AccountId: 011433970860
ContactId: 53c65601-d0a9-42a4-83f0-6757948710e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532590 ms
Total Talk Time (AGENT): 212612 ms
Total Talk Time (CUSTOMER): 127476 ms
Interruptions: 2
Overall Sentiment: AGENT=1.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/53c65601-d0a9-42a4-83f0-6757948710e7_20250331T18:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, you said you're [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], I'm sorry, this is [PII] with the Greenwood Genetics Center in [PII]. I have um one of your, uh, one of your members that has genetic testing coming through to our facility today, and they show having um this insurance. I wanted to see if.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, um, if they, if you're, I'm sorry I can't get it out.
[AGENT][POSITIVE] You're right.
[CUSTOMER][NEUTRAL] If genetic testing is covered under this patient's policy.
[AGENT][NEUTRAL] OK. So you're needing to verify eligibility as well as to see if genetic testing would be a covered benefit. Is that correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 01661549.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Give me just a couple of moments please, wanted to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK, um, her name is [PII] and date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And please bear with me. I had to reopen a few of my screens, so just one moment please.
[CUSTOMER][POSITIVE] That is OK, totally understand.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] I believe it's all opened back up for me now. So any information again that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. I do show she is a dependent on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just a moment to see about genetic testing.
[AGENT][NEUTRAL] I do not see it listed as an exclusion on this policy. So there's an um outpatient benefit maximum for covered person per per calendar year for covered outpatient services of $4500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is an also an outpatient deductible of $500.
[AGENT][NEUTRAL] Per cover person per calendar year.
[AGENT][NEUTRAL] And because this policy is a supplement to their primary insurance, Wanda, when a claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have reviewed our claim and it has been processed, we do have a portal in which you should be able to check claim status for us.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] You should as far as you know.
[CUSTOMER][NEUTRAL] It this would be a genetic testing would be a covered benefit.
[AGENT][NEUTRAL] I do not see it listed as an exclusion on this policy.
[CUSTOMER][NEUTRAL] Covered not in exclusion.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and then the out of pocket, I mean the.
[CUSTOMER][NEUTRAL] Outpatient per year or whatever it is 4500 I'm probably saying that wrong.
[AGENT][NEUTRAL] That's the benefit maximum. Yes, ma'am, that's the maximum benefit uh for covered outpatient services on this policy because this policy is designed to help them with their co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Benefit mate.
[CUSTOMER][NEUTRAL] OK, and then have they met either one of those?
[AGENT][NEUTRAL] So that's
[AGENT][NEUTRAL] I can check. And this is for this calendar year?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And as of now, no, ma'am.
[AGENT][NEUTRAL] She has not.
[CUSTOMER][NEUTRAL] Not me.
[AGENT][POSITIVE] Uh-huh, as of now, that is correct.
[CUSTOMER][NEUTRAL] OK, alright, and um we are out of network um with her primary um insurance and they she yeah.
[AGENT][NEUTRAL] OK, so this.
[AGENT][NEUTRAL] Uh-huh. Go ahead. This would follow the primary insurance?
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] We are not a major medical carrier, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's not a network with APL.
[CUSTOMER][NEUTRAL] OK, so y'all would be.
[AGENT][NEGATIVE] Mhm. And if it's not covered by the primary, then it would also not be covered by this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm writing that down.
[AGENT][POSITIVE] Sure, yes ma'am.
[CUSTOMER][NEUTRAL] OK, and do you have um [PII] a call reference number?
[AGENT][POSITIVE] Yes ma'am, you're actually gonna use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think that answers that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I appreciate your help.
[AGENT][POSITIVE] Well, you're certainly welcome. So is there anything else, [PII] that I can help you with today?
[CUSTOMER][POSITIVE] That is it, that is it. I appreciate it you have a good afternoon.
[AGENT][POSITIVE] Well, you're certainly very welcome. Oh, I hope you do too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK, thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.