AccountId: 011433970860
ContactId: 63a27943-959c-4b33-b6c6-f877e8e16a7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360000 ms
Total Talk Time (AGENT): 162848 ms
Total Talk Time (CUSTOMER): 133069 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/63a27943-959c-4b33-b6c6-f877e8e16a7c_20250228T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning, [PII].
[CUSTOMER][NEUTRAL] Um, my name is [PII].
[CUSTOMER][NEUTRAL] I'm gonna have I, I want, I would like to know my outpatient benefit.
[AGENT][POSITIVE] OK. I'm happy to check on your benefits for you today. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, that would be the group number?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 25,660, I mean 8, no? It could be 022.
[CUSTOMER][NEUTRAL] 556 83 ML 8.
[AGENT][NEUTRAL] That sounds right. So, um, let me pull this up here, one moment.
[AGENT][POSITIVE] Thank you so much. And then [PII] for security, I do need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII], I'm sorry, date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the email address on file is your [PII]. Is that still a good email for you?
[CUSTOMER][NEUTRAL] Yeah, that's my job number that's my job, my job email.
[AGENT][NEUTRAL] OK, alright, so it looks like your outpatient benefit max for the calendar year is $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the max for the calendar year.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Did you have any other questions or concerns?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm gonna have a procedure on Monday, an endoscopy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know, um, that's why I'm calling to see if you guys will cover for that.
[AGENT][NEUTRAL] For the endoscopy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Let me um
[AGENT][NEUTRAL] I feel like that should be something that is covered as far as like we'll pick up whatever your primary insurance doesn't cover.
[AGENT][NEUTRAL] Uh, that, you know, that's the purpose of the plan. Um, I will, let me double check the policy here and just make sure. I don't see anything that's maybe says that it would be like eliminated or, so, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, the plan is mid link select group.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] I just saw the plan name.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Is Metlink Select group M MED support I get medical support, I guess.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Yeah, so I mean.
[AGENT][NEUTRAL] I don't see anything under this that, you know, lends me to think, [PII], that that wouldn't be covered. Um, you know, the only thing I see that like physician office visit fees, those aren't covered. So anytime that, yeah, those fees are not covered, but um, anything like an endoscopy, that would fall under outpatients, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, whoever you're going to see, just give them your card if you have one and let them know that we're the secondary. And so yeah, they should bill your primary first and then we'll pick up any deductible or co-pay or co-insurance, your primary doesn't, um, up to $1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That would be good. Oh I can, I can use this just in case the other one, there's a a balance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm, yeah, absolutely, absolutely, and if they need to call and check your eligibility they can call and do that with us we're happy to do that also.
[CUSTOMER][NEGATIVE] OK, yeah, I'm trying to call them and but they didn't answer.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, just to, because every time I go to the doctor, any doctor, even to the emergency room, I give, I give my, my regular insurance and my, my APL.
[AGENT][NEUTRAL] Yeah, yeah, for sure. Yeah. Mhm.
[CUSTOMER][NEUTRAL] Always. So that they have that in record in case one thing doesn't cover, or whatever the balance, then it goes to you guys.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, all right.
[CUSTOMER][NEUTRAL] So, cause yeah, they told me, they told me that there was gonna be a balance for my, my, my, my endoscopy.
[AGENT][NEUTRAL] Is there anything else I can do for you?
[AGENT][NEUTRAL] Oh yeah, so have them bill us and then um go from there you, you know, um, and then you know see if you have anything remaining that you're responsible for so.
[CUSTOMER][POSITIVE] Mhm. Yeah, no, yeah. OK. All right. Thank you so much.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.