AccountId: 011433970860
ContactId: 3c5c8672-bc12-495b-9ade-7f28d5883389
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213649 ms
Total Talk Time (AGENT): 91114 ms
Total Talk Time (CUSTOMER): 93903 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/3c5c8672-bc12-495b-9ade-7f28d5883389_20250304T21:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, Ms. [PII], good afternoon. My name is [PII]. I'm calling from Valley Baptist Medical Center here in [PII]. I'm needing to find out, um.
[CUSTOMER][NEUTRAL] Benefits and also if a CPC code requires authorization.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's for the patient, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Her date of birth is [PII] and her policy certification number is 018.
[CUSTOMER][NEUTRAL] 68778
[CUSTOMER][NEUTRAL] The group is 16,350.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK, and I apologize, verify that patient's date of birth again?
[CUSTOMER][NEUTRAL] Yeah, her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing her effective date is [PII]. She is active on the policy. Uh, with this policy, it's a secondary supplemental plan, so we don't require any prior authorization.
[AGENT][NEUTRAL] But what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] OK, hold on a second I was writing all that down. Let's see.
[CUSTOMER][NEUTRAL] It's for an EGD, I believe a colonoscopy and an EGD.
[AGENT][NEUTRAL] And this is gonna be in an outpatient facility?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, outpatient.
[AGENT][NEUTRAL] OK. And as far as the colonoscopy, is it screening or is it for diagnostic?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] a
[CUSTOMER][NEUTRAL] Uh, the EGD is for, um, gastro, uh, hemorrhage and iron deficiency anemia, and the colonoscopy is a screening.
[AGENT][NEUTRAL] OK, well, the colonoscopy screening is not covered. Uh, the policy only covers for sickness, um, not a guarantee of payment, just a verification of coverage. Um, as I said that this is a secondary policy, it helps with primary insurance deductible co-pay or co-insurance, and the patient has a benefit max of $2550 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but the colonoscopy you're saying it's not covered?
[AGENT][NEUTRAL] Correct. If it's a colonoscopy screening, it's not covered under the policy. Policy doesn't cover any screenings.
[CUSTOMER][NEUTRAL] Only the EGD.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Only the GED.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Let me see what I was asking you, so, uh, so there's no deductible out of pocket or nothing. It just covers anything at 2500.
[AGENT][NEUTRAL] 2550 of what primary applies towards deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] For a secondary policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Well, I appreciate your time.
[AGENT][NEUTRAL] Uh, yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] And uh could I get for this?
[CUSTOMER][NEUTRAL] Reference?
[AGENT][NEUTRAL] Say again, your phone, uh, reference, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK, I appreciate the time thank you so much.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII]. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] OK