AccountId: 011433970860
ContactId: 3d5163aa-3884-470e-b18c-ed3d29e5f0ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237039 ms
Total Talk Time (AGENT): 99367 ms
Total Talk Time (CUSTOMER): 84469 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/3d5163aa-3884-470e-b18c-ed3d29e5f0ec_20250212T17:16_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Texas Digestive. This is consultant. I'm trying to verify some benefits for a patient.
[AGENT][NEUTRAL] OK, and [PII], may I have your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension.
[AGENT][NEUTRAL] Thank you, what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] 016
[CUSTOMER][NEUTRAL] 12903.
[AGENT][NEUTRAL] Thank you. And to repeat, I have that as 01612903.
[AGENT][NEUTRAL] I verify the patient's name and date of birth, thank you.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you very much for the verification process and you're calling for outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, I need to know if there's a co-pay. I, I'm, I'm aware that this is a secondary insurance, at least for this patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I need to know if there's any co-pay for specialist office visit, also if there's any outpatient hospital surgical benefit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for benefits, please note verification of benefits provided does not guarantee payment. The member does not have a benefit to cover for a specialist office visit or any services or procedures inside the office.
[AGENT][NEUTRAL] The member does have up to $5000 calendar year max for facilities but not for an office setting.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is a $250 deductible calendar year deductible.
[CUSTOMER][NEUTRAL] OK, is something something has been met.
[AGENT][NEUTRAL] Um, I can check that for you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing has been met for [PII].
[CUSTOMER][NEUTRAL] OK, is there an out of pocket?
[AGENT][NEUTRAL] No, there's no deductible or copay or co-insurance that has to meet with us.
[AGENT][NEGATIVE] Outside from the $250 deductible which has not been met for this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2500 deductible, right?
[AGENT][NEGATIVE] No, $250 deductible.
[CUSTOMER][NEUTRAL] Uh, 250, OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So there's no copay and no.
[CUSTOMER][NEUTRAL] Co-insurance for outpatient surgery, right?
[AGENT][NEUTRAL] Correct, there's only the $250 deductible.
[CUSTOMER][NEUTRAL] OK. Just one more question. If the patient made up getting a screen colonoscopy, can you tell me if you will cover that 100%?
[AGENT][NEUTRAL] We help with the major medical deductible co-pay or co-insurance. Um, it has been due to a sickness or an injury, and of course we don't process claims over the phone so you can submit that claim for.
[CUSTOMER][NEGATIVE] Well, there's no coverage.
[AGENT][NEUTRAL] Review and processing.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there, uh, OK, that will be all. Can I have a number of reference for this?
[AGENT][NEUTRAL] We do not use reference numbers [PII]. You can use my name [PII] last initial [PII]
[AGENT][NEUTRAL] And today's date, anything else I can assist you with with the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That will be all. Thank you, [PII].
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a good day bye.
[CUSTOMER][NEUTRAL] You as well bye bye.