AccountId: 011433970860
ContactId: 8f923d19-d6a3-4663-bf97-7757f2e1605c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369070 ms
Total Talk Time (AGENT): 141720 ms
Total Talk Time (CUSTOMER): 119146 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/8f923d19-d6a3-4663-bf97-7757f2e1605c_20250317T19:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um,
[CUSTOMER][NEUTRAL] I'm calling because um I um received a um.
[CUSTOMER][NEUTRAL] So, so my, my doctor had ordered an ultrasound and a mammogram for me, um.
[CUSTOMER][NEUTRAL] And um my, under APL um diagnostic ultrasounds and mammograms are not covered. Um, however, the provider wants to know if um screening ultrasounds or screening mammograms are covered under my um benefits.
[CUSTOMER][POSITIVE] And if I could get information on that, that'd be great.
[AGENT][NEUTRAL] I can check and see what type of product you have. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's um [PII]
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And um [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the policy number is
[CUSTOMER][NEUTRAL] 02596755
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And this name for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] It is um [PII] and um [PII]. Um email address is [PII].
[AGENT][NEUTRAL] Thank you. Let me pull your benefits for your certificate really quick. One moment.
[AGENT][NEUTRAL] Alright, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And um I'm waiting on the documents. I'm sorry, it's taking a little bit to pull up.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, here we go.
[AGENT][NEUTRAL] OK, so this one has.
[AGENT][NEUTRAL] Ming test.
[AGENT][NEUTRAL] OK, so this one doesn't have any um wellness or screening or yearly um checkups or tests. So mammogram, Pap smear, ultrasound, those are not covered if they're like screening tests or preventive tests. Um, I do see that you have the VIP plan with benefits in a card.
[AGENT][NEUTRAL] So you may have benefits to IMA for preventatives. Have you checked their benefits with them, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, I am trying to, um, I, I, I, um, called them earlier. I'm waiting for a call back, um.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, um, and, and the, so, um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So is it listed under my EOB um saying that it's just, it's um not covered.
[AGENT][NEUTRAL] OK. Um, when, if you have received the booklet with the benefits, um, it's gonna indicate what is covered in a screenings are not covered or wellness are not covered unless it's a colonoscopy. Um, if you have submitted a claim and we have denied the claim that the denial is gonna read that it's not covered under the policy.
[AGENT][NEUTRAL] So I'm not sure if you have submitted a claim or not or if they have submitted a claim. Um, but, um, based on what I'm seeing here under the policy, it is a non-cover service.
[CUSTOMER][NEUTRAL] OK, alright, thank you, um, OK, yeah, as long as, um, the provider just wanted to, um, uh, have a copy of the EOB, um, because if, if they do so I might be able to get, um, like a free go through a free program so I just needed like, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, like a written, you know, like a written, um, proof that it's not covered, um, so I guess as long as it's under the EOB, then, then it should be OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Yeah, if, if they have sent in a claim. If they have not sent in a claim, you can always have them to submit a claim, and if we need to send a denial, we will so they can go ahead and do what they need to do. OK?
[CUSTOMER][POSITIVE] OK, all right, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Um, no, that is all. Thank you.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] You too thank you so much bye bye.
[AGENT][NEUTRAL] You're welcome. Bye bye Miss [PII].