
Total Talk Time (AGENT): 114920 ms
Total Talk Time (CUSTOMER): 133720 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/22a4195d-a7a7-4bfa-87cf-e70dcc2b066f_20250110T22:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling with the office of Doctor [PII] about a patient's, um, benefits and eligibility.
[AGENT][POSITIVE] Yeah, I can check benefits and eligibility for you [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] You got it
[CUSTOMER][NEUTRAL] Yes, it's uh [PII] option one.
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, so what I have here is 02474924.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan. So it is designed to help, uh, I'm sorry, uh, essentially it just pays with, um, a set dollar amount per procedure or office visit. What kinds of benefits do we need to check?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Also just left, right?
[CUSTOMER][NEUTRAL] I thought I heard her voice, yeah, he just.
[CUSTOMER][NEUTRAL] And her no so I have to stay so far.
[CUSTOMER][POSITIVE] But if we all go with one he can't stop us all. Uh, for specialty office visit? You are.
[AGENT][NEUTRAL] Office visit? OK, is this in regards to an accident or a sickness?
[CUSTOMER][NEUTRAL] I was like you can probably catch at least one person, but that's it. That I'm aware of no it for specialty care just for screening.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, give me just a moment, let me check that for you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so of course I will also let you know that uh verification of coverage is not a guarantee of payment for claims. They don't have a benefit for specialty office visits. Uh, this plan has benefits for, uh, if they were if excuse me, if it was regarding a sickness, they also have a wellness exam and diagnostic testing benefit that's limited to, uh, MRI, CT, and colonoscopy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, for the colonoscopy, what's it covered up to how much?
[AGENT][NEUTRAL] Oh, let me check. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that is $250 per test.
[CUSTOMER][NEUTRAL] OK. And is that for like a kit that they check or is it for the actual procedure?
[AGENT][NEUTRAL] Foot procedure.
[CUSTOMER][NEUTRAL] OK, up to 350.
[AGENT][NEUTRAL] 2250.
[CUSTOMER][NEUTRAL] 0 250.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is it possible to send me that via fax?
[AGENT][NEUTRAL] Um, I can't unfortunately send that, um, as I'm just looking at their policy.
[CUSTOMER][NEUTRAL] OK, so there's no way of having that information sent to us like their, their benefits?
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Not for this kind of policy. I don't have anything that I could send to you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So for an office visit for like a specialty care office is that's not covered?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um any procedures or just the colonoscopy is covered up to 250.
[CUSTOMER][NEUTRAL] Per test, right?
[AGENT][NEUTRAL] Right, that's, that's for the diagnostic testing benefit, yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And may I have your, um your reference number? Do you have one?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] And was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] To the 17
[CUSTOMER][POSITIVE] Uh, no, thank you very much. um, I appreciate it. You have a wonderful day.
[AGENT][POSITIVE] OK, yeah, thanks calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.