AccountId: 011433970860
ContactId: 895a0f14-e046-43d0-9ed0-93d79e0b1ab2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195669 ms
Total Talk Time (AGENT): 112769 ms
Total Talk Time (CUSTOMER): 49613 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/895a0f14-e046-43d0-9ed0-93d79e0b1ab2_20250625T21:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, [PII]. I'm trying to get benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK, I could check eligibility benefits for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 02622726.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan, so pays a set dollar amount per covered procedure or office visit. So give me one moment, I will get those benefits pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold just for one moment.
[AGENT][POSITIVE] Oh, sure, no worries.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Oh, it's, it's still me.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, sorry. We have a new phone system and we're not sure how to work it, so, so they'll just have to wait.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Oh no, you're OK.
[AGENT][NEUTRAL] I'll be fast as I can, um, OK, what are they being seen for? What kind of benefits are we checking?
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] So it's for a home sleep study and I do have a CPT code.
[AGENT][NEUTRAL] OK, so I am unable to search using CPT codes. I can, however, uh, go ahead and give you a brief breakdown. I do not believe that would be a covered benefit under this policy. Um, of course, I will let you know verification of coverage is not a guarantee of payment for claims. So they've got benefits for, um, hospital admission, hospital consignment, uh, intensive care, rehabilitation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, accident sickness, uh, surgical benefits, uh, treatment in emergency room, urgent care, physician's office, physical speech or occupational therapy, diagnostic testing benefits, which is medical imaging tests, uh, prescription drugs, ambulance, um, and then preventative elective surgeries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is the extent of the benefits for this policy.
[CUSTOMER][NEUTRAL] Gotcha, gotcha. So would it fall under diagnostic testing or that's just for imaging?
[AGENT][NEUTRAL] Diagnostic, yes, it does specify medical imaging tests.
[CUSTOMER][NEUTRAL] OK. All right, well, it looks like it's a non-covered benefit. Can I just get a ref uh reference number, please?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] A. last initial is A. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] And that's it, and thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.