AccountId: 011433970860
ContactId: 9ca7eea1-fc3b-438f-99dd-3048f0fb6a95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275670 ms
Total Talk Time (AGENT): 137293 ms
Total Talk Time (CUSTOMER): 56963 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/9ca7eea1-fc3b-438f-99dd-3048f0fb6a95_20250520T12:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I was calling to verify coverage and see if the offer is required.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits and the authorization. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], callback number [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, that is D as in Delta 43731408.
[AGENT][NEUTRAL] OK, and do you have a copy of the member's ID card with you?
[CUSTOMER][NEUTRAL] Um, yeah, I can pull it up.
[AGENT][NEUTRAL] OK, um, we're looking for the in-hospital or outpatient policy er number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's 02513068.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So prior off or pre-cert none of our policies required because we're not a major medical insurance company. And then what benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Outpatient hospital and if I can get you, give you the CPT code, you don't have to verify it or anything.
[AGENT][NEUTRAL] No, we don't use CPT codes. I mean, we do, but not for coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is this outpatient hospital.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the um benefits to pop up here. Hold on one second.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity policy. So for, is it like an outpatient surgery or it's just like
[AGENT][NEUTRAL] outpatient office visit.
[CUSTOMER][NEUTRAL] It's a colonoscopy.
[CUSTOMER][NEUTRAL] At the hospital.
[AGENT][NEUTRAL] Let me see if that's hm, the reason I'm asking is because, because it's a hospital indemnity, it only has hospital admission like after they're admitted hospital confinement after 24 hours and then there's a benefit for
[AGENT][NEUTRAL] Um, if it's in reference to an accident or sickness, a surgery, um, so let me see if colonoscopy is considered and then we could use that or
[AGENT][NEUTRAL] Let me see if they have diagnostic test. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let's see, I see.
[AGENT][NEUTRAL] OK, so for the diagnostic testing benefit.
[AGENT][NEUTRAL] A colonoscopy.
[AGENT][NEGATIVE] It's not listed.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So this policy doesn't have any coverage for um colonoscopy. I looked under diagnostic testing, but it's a, it's a list, and if it's not on that list, it's not covered. So colonoscopy wasn't one of them, and then I looked under um the accident and sickness surgery benefit to see if that would be considered a surgery, but it's not.
[CUSTOMER][NEUTRAL] OK, OK, um, if I could just get the initial of your last name and the call reference if you got it?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], and again my name is [PII].
[CUSTOMER][POSITIVE] All right. uh, thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome, [PII]. You also, was there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh no, ma'am, that was all. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling API. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.