AccountId: 011433970860
ContactId: a2be1ec9-6419-4b02-a541-42316721700e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410920 ms
Total Talk Time (AGENT): 188118 ms
Total Talk Time (CUSTOMER): 148473 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/a2be1ec9-6419-4b02-a541-42316721700e_20250512T12:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, good morning. Um, I'm just calling because I want to make sure that uh
[CUSTOMER][NEUTRAL] Well, I can give you um a code to see that it's covered.
[AGENT][NEUTRAL] OK, so you want, are you the insured or are you calling from a provider's office?
[CUSTOMER][NEUTRAL] No, I'm, I'm the patient.
[AGENT][NEUTRAL] OK, and you're wanting to see if a specific code is covered, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, I have my primary insurance. I have, I mean, but I just in case, um.
[AGENT][NEUTRAL] OK, I can
[CUSTOMER][NEUTRAL] They you get billed something about this. I wanna make sure that it's covered and I want to know how much is left in my.
[CUSTOMER][NEGATIVE] I don't know how to pay it for the rest of the year.
[AGENT][NEUTRAL] OK, so yes I can partially help you with some of this information, but first off, who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh. And your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, Mr. [PII]. What is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the policy number for you please.
[CUSTOMER][NEUTRAL] Uh, I guess it would be outpatient. 02568979 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please to get your information pulled up and then I will have to verify several several things with you first, Mr. [PII], for security purposes and also any information that is provided today will be a verification of your benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Thank you. And lastly, your email address?
[CUSTOMER][NEUTRAL] I see it's my name [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], this this policy helps you with your co-pays, deductibles, and co-insurance amounts of covered services. So as far as the code being covered or not, we will just have to receive the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your primary insurance company's explanation of benefits for review.
[AGENT][NEUTRAL] I can't guarantee payment on a code itself.
[AGENT][NEUTRAL] And then you were wanting to know is this gonna, how much, what's your remaining?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Benefits are for this calendar?
[CUSTOMER][NEUTRAL] No, I don't, I don't know it's it.
[CUSTOMER][POSITIVE] Yes, what's the remaining benefit, yeah.
[AGENT][NEUTRAL] OK, is it, are you needing your outpatient benefits or an inpatient hospitalization benefits?
[CUSTOMER][NEUTRAL] No, it's not hospitalization. It's, it's a monitor that is gonna be monitoring, uh-huh.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so as of now, Mr. [PII], you have not used any of your benefits for this calendar year.
[CUSTOMER][NEUTRAL] Oh, OK, so I still have left, I think it.
[CUSTOMER][NEUTRAL] I believe it's 3000.
[AGENT][NEUTRAL] As of now
[AGENT][NEUTRAL] As of now for your outpatient benefit, the maximum per calendar year for covered outpatient services is $1500.
[CUSTOMER][NEUTRAL] What do you mean 1000 isn't it 3000? I'm paying the 3000.
[AGENT][NEUTRAL] 3000, no, ma'am, that's an inpatient benefit. That's your in-hospital admission benefit. If you were admitted inpatient into the hospital, an outpatient is 1500 per calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEUTRAL] that I didn't know.
[AGENT][NEUTRAL] Now I can see that you're
[CUSTOMER][NEUTRAL] Cause I used to have a $5 yeah.
[AGENT][NEUTRAL] I'm, I'm so sorry, Mr. [PII]. For some reason, your voice is very muffled and I'm having trouble understanding everything that you say.
[CUSTOMER][NEUTRAL] Yeah, sometimes you're breaking out, so, OK. So it's not 15 1500.
[CUSTOMER][NEUTRAL] For the calendar year. Now, I know that you don't cover the um anything that is done in a a doctor's visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, or a doctor's office. My question is, this is, OK, so this won't be in a doctor's office. It's a monitor that's gonna be.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] Um, checking my heart for 14 days.
[CUSTOMER][NEUTRAL] So is that that's not in the doctor's office.
[AGENT][NEUTRAL] Yes, ma'am. If it's
[AGENT][NEGATIVE] If it's considered in a physician's office setting, then no, ma'am, it would not be covered.
[CUSTOMER][NEUTRAL] OK, now my question is, is it a monitor that's gonna be on me for 14 days.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That would be covered just in case you get something.
[AGENT][NEUTRAL] I cannot guarantee payment of that. That would be something that would have to be reviewed along with the claim from your primary, I mean, from your physician.
[CUSTOMER][NEUTRAL] And he was
[CUSTOMER][POSITIVE] OK, well, thank you so much for your help.
[AGENT][POSITIVE] Oh, you're very welcome. Is there anything else, Mr. [PII], that I could help you with this morning?
[CUSTOMER][NEUTRAL] No, that's it. That's all.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][NEUTRAL] You're