AccountId: 011433970860
ContactId: 93222c2a-d417-4cb3-9705-a5ad60d07b55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444779 ms
Total Talk Time (AGENT): 82281 ms
Total Talk Time (CUSTOMER): 89192 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/93222c2a-d417-4cb3-9705-a5ad60d07b55_20250306T18:17_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'm calling from Glen Doherdigestive disease. I'm calling to verify benefits and eligibility on a patient.
[AGENT][POSITIVE] I'll be happy to assist with benefits and eligibility. May I have your first name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And um if I could get a good call back number for you.
[CUSTOMER][NEUTRAL] Sure, it's area code [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Policy number 02576313.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And is this for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient. And do you have a termination date?
[AGENT][NEUTRAL] Policy is still active?
[AGENT][NEUTRAL] And where will treatment take place?
[CUSTOMER][NEUTRAL] The patient will be having a medical colonoscopy and an ambulatory surgical center or billing for the facility.
[AGENT][NEUTRAL] OK, so that would fall under the wellness and this is for just regular wellness diagnosis or?
[CUSTOMER][NEUTRAL] It, no, it's a medical colonoscopy. There's a.
[AGENT][NEUTRAL] Medical colonoscopy?
[CUSTOMER][NEUTRAL] It's nonstreaming.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that would fall under the surgical benefit.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um, one moment please.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And I'm sorry, what is your name?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that was a colonoscopy.
[AGENT][NEUTRAL] I'm looking on the schedule.
[AGENT][NEUTRAL] So they have a $2000.
[AGENT][NEUTRAL] Calendar year maximum for surgical procedures.
[CUSTOMER][NEUTRAL] Is that a deductible?
[AGENT][NEUTRAL] No, that's their benefit amount that's the maximum that we'll pay.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It does.
[AGENT][POSITIVE] 2000, that's correct.
[CUSTOMER][NEUTRAL] X.
[CUSTOMER][NEUTRAL] And can you check to see if we're in network?
[AGENT][NEUTRAL] Um, with this policy, there is no network patient can see any provider that they choose.
[CUSTOMER][NEUTRAL] Oh, OK, so it doesn't matter if they're in network or out of network.
[AGENT][NEUTRAL] Yeah, we don't have internet out of network benefits since there is. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So you won't go by a deductible or co-insurance, nothing like that.
[CUSTOMER][NEUTRAL] So you won't have no deductible, no co-insurance, nothing, co-pay, just 2000 max.
[AGENT][NEUTRAL] No. No.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And do they need pre-certification?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And can I have a reference number for this call, please?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] And, um, yes, hold on one second.
[CUSTOMER][NEUTRAL] Would you mind holding? I just wanna ask my biller if there's any anything else that I should ask you. One second please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you for holding [PII].
[CUSTOMER][POSITIVE] Hello, thank you for holding, [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.