AccountId: 011433970860
ContactId: 736cbadf-2fd9-4408-a703-50de9bda83fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305410 ms
Total Talk Time (AGENT): 106947 ms
Total Talk Time (CUSTOMER): 81697 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/736cbadf-2fd9-4408-a703-50de9bda83fc_20250410T15:43_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, that's fast. Hi [PII]. My name is [PII], and I'm calling from [PII], and I'm trying to paying patients benefits for an outpatient procedure, please.
[AGENT][POSITIVE] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Policy number 02.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] 3602.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you need benefits for outpatient services or what type of services?
[CUSTOMER][NEUTRAL] Yeah, patient is coming in for an outpatient colonoscopy, which is diagnostic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's a basic outline of the policy. Let me get that pulled up.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, he does have a diagnostic testing benefit. Let me make sure there's not a definition of what that specifies.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the diagnostic testing benefits which pays $400 a day, it only covers MRIs, CAT scans,
[AGENT][NEUTRAL] Um, PET scans and radioactive iodine uptake tests.
[CUSTOMER][NEUTRAL] OK, so it does not come with colonoscopy.
[AGENT][NEUTRAL] Yeah, let me make sure there's not another benefit that potentially could be under.
[AGENT][NEUTRAL] Yeah, so no, it would not cover the colonoscopy.
[CUSTOMER][POSITIVE] You covered, perfect. And does the patient has
[CUSTOMER][NEUTRAL] How much for office visits for specialists?
[AGENT][NEUTRAL] Um, yes, so for physician's office, it would be a $150 payout, um, per day, a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK, so patient does not have no coverage for an outpatient diagnostic colonoscopy, so patient will be self-pay.
[CUSTOMER][POSITIVE] And patient is effective date.
[AGENT][NEUTRAL] Uh, the effective date of the policy is [PII]. Policy is currently active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not coverage for and no surgical coverage either, right? I'm assuming?
[AGENT][NEUTRAL] Um, let's see. So, yes, they do have a surgical benefit.
[AGENT][NEUTRAL] Um, surgery in a hospital, hospital outpatient facility or free-standing surgery center, $2000 per day, and that's a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK, sounds great. So, but patient does not have enough coverage for colonoscopy, only for a surgical, which is only $2000.01 per calendar year. Is that one still open?
[AGENT][NEUTRAL] Uh, let me see what they've used this year.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Yes, he still has that benefit available. Only thing he's used is a one office visit a benefit.
[CUSTOMER][NEUTRAL] One office visit. OK, out of the 4 sounds great to me, [PII] and [PII], can I please have a reference number for our call?
[AGENT][NEUTRAL] Uh, reference number is just my name and then today's date.
[CUSTOMER][NEUTRAL] [PII] [PII], correct?
[AGENT][NEUTRAL] Yes, [PII], first initial to last name, [PII].
[CUSTOMER][POSITIVE] Thank you so much and have a great day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day too.
[CUSTOMER][NEUTRAL] Yes, sir.