AccountId: 011433970860
ContactId: 4334e44b-37c1-4e09-9f88-f576709ab390
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241470 ms
Total Talk Time (AGENT): 114476 ms
Total Talk Time (CUSTOMER): 73025 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/4334e44b-37c1-4e09-9f88-f576709ab390_20250417T13:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm trying to see if a um CT of the chest is covered and if there's authorization needed for a patient.
[CUSTOMER][NEUTRAL] That's having an order put in fat.
[AGENT][POSITIVE] OK, I can definitely um help you with the authorization and and benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And tell me, may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is, it's saying 02507990.
[CUSTOMER][NEUTRAL] And then there's a medical ID number down there. I don't know which one you need.
[AGENT][NEUTRAL] Let me see. And can you, um, if this pulled up a policy, can you verify the member's first and last name just to make sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes, that's correct. And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So in terms of the authorization, um, APL does not require any prior authorization or pre-cert because we're not a major medical company, um, and I am looking up the benefits now to check for the CT scan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And it's gonna be outpatient?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for it to come up here.
[AGENT][NEUTRAL] So for diagnostic test in the policy we will pay up to $250 per test with a max of $500 per calendar year, so two tests per year.
[AGENT][NEUTRAL] Um, do you want me to see if they've used any of the diagnostic tests and benefits?
[CUSTOMER][NEUTRAL] Yes ma'am, so you're saying they'll only pay $250 of it?
[AGENT][NEUTRAL] Yes, um, because this is a hospital indemnity policy, so it's not a, um, it's a limited medical policy. So yes, for that policy, you will pay up to $250 for the diagnostic testing, and I'm not showing that um he's used any of the benefits, so they still have the full $200 or sorry, full two tests at $500.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So like if it's a test CT scan and and it like if it's 300 to $4000 they're only gonna pay $250 she'll be responsible for the rest, right?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility. If there's no other insurance, um, the provider would have to, you know, whatever your your policies are, write it off, bill them, uh, it would be up to you at that point or the provider.
[CUSTOMER][POSITIVE] OK, alright, and that's because it's limited. OK, I got you alright thank you for the information. I appreciate it and what is your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] All right, is there a number for the call or reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, all right, I've got it thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's all that'll do it thank you.
[AGENT][POSITIVE] All right. Well, thanks for calling APL. You're welcome. Have a great day.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.