AccountId: 011433970860
ContactId: 82c4b15e-fc9d-4d75-857a-a3dee5b1292e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 179839 ms
Total Talk Time (AGENT): 93462 ms
Total Talk Time (CUSTOMER): 57320 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/82c4b15e-fc9d-4d75-857a-a3dee5b1292e_20250428T15:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling because I need benefits on the patient, please, and [PII], can you spell your name for me please?
[AGENT][NEUTRAL] Yes, it is spelled [PII] last initial of [PII] and today's date will be used as the call reference.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, and may I have your name and a callback number, please?
[CUSTOMER][NEUTRAL] Of course, yes, and yeah, that's [PII]
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[AGENT][NEUTRAL] And may I please have the policy number?
[CUSTOMER][NEUTRAL] Of course the policy number is oh.
[CUSTOMER][NEUTRAL] 02140843ML8
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for eligibility and benefits. Is there a specific benefit that you're calling in for?
[CUSTOMER][NEUTRAL] Yes, she's going to have an outpatient procedure. She's gonna have an EGD and a colonoscopy.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, and verification of coverage does not guarantee the payment of the claim. For eligibility, it is showing that the policy is currently active with the effective date of [PII].
[AGENT][NEUTRAL] For the outpatient benefits, the member has up to $7900 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It will not cover any preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yes, has any of that 7900 been used?
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK, and so you said nothing that's preventative is um.
[CUSTOMER][NEUTRAL] Is um covered?
[AGENT][NEUTRAL] For preventative or wellness, it's not, we don't cover that, but for sickness and injury is covered.
[CUSTOMER][NEUTRAL] OK, so would this procedure be considered preventative?
[AGENT][NEUTRAL] It's according to what is billed. If it's for preventative services, then it's not covered, but if it's for sickness or injury, then it's considered covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK perfect um can I have a reference number for our call?
[AGENT][NEUTRAL] The call reference is my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Oh, that's right OK perfect. OK, thank you so much have a great day.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too.