AccountId: 011433970860
ContactId: 470362c7-7e53-42d3-b094-4c7a71919d2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268290 ms
Total Talk Time (AGENT): 113784 ms
Total Talk Time (CUSTOMER): 112638 ms
Interruptions: 9
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/470362c7-7e53-42d3-b094-4c7a71919d2c_20250121T15:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Hi [PII], I'm trying to get some benefits information please.
[AGENT][POSITIVE] Yeah, I can check benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 01912980.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] What was the name and the first name.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're we need to look at, uh, outpatient benefits.
[CUSTOMER][NEUTRAL] But this was effectively was [PII].
[CUSTOMER][NEUTRAL] Medical policy is to help the co-pay deductible insurance and medical.
[CUSTOMER][NEUTRAL] Yes, um, specialist office copay, go ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, yes, give me just a moment, let me see if that is going to be covered.
[CUSTOMER][NEUTRAL] Yes, just because that is going to be.
[AGENT][NEUTRAL] Will the patient be receiving any sort of treatment or is this gonna be more of a consultation?
[CUSTOMER][NEUTRAL] Consultation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course, alright, so I will let you know verification of coverage is not a guarantee of payment for claims. The office visits are not going to be covered under this policy, uh, however, treatment received in office could be.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] All the
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] on the city.
[CUSTOMER][NEUTRAL] OK, um, did you say?
[AGENT][NEUTRAL] So if it's just a consultation visit then oh sorry go ahead.
[CUSTOMER][NEUTRAL] Did you say you guys cover the deductible and co-insurance?
[AGENT][NEUTRAL] Yes, this policy is designed to help with that. However, office visits are not going to be covered under this policy.
[CUSTOMER][NEUTRAL] Yeah this is with that.
[CUSTOMER][NEUTRAL] OK, um, how about a colonoscopy or an EGD?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, that was a colonoscopy and what I'm sorry.
[CUSTOMER][NEUTRAL] Or an EGD
[AGENT][NEUTRAL] OK, let's see, just a moment.
[AGENT][NEUTRAL] Bear with me just a moment. I'm sorry, system's running a little bit slow today.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so the EGD and the colonoscopy would be taking place in a physician's office setting, correct?
[CUSTOMER][NEUTRAL] No, that would be outpatient hospital or ambulatory mhm.
[AGENT][NEUTRAL] It would be OK.
[AGENT][NEUTRAL] OK, the diagnostic testing in a hospital outpatient facility is going to be covered, so their total outpatient benefit is $8050 per calendar year.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The total is $80 OK.
[CUSTOMER][NEUTRAL] They haven't met anything yet, right?
[AGENT][NEUTRAL] I can double check that give me just a moment.
[CUSTOMER][NEUTRAL] I'll check back with me.
[AGENT][NEUTRAL] No, none of that has been used so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I have a reference number then?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] My first
[CUSTOMER][NEUTRAL] and is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That is it, thank you so much have a great day.
[AGENT][POSITIVE] Alright, yeah, thanks for the APL. You too, bye bye.
[CUSTOMER][NEUTRAL] Bye.