AccountId: 011433970860
ContactId: a215f60c-014e-4bb0-8580-df3c1c720279
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187649 ms
Total Talk Time (AGENT): 117477 ms
Total Talk Time (CUSTOMER): 57941 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/a215f60c-014e-4bb0-8580-df3c1c720279_20250122T21:16_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, ma'am. I've uh got an MRI scheduled uh this coming Monday. I'm wondering if I can get some kind of idea on what APL might cover for this procedure.
[AGENT][POSITIVE] OK, be glad to help you. Go ahead and give me your name and your policy number, please, sir.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] Do you need the group number or the payer ID number?
[AGENT][NEUTRAL] No sir, I need your certificate number which is gonna be your ID number here, see that certificate number? Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, uh, so it's gonna be we're gonna go 025799.
[CUSTOMER][NEUTRAL] 83 Mike Lima 8
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information and while I'm pulling your file up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][POSITIVE] Alrighty thank you so much for all that information there. Now go ahead and verify your date of birth and your address for me please sir.
[CUSTOMER][NEUTRAL] [PII] and address is [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thanks so much for all of that information. Now, what you're calling about is to see you said you were having an MRI done outpatient at the hospital and you wanting to know kind of your benefits here. Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] All right, let me get that pulled up. Now I do see your original effective date here on this medical supplemental plan here at APL is [PII]. You are current and active.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] But I must advise that verification of coverage is not a guarantee of payment on a claim. Now what we are, [PII], is your medical supplemental plan. So the only thing that we would pick up and pay is anything for sickness and injury that is applied towards your deductible, co-pay or co-insurance at your primary insurance company.
[AGENT][NEUTRAL] Now what your benefit here would be is uh no pre-start, no deductible, and you have a $1500 outpatient benefit max here [PII] per calendar year.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] When I go into this procedure, the testing facility, I, I should give them this APL card and they can submit a claim that way, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir, yes sir, because what they're gonna do, you're gonna give them your primary insurance company ID as well as your APL ID that way once they file your primary insurance carrier and they get the ELB back then they can submit that claim here to APL for you, yes sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you. OK. OK. Well, I, I think that answered that. That's uh that's pretty much all I needed.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, alrighty then, Mr. [PII], if that's all I can help you with. Thanks for calling APO and you have a great rest of your day, OK?
[CUSTOMER][POSITIVE] Yeah, you too. Thank you, ma'am.
[AGENT][POSITIVE] Thank you, sir. Mhm.
[CUSTOMER][NEUTRAL] Alright bye.