AccountId: 011433970860
ContactId: 8bd8434d-d21e-448a-8eef-afc644062928
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277609 ms
Total Talk Time (AGENT): 61486 ms
Total Talk Time (CUSTOMER): 140731 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/8bd8434d-d21e-448a-8eef-afc644062928_20250528T21:35_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. I just have some questions about a possible procedure that, uh, my doctor wants to do, like both him and I wanna do, if you will.
[CUSTOMER][NEUTRAL] See about my coverage for it.
[AGENT][POSITIVE] I'd be happy to assist with your coverage today. May I have your policy number, please?
[CUSTOMER][NEUTRAL] Um, give me one minute. I can pull it up.
[CUSTOMER][NEUTRAL] So that is going to be.
[CUSTOMER][NEUTRAL] 0246.
[CUSTOMER][NEUTRAL] 2046
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and then I'm going 8.
[AGENT][NEUTRAL] Your name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what's your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. Now is this gonna be an outpatient or inpatient?
[CUSTOMER][NEUTRAL] Um, I believe it's an outpatient.
[AGENT][NEUTRAL] I'm showing your per day maximum for outpatient procedures is $3000.
[CUSTOMER][NEUTRAL] OK, and it's not, so it, it doesn't really matter, it's not sort of like procedure specific it's just like dollar amount specific.
[AGENT][NEUTRAL] Well, it's place of service driven.
[AGENT][NEUTRAL] So, I mean, is it, is it medically necessary? Is it something that's approved through your major medical?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, like I had um a septoplasty, um.
[CUSTOMER][NEUTRAL] And there's still kind of something going on there and so there's this procedure called the Vivair procedure um that it's kind of uh an outpatient thing, um, and yeah, that's what my doctor wants to do for my breathing, um.
[CUSTOMER][NEUTRAL] And yeah I I believe he they were putting in an order in the next couple of days um but I guess we gotta wait on them for that to sort of make sure on everything.
[AGENT][NEUTRAL] OK. Well, as long as it's um approved by the, your major medical, um, yeah, then it will.
[AGENT][NEUTRAL] And it's medically necessary, um, then yeah.
[CUSTOMER][NEUTRAL] OK, and then it's OK so it's gotta go through the primary first and then kinda go from there.
[AGENT][NEUTRAL] Right, cause the primary is gonna determine your patient responsibility and that determines how much we pay.
[CUSTOMER][POSITIVE] Got it, got it. Alright, perfect, um, alright, I'll give him a call and sort of go from there. Thank you so much.
[AGENT][NEUTRAL] Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Actually, yes, I had another question. I was submitting claims earlier and I saw.
[CUSTOMER][NEUTRAL] Something about submitting a wellness claim, could you tell me more about that by any chance?
[CUSTOMER][NEUTRAL] Like what that is?
[CUSTOMER][NEUTRAL] I think I have an idea, but I'm not sure.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Where did you see that?
[CUSTOMER][NEUTRAL] So when I logged in and to submit my.
[CUSTOMER][NEUTRAL] EOBs
[CUSTOMER][NEUTRAL] Is what I believe you guys call them. There was one button that said, you know, submit your your EOB claim forms, and there was one on the other side on the right that said uh wellness claim.
[CUSTOMER][NEUTRAL] And I was wondering if that's like a.
[CUSTOMER][NEUTRAL] Like a reimbursement for like going to the gym and stuff like that. I think I've, I've done that before with other services, but I'm not.
[CUSTOMER][NEUTRAL] I don't, you know, I'm just wondering since I have you on the phone if it's the same thing.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um, let me see if you have that benefit.
[AGENT][NEGATIVE] I don't see where you have the wellness benefit.
[CUSTOMER][NEUTRAL] OK, that's, that's kind of what I saw, but I saw that button and I was, you know, just wondering, but all good. I understand.
[CUSTOMER][NEUTRAL] Um, and yeah, that was it.
[AGENT][POSITIVE] OK, well thank you for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thanks you too
[AGENT][NEUTRAL] Mhm bye bye.