AccountId: 011433970860
ContactId: 74845929-fb09-4e40-b868-3269703b9314
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353000 ms
Total Talk Time (AGENT): 128745 ms
Total Talk Time (CUSTOMER): 196197 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/74845929-fb09-4e40-b868-3269703b9314_20250228T19:00_UTC.wav
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[AGENT][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] Hey, I've got an insured on the back line that's wanting to see what her benefits are, her gap plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her policy number is 2483107, and I'm sending her the information on how she can register on the online service center and temporary cards um along with physical cards, but just so you know she didn't have that information and she's been verified.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] All right. Here she goes. Thank you.
[CUSTOMER][NEUTRAL] Oh, you want to call back number?
[AGENT][NEUTRAL] Is it the one on the screen, the 954?
[CUSTOMER][NEUTRAL] [PII]. I can't see it no more. [PII], is that it? Yeah, that's it. All right. Yes, thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] Hi [PII], this is [PII], and I'll be happy to help you with those benefits. How are you today?
[CUSTOMER][POSITIVE] I'm doing well, thank you for asking, [PII]. How are you?
[AGENT][NEUTRAL] I am great, thank you. Please be advised that please be advised that verification of coverage does not guarantee the payment of a claim. And which benefits can I provide for you?
[CUSTOMER][POSITIVE] Good to hear.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] OK. So how do I go about this? I have an imaging order. I have 2 imaging orders. I can start with that. Actually 3 imaging orders.
[CUSTOMER][NEUTRAL] From the doctor.
[AGENT][NEUTRAL] OK. So the inpatient, outpatient?
[CUSTOMER][NEUTRAL] Oh, they're all outpatient.
[AGENT][NEUTRAL] OK, so under this plan, well normally we advise our insured to give the card to the person at time of service so that they can file your claims for you. So under the, under this policy, you have uh inpatient and outpatient combined benefit of 9100, so that's for inpatient and outpatient.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood. And so if what I'm going to go get is a bone density and I have the diagnosis code, would you be able to tell me whether that's covered or not?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me know when you want me to give it to you.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK. So the diagnosis is osteoporosis and it's ICD 10, M as in Mary, 81.0.
[AGENT][POSITIVE] Thank you, and yes, that will be coverable under your plan.
[CUSTOMER][NEUTRAL] So the whole co-pay and everything will be covered? Is that how it works?
[AGENT][NEUTRAL] Yes, it will pick up your copays, your co-insurance and or deductibles up to your benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Up to the 9000. OK, and then do we know how much that would be or we have to wait for them to bill?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You would have to wait until they bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, then I have
[CUSTOMER][NEUTRAL] Um, so, so if I have Cigna and Cigna is a PPO and it's, it's not at 80/20 until the deductible is met, and the deductible yearly is 8000, that means.
[CUSTOMER][NEUTRAL] All of it would be
[CUSTOMER][NEUTRAL] Under you
[CUSTOMER][NEUTRAL] And whichever gets used up first is what gets paid, right?
[AGENT][POSITIVE] Correct. Basically, yes, ma'am.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] All right. Then I have ICD 10, Z as in Zebra, 12.39.
[AGENT][NEUTRAL] OK, let me get
[CUSTOMER][NEUTRAL] For a mam uh the mammogram.
[AGENT][NEUTRAL] OK, let me get this pulled up.
[AGENT][NEUTRAL] Now, because it is a screening, if it's only billed with that zip code and there's no other codes, it will be denied as uh not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] An injury or illness.
[CUSTOMER][NEGATIVE] Gotcha. But not, that doesn't apply to the, the, the bone density.
[AGENT][NEUTRAL] That is correct. That's not a screening.
[CUSTOMER][NEUTRAL] On then with it right.
[CUSTOMER][NEUTRAL] OK, then we have um lab work at Quest.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] You do have that lab writer on here as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so it has um I guess these are CPT codes that I'm being given. I can give you those.
[AGENT][NEUTRAL] If it's for labs, you do have your lab writers, so those will be fine.
[CUSTOMER][MIXED] Those will be fine so long as it's the total up to 9000, but I won't know how much each one is.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm, got you.
[CUSTOMER][NEUTRAL] OK. Let's give it a try. I'll do the CT scan first, which is the, the bone density is the most important one, and then we'll go from there.
[AGENT][NEUTRAL] Yes, ma'am. And did you get registered for the account and you can see everything online?
[CUSTOMER][NEUTRAL] I haven't yet. They were going to send me an email and she gave me the policy number. She's going to send me the card and how to register and um I'm there, is there a possibility to get an estimate of cost per CPT code, your, your website offer that?
[AGENT][NEUTRAL] No, ma'am, it does not. We don't have a list of the calls that will come from your provider.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, understood. All right, sounds good.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Mm, no, that's if you also wouldn't know whether one provider is less expensive than another.
[AGENT][NEUTRAL] Oh, no, ma'am. We do not require a pre-op. You can utilize any provider. There's no network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. All right, thank you very much. I appreciate it.
[AGENT][POSITIVE] Well, you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.