AccountId: 011433970860
ContactId: 2deff5e5-8176-4df1-9bf4-0e8f1164c59e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398519 ms
Total Talk Time (AGENT): 96200 ms
Total Talk Time (CUSTOMER): 83999 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/2deff5e5-8176-4df1-9bf4-0e8f1164c59e_20250227T17:56_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes, [PII], I hope I'm at the right department. Uh, my name is [PII] and I was calling to verify medical benefits.
[AGENT][POSITIVE] OK, I'll be happy to assist with benefits today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] That's [PII] direct.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] OK, I don't have the number I had was a D number, so the lady told me that um maybe you could look it up with social or either uh the name.
[AGENT][NEUTRAL] OK, I'll take the social.
[CUSTOMER][NEUTRAL] OK, that is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], last name [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. Are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient and can you give me the ID number?
[AGENT][NEUTRAL] Oh, I'm sorry, um, ID number is 024.
[AGENT][NEUTRAL] 68294
[CUSTOMER][NEUTRAL] And is there a group number?
[AGENT][NEUTRAL] Um, group number is.
[AGENT][NEUTRAL] 70055
[CUSTOMER][NEUTRAL] 70055
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And where will treatment take place?
[CUSTOMER][NEUTRAL] Uh, out outpatient hospital facility.
[AGENT][NEUTRAL] OK, so I, I do show she doesn't have benefits for treatment in a um facility unless it's a surgical procedure.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, so she's having a CT cardiac coronary.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you tell if I give you a CPT code, whether it would be covered?
[AGENT][NEUTRAL] What's the CPT code?
[CUSTOMER][NEUTRAL] 75574
[AGENT][NEUTRAL] A CT scan, I believe that's covered under her diagnostic testing benefit. One moment, let me just verify.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Um, thank you for your patience. I'm still researching that.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] OK, so a CT is covered under her diagnostic testing benefit which is $200 per calendar year.
[CUSTOMER][NEUTRAL] OK, and does she have out of pocket max or anything deductible?
[AGENT][NEUTRAL] No, she just has a benefit amount. Um, this is not a major medical plan. It's a limited benefit hospital indemnity plan. So the benefits are limited.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and uh where do the claims go to?
[AGENT][NEUTRAL] Claims are sent to PO Box. Oh, I'm sorry, one moment.
[AGENT][NEUTRAL] Um, the claims are sent to IMA.
[AGENT][NEUTRAL] And that PO box is 21704.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Oh, I think that's all I need and I need a call reference number.
[AGENT][NEUTRAL] OK, reference is just my name [PII] last initial [PII], and the date and time of the call.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] No, that was all.
[AGENT][POSITIVE] OK, well thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.