AccountId: 011433970860
ContactId: 67a0d74c-31a2-4a60-948b-670fc0100549
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209910 ms
Total Talk Time (AGENT): 75083 ms
Total Talk Time (CUSTOMER): 117529 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/67a0d74c-31a2-4a60-948b-670fc0100549_20250410T15:56_UTC.wav
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[AGENT][POSITIVE] Thank you for calling
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, can you repeat your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], and can I have the initial for your last name please, the first initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you [PII]. My name is [PII] I'm calling on behalf of a patient that I have here with me. He's scheduled to do a colonoscopy today in an ambulatory outpatient center. I'm happy to give you the MPI number or the tax ID.
[AGENT][NEUTRAL] Uh, no, I don't need neither. Um, I'll need the policy number though, mm mm.
[CUSTOMER][NEUTRAL] You don't need them?
[CUSTOMER][NEUTRAL] OK, I do have the policy number of the patient that's 01843884 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK, thanks [PII]. What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, thank you for verifying the information.
[CUSTOMER][NEUTRAL] No, I did call not too long ago and spoke to [PII]. She mentioned to me of a $500 maximum daily amount for um that the patient can use at the ambulatory surgical centers. However, I believe there's a discrepancy. He's currently on a policy that's $5000 annual maximum, so we're hoping to see if you can, you know, re-verify and confirm what's accurate.
[AGENT][NEUTRAL] OK, and so is, is it a screening colonoscopy?
[CUSTOMER][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] I have the diagnosis code is Z12.11. Give me one second and I can give you some CPT codes. That's a screening, OK.
[AGENT][NEUTRAL] So that's a screening.
[AGENT][NEUTRAL] Yeah, that's a that's a screening, um, and so this Metlink policy covers, uh, as a result of an accident or sickness, so wellness or screenings are not covered. And regarding the $5000 benefit, um, there is an outpatient benefit of up to $500 per calendar day and then the in the inpatient benefit is $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the benefit you were provided is correct, but colonoscopy, if it's a screening is not covered under this policy.
[CUSTOMER][NEUTRAL] The inpatient? I'm.
[CUSTOMER][NEUTRAL] OK, I'm just gonna explain this very quickly to Roger while I have you on the phone. So the $5000 is for accidental or inpatient like emergency room visits and then the $500 daily is for outpatients, but you mentioned that's not covering screening?
[AGENT][NEUTRAL] OK. OK, sure.
[AGENT][NEUTRAL] OK, so the outpatient and inpatient benefit is 5000, 2 separate buckets, but it's it, yeah.
[CUSTOMER][NEUTRAL] OK, so the outpatient and the inpatient are both 5000, however.
[AGENT][NEUTRAL] Screenings or wellness services are not covered under the policy.
[CUSTOMER][NEUTRAL] You mentioned
[CUSTOMER][NEUTRAL] Mhm, screening or wellness is not covered under this policy that you have, OK?
[CUSTOMER][NEUTRAL] All right, um, is there any way I can get a reference number for this call?
[AGENT][NEUTRAL] Uh, we do not provide reference numbers, but you can definitely use my name in today's date as your reference.
[CUSTOMER][POSITIVE] Thank you so much [PII] for your help today.
[AGENT][NEUTRAL] You're welcome [PII]. Any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's all thank you.
[AGENT][POSITIVE] OK, you're welcome thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You as well goodbye.