AccountId: 011433970860
ContactId: 63ce1740-1631-4b5e-993d-06c4300ad7f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230630 ms
Total Talk Time (AGENT): 130847 ms
Total Talk Time (CUSTOMER): 70860 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/63ce1740-1631-4b5e-993d-06c4300ad7f3_20250319T19:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, [PII]. I need to, um,
[CUSTOMER][POSITIVE] Get uh a benefit like for an outpatient surgery on one of our patients.
[AGENT][POSITIVE] Well, it would be my pleasure to help you with those benefits this afternoon. What is your name, please?
[CUSTOMER][NEUTRAL] It's [PII] is the last initial to my name.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient?
[CUSTOMER][NEUTRAL] It is 02002755.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with those benefits for [PII]. I am showing her policy is active. Effective date is [PII].
[AGENT][NEUTRAL] This is a secondary policy to her major medical insurance.
[AGENT][NEUTRAL] And you were needing outpatient surgical benefits?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right, she does have outpatient coverage up to $1000 per calendar year.
[AGENT][NEUTRAL] And that is the amount that we can pay toward her deductible, co-pay or co-insurance of her major medical.
[AGENT][NEUTRAL] And [PII], if you would please note that is a verification of coverage and not a guarantee of payment.
[AGENT][NEUTRAL] As of right now, she has that full benefit remaining for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, she's also having a colonoscopy.
[CUSTOMER][NEUTRAL] Do you have a
[CUSTOMER][NEUTRAL] Separate benefit for a colonoscopy.
[AGENT][NEUTRAL] If it is a diagnostic, it could be considered under her, under this policy, it would be under the same benefit. If it is wellness or preventive, um, this policy does not cover wellness or preventive services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so up to means like for the professional, for the uh uh facility, that type of thing for surgery?
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] That's right, so the calendar year maximum benefit is $1000 and we do process claims in order that we receive them.
[AGENT][NEUTRAL] So we can pay up to that $1000 either for facility or professional fee or both if there's benefits still remaining when we receive those claims.
[CUSTOMER][NEUTRAL] How about prior off? Do you require any kind of prior off?
[AGENT][NEUTRAL] If we do not, we do follow the guidelines of the major medical, so the major medical has to pay benefits to that service.
[AGENT][NEUTRAL] And once you receive that EOB from the primary, then you would send the claim to APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Sounds good. And do you give like a reference number or?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name in today's date, and I spell my name [PII].
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with those benefits this afternoon for [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all I need. Thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a lovely afternoon.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.