AccountId: 011433970860
ContactId: 6a56c996-2013-42d3-b123-f496ef430c44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408410 ms
Total Talk Time (AGENT): 124144 ms
Total Talk Time (CUSTOMER): 147759 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/6a56c996-2013-42d3-b123-f496ef430c44_20250415T15:47_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] If you're speaking, I cannot hear you.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Um, first line of my last name is [PII]. I'm here. I'm calling to verify benefits for a number.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, it's going to be.
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's going to be.
[CUSTOMER][NEUTRAL] Um, 245-483-7.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[AGENT][NEUTRAL] And what's the name of the patient?
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII]. And you were wanting benefits?
[CUSTOMER][POSITIVE] Um, yes, I'm running benefits and.
[CUSTOMER][NEUTRAL] I'm wanting benefits. I need to check the CBT code for 93306.
[AGENT][NEUTRAL] OK. Is this for outpatient or doctor's office or inpatient?
[CUSTOMER][NEUTRAL] Outpatient, outpatient facility.
[AGENT][NEUTRAL] OK. I can help you with the benefits. The effective date is [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment?
[AGENT][NEUTRAL] This policy coordinates with the primary insurance.
[AGENT][NEUTRAL] Whatever the primary applies to their deductible, co-pay, or co-insurance only.
[AGENT][NEUTRAL] We'll pay up to
[AGENT][NEUTRAL] $2000 per calendar year for outpatient.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Were you able to check the CPT code?
[AGENT][NEUTRAL] That's what we pay.
[CUSTOMER][NEUTRAL] OK, but
[CUSTOMER][NEUTRAL] For the CPT code.
[AGENT][NEUTRAL] It doesn't go by CPC code. It goes by outpatient inpatient. It coordinates with the primary insurance. Whatever the primary applies to their deductible, co-pay, or co-insurance will pick up up to $2000 for outpatient services.
[CUSTOMER][NEUTRAL] Is there any like restrictions or limitations to this?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] And is this only so.
[CUSTOMER][NEUTRAL] OK, just to get it right.
[CUSTOMER][NEUTRAL] It does this not cover preventative? Does this cover preventative? Like, is there, are there, are there restrictions in that sense?
[AGENT][NEUTRAL] Yes, it does not cover preventative services.
[CUSTOMER][NEUTRAL] Um, can I get the um.
[AGENT][NEGATIVE] So if it's for a wellness, it would not be covered.
[CUSTOMER][NEUTRAL] OK, but if the patient's having like an echocardiogram.
[CUSTOMER][NEUTRAL] It would be covered in a sense.
[AGENT][NEUTRAL] Right. As long as it's not a wellness diagnosis.
[CUSTOMER][NEUTRAL] OK. Can I get the, can I get the um claims address?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and just to repeat it back to you so, so I know I got it right. [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And then one more thing you said, so you said the gap insurance coordinates with the, with the, with the main insurance.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And then you said with this, with that being said, when you mean the coordinates or whatever the.
[CUSTOMER][NEGATIVE] Primary doesn't pick up, the gap will pick the rest up.
[AGENT][NEUTRAL] If the primary doesn't pay on it, we do not pay on it. Only if it's applied to the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK, I see. So if the primary is applying a deductible called the coinsurance.
[CUSTOMER][NEUTRAL] Then that's when you then you guys will also coordinate just like that.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. Can I please get a um
[CUSTOMER][NEUTRAL] Can I please get a um.
[CUSTOMER][NEUTRAL] Reference number for this call.
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] What's your, what's your name one more time?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Perfect and then what's the first of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you, [PII] for calling IPL. You have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.