AccountId: 011433970860
ContactId: 8aad96e9-079a-4e1d-b5ed-ef2733861121
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 162520 ms
Total Talk Time (AGENT): 67664 ms
Total Talk Time (CUSTOMER): 54820 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/8aad96e9-079a-4e1d-b5ed-ef2733861121_20250305T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII], and I am calling from the facility Prisma Healthful Coy Memorial Hospital to try to determine eligibility.
[CUSTOMER][NEUTRAL] On a member that's having hospital outpatient surgery, please.
[AGENT][NEUTRAL] Sure, I can check eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, that would be.
[CUSTOMER][NEUTRAL] 02513034.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. So this policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, he's having, um,
[CUSTOMER][NEUTRAL] A colonoscopy.
[CUSTOMER][NEUTRAL] On Friday, trying to see if will that be covered, is that a coverage benefit?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Give me just a moment, let me get that policy pulled up and we will take a look. I will let you know this is a limited indemnity medical plan, so essentially it pays a set dollar amount per covered procedure or office visit and let me see if a colonoscopy is one of those.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so that is going to be uh covered under their diagnostic testing benefits.
[AGENT][NEUTRAL] Let me see how much that pays. Give me just a moment.
[AGENT][NEUTRAL] OK, so that benefit amount is $250 per test.
[CUSTOMER][NEUTRAL] $250 per test. OK, alrighty, and your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] First initial to last name [PII].
[AGENT][NEUTRAL] It's [PII] uh, was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, but thank you so much for your help. You have a wonderful rest of the day.
[AGENT][POSITIVE] Of course, yes ma'am, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.