AccountId: 011433970860
ContactId: 2952493a-420c-433c-8c1c-b9b88f4ff11d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1065479 ms
Total Talk Time (AGENT): 377344 ms
Total Talk Time (CUSTOMER): 546275 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/2952493a-420c-433c-8c1c-b9b88f4ff11d_20250522T16:25_UTC.wav
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[AGENT][POSITIVE] We one of theirs gracias apele meiamali and ar.
[CUSTOMER][NEUTRAL] Oh [PII] process.
[CUSTOMER][NEGATIVE] not to go.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ya they call it enumera de la polia give atiniconapele.
[CUSTOMER][NEUTRAL] And er
[CUSTOMER][NEUTRAL] Tea.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And numerrodos.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Benicinco
[CUSTOMER][NEUTRAL] Sincuentocho Sincuentocho MLA C.
[AGENT][NEUTRAL] OK, classes it almost almost it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Gracias la la la semiento.
[CUSTOMER][NEUTRAL] Paris.
[CUSTOMER][NEUTRAL] For 95.
[AGENT][NEUTRAL] Irexion de la casa.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's lauravor.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] Yeah, this is quinoubre la polia de Apie.
[CUSTOMER][NEUTRAL] Say no.
[CUSTOMER][NEUTRAL] OK so uh cure surgical benefits pero mi bolia this queo menegure uh they are not you said you you to come on you not go to so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See Clara.
[AGENT][NEUTRAL] Is that, yeah, I'll read that?
[CUSTOMER][NEUTRAL] I mean, I know like.
[AGENT][NEUTRAL] OK. Oh, is that any beneficials?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Pores.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know my
[AGENT][NEUTRAL] Uh, so checking on that the moment detail.
[CUSTOMER][NEUTRAL] They said
[AGENT][POSITIVE] Oh, it's for, it's in [PII]. It's [PII], that'll look good.
[AGENT][NEUTRAL] Dondevacelo?
[CUSTOMER][NEUTRAL] And and [PII] fine I don't know if you.
[AGENT][NEUTRAL] Torquetini queer and una facilitate the outpatient commo on.
[AGENT][NEUTRAL] Hospital or outpatient facility or freestanding outpatient surgery center.
[AGENT][NEUTRAL] The Lawson in [PII].
[CUSTOMER][NEUTRAL] And don't have to get a numeral I.
[AGENT][NEUTRAL] It all depended decom a little um um.
[AGENT][NEUTRAL] Mandanrelamo cone corrio de facilidad porque lopo in uno fascia no I beneficials.
[AGENT][NEUTRAL] Porque inlapolia [PII] Apele soloubre the inpatient hospitality outpatient facilitates no beneficials for.
[AGENT][NEUTRAL] Uh, cause it's in [PII].
[AGENT][NEUTRAL] Um, yoveoque un proveor Yamaa no sotrosport beneficios yeah you see herunque es barela offaina.
[CUSTOMER][NEUTRAL] OK, it's [PII] I don't, uh, um, his wife, it's [PII]. It's outpatient. It's an outpatient facility. So they told him that it might cover the gap might cover it. When we checked the benefits that the gap, uh, shows you, it says that it will cover diagnostic exams. He's getting this diagnostic exam at an outpatient facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it, um, let me ask you, is it like for an endoscopy or colono what, what type of procedure, if I may ask?
[CUSTOMER][NEUTRAL] Yeah, it's for both, yes, they're, they're gonna do both the same day, an endoscopy and a colonoscopy. He's been having stomach issues, and they told him that these are diagnostic procedures he's gonna get in order to, of course, get a diagnosis of what's going on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, because a lot of times those facilities do have a surgical center attached to the offices, you know, in the.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] For general, for the GI associates, a lot of times they do have that surgical center attached to their offices, and if they bill through that surgical center and bill it as an outpatient facility, there are benefits.
[AGENT][NEUTRAL] For outpatient facility.
[CUSTOMER][NEUTRAL] OK, my question is how, how can we know if this is gonna be covered by the gap? Does he have to call the police and ask them, or do we know this through you guys? because they told him to call the gap we called you guys and then we read it online and it says that it covers the agnostic exams, but then you're telling me that this is not an outpatient facility, but it is an outpatient facility according to them.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it does, it, it, everything is going to depend on what code they send in with the claim. Um, normally, like I said, for a colonoscopy and endoscopy, they do have that surgery center attached and if it is an uh outpatient surgery center, then they bill as an outpatient surgery center.
[AGENT][NEUTRAL] Then it could be covered. It, it just depends on how they bill. Do y'all happen to have a number for the provider for the office? A phone number?
[CUSTOMER][POSITIVE] We do have a number for the office where he's gonna be getting it, yes.
[AGENT][POSITIVE] And would you like to do, let's see if we can do a three-way call with them. I'll be happy to call him.
[CUSTOMER][NEUTRAL] When he's gonna be getting the procedure done.
[CUSTOMER][NEUTRAL] Well that
[CUSTOMER][POSITIVE] Yeah, that would be great. Please, I have a number right here.
[AGENT][NEUTRAL] OK, if you can provide.
[AGENT][NEUTRAL] OK. What's the phone number?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, let me see if I can get someone on the line and then I'm going to add y'all on the call as well so you you know what's going on and see if I can figure out if they're gonna bill as inpatient or outpatient because I know with things like that, you know, sometimes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If you have to pay upfront it's a lot of money so.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah, because they're, they're talking about like $900 so we wanted to know if it would be covered or not, yeah.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Well, yeah, well, and if you have benefits, we definitely wanna get those for you. So, if you will give me just a minute, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Because it, it's
[CUSTOMER][NEUTRAL] OK, alright, alright, no, I just wanted to let you know because we're reading like through the what's included in his APL insurance coverage gap and it talks about in uh outpatient and then inpatient benefits. So either or we wanted to know if that'll be covered either way because it talks about both of them.
[AGENT][NEUTRAL] In his policy?
[AGENT][NEUTRAL] Right. So normally with the endoscopy and, and colonoscopy, that is not considered inpatient. Inpatient on the policy is when he is in the hospital more than 18 hours.
[AGENT][NEUTRAL] And admitted into the hospital. So that's what the inpatient benefit would cover, but the outpatient would be for like diagnostic surgical procedures if it's performed in the um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right facility, but let's see if I can get a rep uh someone at the doctor's office on the phone, see how they're gonna bill, and that might give us a better idea. Now, you know, of course I cannot guarantee payment of a claim until we have it on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But I can guarantee the benefits on your policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But if you'll just, if you'll just give me one moment, please, ma'am.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] I appreciate it. One moment. Thank you.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Thank you for calling Digestive Medicine Associates. [PII] and Digestive Medicine Associates. If you're calling from a hospital pharmacy or doctor's office, press 4 pacio office in [PII] cuadro for medications, refills and medication authorizations, press 5. Paramedicamentos refi medicamentos for insurance verification and co-pays, press 8.
[CUSTOMER][NEUTRAL] For insurance verifications and co-pays for office visits, press 1.
[CUSTOMER][NEUTRAL] For procedures, press 2 Paraver de pagos consta please hold a moment.
[CUSTOMER][NEUTRAL] Thank you for calling Digestive Medicine Associates. Digestive Medicine Associates. You're now able to schedule your own appointments by going to our website [PII] and click on the Make your appointment section. Here you will be able to make new patient and follow-up appointments with one of our providers at any of our locations. Web [PII] make appointmentercita.
[CUSTOMER][NEUTRAL] Aquipo de voso conodores and alra noses. You may experience a high call volume during the hours of [PII] in the morning to [PII] for more expedited service, you can contact us between [PII] in the morning or [PII] in the afternoon. [PII].
[CUSTOMER][NEUTRAL] Enter de la man relatariora puede comunic soo la mano de la res alasin media de latan.
[CUSTOMER][NEUTRAL] For appointments and scheduling, press 5. But the fundamental cinco. If you're calling from a hospital pharmacy or doctor's office, press 4.acia office in [PII] cuadro for medications, press Pamedicamento press for medical records, press 7. Paes. If you know your policy extension, you can dial it any time. Sinoiddo puede momento.
[CUSTOMER][NEUTRAL] For referrals press 8 for billing questions, press 9. cuenta for fast and locations, press. If this is a medical emergency, please hang up and dial [PII] for all of the calls. Please stay on the line or press [PII] for an operator. Thank you.
[CUSTOMER][NEUTRAL] Please hold a moment.
[CUSTOMER][POSITIVE] Thank you for calling the of Medicine. How may I help you?
[AGENT][NEUTRAL] Hi, my name is [PII]. I am with APL um Gap Insurance. I'm calling with one of your patients on the line regarding coverage for endoscopy or an endoscopy.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Colonoscopies uh procedure that you're going to, he's going to have and regarding the coverage with this gap policy. Can you help us?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, let me actually get you with someone in our insurance department so that they can help you with that cause I wouldn't, um, no information in regards to that.
[AGENT][POSITIVE] OK. I appreciate that. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Thank you for calling Digestive Medicine Associates. Your call is very important to us. All of our operators are currently assisting other callers. Please hold the line and someone will be right with you. You're now able to schedule your own appointments by going to our website [PII] and clicking on the Make Appointments section. Here you will be able to make new patient and follow up appointments with one of our providers at any of our locations. That's for Yamada Digestive Medicine Associates. Yamada.
[CUSTOMER][NEGATIVE] That's too many I gonna have to sign up for.
[CUSTOMER][NEUTRAL] Aeti.
[AGENT][POSITIVE] Yes, hi, how are you? How are you doing today?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] Good. May I ask your name?
[CUSTOMER][NEUTRAL] [PII], how can I help you?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. My name is [PII]. I am with APL Insurance Company. I have one of your patients on the line that's going to have an endoscopy, colonoscopy performed, and they were told that it's not covered. Can you assist us?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the date of the location?
[AGENT][NEUTRAL] Uh, um, do you need him to give you his information?
[CUSTOMER][NEUTRAL] Um, I need the date of birth so I can see with the patient and get the information.
[AGENT][NEUTRAL] OK. His date of.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII] [PII], sorry, [PII].
[CUSTOMER][NEUTRAL] What is the name of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] all
[CUSTOMER][NEUTRAL] OK, did he have a procedure on on in the office on Pembropines?
[CUSTOMER][NEUTRAL] OK, and how can I help you? He will be having it on the [PII], yeah, he will be having it on the [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK, and what is the issue that you guys have? I'm sorry.
[AGENT][NEUTRAL] OK, so they called and said that um someone told them that it would not be covered with the APL. So I was explaining that his APL policy does have outpatient surgical procedure benefits as long as it is formed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, but the thing is that he's, yeah, the thing is that he's not gonna do the procedure in an outpatient surgery center. He's going to do the procedure at the office.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And will y'all bill as an office setting?
[CUSTOMER][NEUTRAL] Is there a possibility? Um, yes, yes, it will be billed off, yeah.
[AGENT][NEUTRAL] OK, so that's what we were calling to see if y'all possibly were going to bill as outpatient or office code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it's not gonna be outpatient. It will be offices.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have a question. Is there a possibility to do this procedure in an outpatient center and bring you guys the results?
[CUSTOMER][NEGATIVE] Mm, no, that doesn't work like that.
[CUSTOMER][NEUTRAL] I mean we can do that in the in the in the ASC we have an outpatient surgery center, but we have to talk to the doctor to see if they uh if he approved to do the procedure at the ambulatory surgery center.
[CUSTOMER][NEUTRAL] OK, is there a possibility to do that? Yeah, we have to call it. We have to send a message to the doctor so to see if he can approve that your, I mean, [PII] can do the procedure at the ASC. First we have to do that and then, um, if you say yes, we have to call me we call you back and see if Doctor [PII] wants to do the the procedure at the ASC.
[CUSTOMER][NEUTRAL] Could you please do that because they were talking about uh having to pay an amount of $900 if it's not done outpatient.
[CUSTOMER][NEUTRAL] Mhm. OK, we're gonna, I mean, I'm gonna send a message to the Dowari so he, so to see if he can approve it or not and then.
[CUSTOMER][NEUTRAL] I'll call you back telling you what what is the decision the decision that the already made, OK.
[CUSTOMER][NEUTRAL] Alright, sounds good. Do you have his phone number on file? Yeah, yeah, I have [PII].
[CUSTOMER][POSITIVE] Sounds good. It could be in Spanish. That would be better because he doesn't no, no, no, it's fine. OK, no problem. Thank you so much. Thank you.
[AGENT][NEUTRAL] Yeah, [PII], uh.
[AGENT][POSITIVE] To get in the Linux. Thank you, [PII].
[CUSTOMER][POSITIVE] Yeah you're welcome. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] OK. Hopefully, they're gonna get that taken care of for you so that it will be an outpatient facility.
[CUSTOMER][POSITIVE] OK, thank you so much for all your help. He says thank you.
[AGENT][NEUTRAL] Oh, it's my
[AGENT][POSITIVE] Yeah, it's my pleasure and I hope they could get that taken care of for you, but if you need anything at any time, don't hesitate to give us a call.
[CUSTOMER][POSITIVE] All right, thank you, thank you so much. We really appreciate it.
[AGENT][POSITIVE] It's my pleasure and thank you for calling APL. I hope you all have a wonderful afternoon.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.