AccountId: 011433970860
ContactId: 348df355-2baa-4c1e-b79e-d0643da215e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283160 ms
Total Talk Time (AGENT): 104124 ms
Total Talk Time (CUSTOMER): 143181 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/348df355-2baa-4c1e-b79e-d0643da215e4_20250326T15:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I wanted to check the benefits on a procedure that I have to do.
[CUSTOMER][NEUTRAL] Um, today I wanted to verify, uh, if APL would cover.
[AGENT][NEUTRAL] I can verify benefits, [PII]. May I have a policy number?
[CUSTOMER][NEUTRAL] Uh, sure, yeah.
[CUSTOMER][NEUTRAL] I have a payer ID, a benefit certificate number, outpatient certificate number.
[CUSTOMER][NEUTRAL] and a group number.
[AGENT][NEUTRAL] Yes, the outpatient.
[CUSTOMER][NEUTRAL] Outpatients 01.
[CUSTOMER][NEUTRAL] 861
[CUSTOMER][NEUTRAL] 675
[CUSTOMER][NEUTRAL] M like Mary. L like Larry 8.
[AGENT][POSITIVE] Thank you. [PII], may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII]. My mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII] and what else did you want?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And which benefit can I provide for you today, [PII]?
[CUSTOMER][NEUTRAL] So I have to have uh a test done at a uh cardio center for uh an eco I guess they call it Eco ECHO.
[CUSTOMER][NEUTRAL] And so I, I, I wanted to make sure that the, the difference between what they're charging and what the insurance my primary has has authorized, um, there's a $1000 payment they're asking me for, and I'm not sure if the APL will, will kick in and cover that cost.
[AGENT][NEUTRAL] Will this be inpatient?
[CUSTOMER][NEUTRAL] Or if there's a specific location.
[AGENT][NEUTRAL] Will this be inpatient outpatient? OK, so under your outpatient calendar year, the benefit amount allows $5000. So it will pick up your copays, your co-insurance, and our deductibles up to the $5000.
[CUSTOMER][NEUTRAL] It's uh outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now does that have to be at a specific.
[CUSTOMER][NEUTRAL] A uh outpatient center or can it because this is kind of a, they have a, it's a mixture, right? It's a, it's a cardiologist group that has a center to do these tests there.
[CUSTOMER][NEUTRAL] So I, I don't wanna, I don't, I don't wanna run into uh a situation where it's considered his office and not an outpatient center and then the the coverage doesn't kick in.
[AGENT][NEUTRAL] Correct, as long as it's not at the office.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] So it's not as long as it's not at the doctor's office.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so it's gotta be, how, how, how do I know if it's an actual outpatient center that's not attached to the to their office?
[AGENT][NEUTRAL] OK, so you can ask.
[CUSTOMER][NEUTRAL] There's something I should be asking?
[AGENT][NEUTRAL] You can ask the provider where your place of service will be, and as long as he tells you that it's not the actual doctor's office, then you're fine. Under your outpatient, let's see, it has to be
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment, I'm just waiting on your policy to load. So it has to be an outpatient facility or MRI facility. It has to be outpatient.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Free standing surgical Center.
[AGENT][NEUTRAL] If you have any type of surgery, it has to be outpatient facility or freestanding surgical center. If you go to the emergency room, it has to be emergency room. As long as it's not an office visit, you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Alright, let me find out what the case is and I will go with that. Thank you so much for your help.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Right.