AccountId: 011433970860
ContactId: 2a69fbf3-a765-4d66-8b3e-c2a4e138ee6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263970 ms
Total Talk Time (AGENT): 76248 ms
Total Talk Time (CUSTOMER): 96167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/2a69fbf3-a765-4d66-8b3e-c2a4e138ee6a_20250612T17:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from the product office, and I'm looking for benefits and eligibility.
[AGENT][POSITIVE] Hey [PII], I can help you with benefits and eligibility. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And the policy number of the patient?
[CUSTOMER][NEUTRAL] That is 025057.
[CUSTOMER][NEUTRAL] 9 M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK sure the policy is active and effective [PII].
[AGENT][NEUTRAL] Are you needing benefits for outpatient or?
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] It's not a guarantee of payment, basic outline.
[CUSTOMER][NEUTRAL] And the plan
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The plan
[AGENT][NEUTRAL] And type.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I have a CPT code for the benefits.
[AGENT][NEUTRAL] Um, but we, uh, this is just for, is this for outpatient services in a hospital or?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The place of ambulatory surgery center and its billing for professionals.
[AGENT][NEUTRAL] OK, um, this is not a guarantee of payment, basic outline of the policy. The benefit is $2500 per calendar year.
[CUSTOMER][NEUTRAL] Uh, this is for medical, am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Sure, I have a, uh, you.
[CUSTOMER][NEUTRAL] For the CPT code, could you please verify benefits?
[AGENT][NEUTRAL] What is the CPT code? What's it for?
[CUSTOMER][NEUTRAL] Yeah, sure, it's 43249.
[AGENT][NEUTRAL] And what is it for?
[CUSTOMER][NEUTRAL] It's for endoscopy.
[AGENT][NEUTRAL] Yeah, they've got an outpatient benefit that like I said, pays $2500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or outpatient services.
[CUSTOMER][NEUTRAL] The plan will cover?
[AGENT][NEUTRAL] Yes, this is a secondary policy. So after Primary processes the claim, any deductible, co-pay, or co-insurance left over, this plan will pay up to $2500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that is, uh, uh, that is the 2500 is the amount which is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is it uh.
[CUSTOMER][NEUTRAL] The leftover amount of the primary will be paid by the secondary, but the amount is 2500. Am I right? This is a limited amount.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there any authorization is required?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Authorization is required or not?
[AGENT][NEUTRAL] No authorizations required?
[CUSTOMER][NEUTRAL] OK. And could you please spell out your name for me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you please spell out your name for me?
[AGENT][NEUTRAL] Um, it's [PII], it's [PII]
[CUSTOMER][NEUTRAL] And your last name first initial.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And can I have the call reference number?
[AGENT][NEUTRAL] It's my name and today's date.
[CUSTOMER][POSITIVE] OK, and that is for today. Thanks for assisting.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.