AccountId: 011433970860
ContactId: 61d88e1d-4e62-4af8-a759-bbe068622755
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272720 ms
Total Talk Time (AGENT): 110689 ms
Total Talk Time (CUSTOMER): 58925 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/61d88e1d-4e62-4af8-a759-bbe068622755_20250530T18:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm calling to verify benefits for a patient, please.
[AGENT][NEUTRAL] I can help you with benefits, [PII]. um, can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. Excuse me, 01346368 M as in Mike, L as in Lima, the number 8.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please, [PII]?
[CUSTOMER][NEUTRAL] Yes, Patience's first name is [PII]. It's [PII] Last name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII]. This is a medling policy, so it's secondary gap insurance.
[AGENT][NEUTRAL] And were there specific benefits you were wanting? Oh, go ahead.
[CUSTOMER][NEUTRAL] OK, I have the patient scheduled.
[CUSTOMER][NEUTRAL] Yeah, I have the patient scheduled for an outpatient colonoscopy and upper endoscopy. Colonoscopy is diagnostic. So I'm looking to find out if um
[CUSTOMER][NEUTRAL] This plan will cover anything towards outpatient services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And since this is secondary gap insurance, I will say that when filing a claim under this policy, you will need to um submit the primary insurance explanation of benefits as well. Um, let me go ahead and look that up for a colonoscopy though while we're on the phone.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just a verification of benefits, not a guarantee of payment. It looks like this policy has an outpatient benefit maximum.
[AGENT][NEUTRAL] Of up to $2000 per calendar year per uh
[AGENT][NEUTRAL] Covered person
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I'm trying to see if that includes, it does look like there is diagnostic testing in the hospital, subject to a maximum of 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK, this is gonna be done in an ambulatory surgery center. We'll cover that.
[AGENT][NEUTRAL] Um, give me just a moment, let me check.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You said in a surgery room, or I'm sorry, in a hospital?
[CUSTOMER][NEUTRAL] Uh, no. Ambulatory, yeah, Ambulatory surgery center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, it should cover that. I see outpatient benefits um for a hospital emergency, urgent care, surgery in the hospital, diagnostic testing.
[AGENT][NEUTRAL] Ambulance and physical therapy. So yes, it should be covered.
[CUSTOMER][NEUTRAL] OK, and has she used any of that $2000 yet this year?
[AGENT][POSITIVE] I can go ahead and check for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm not showing anything's been used to date.
[CUSTOMER][NEUTRAL] All right, and [PII], may I get a reference number, please?
[AGENT][NEUTRAL] So we don't have call reference numbers but you can use my name and last initial in today's date.
[AGENT][NEUTRAL] So [PII], last initial, [PII].
[CUSTOMER][NEUTRAL] And initial?
[CUSTOMER][POSITIVE] All right, and I thank you so much for your help.
[AGENT][POSITIVE] Right, thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.