AccountId: 011433970860
ContactId: a328e9c2-a7a8-415f-adcb-8786d041a4b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267239 ms
Total Talk Time (AGENT): 113604 ms
Total Talk Time (CUSTOMER): 60727 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/a328e9c2-a7a8-415f-adcb-8786d041a4b4_20250306T15:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Swanga Pasiri Radilogy. I need to verify coverage on a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with coverage, your eligibility. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm sorry, I didn't get your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII], what's yours?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02596755.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you. All right, and we have an effective date of [PII].
[AGENT][NEUTRAL] It is active at the moment and this is one of our limited hospital indemnity policies.
[CUSTOMER][NEUTRAL] OK, so it's only covered for hospital?
[AGENT][NEUTRAL] No, it has several benefits. What type of service is being rendered?
[CUSTOMER][NEUTRAL] The diagnostic testing, a mammogram and a breast sonogram.
[AGENT][NEUTRAL] Is this preventative?
[AGENT][NEUTRAL] Or diagnostics.
[CUSTOMER][NEUTRAL] Yeah, diagnostic.
[AGENT][NEUTRAL] I know. OK, let me check and see if it's a cover service. One moment.
[AGENT][NEUTRAL] 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 let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][MIXED] OK, so this one has diagnostic benefit, but it is limited to MRI, CT scan, PET scan, and thyroid intake. It doesn't have benefits for a mammogram or breast ultrasound.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it, they do have benefits for MRI, CT, and PET.
[AGENT][NEUTRAL] Yes, mhm. MRI, CT scan, PET scan, thyroid intake.
[CUSTOMER][NEUTRAL] OK, and um if those were needed, do they require authorization?
[AGENT][NEUTRAL] No authorization is not gonna be required because this is a limited policy, so it pays just a flat amount. Uh, the benefit amount for a diagnostic testing is just $100 per day maximum of 1 per year.
[CUSTOMER][NEUTRAL] All right. So if they have a an MRI CT or whatever, it's only covered at $100.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And one per year.
[AGENT][POSITIVE] This one per year, correct.
[CUSTOMER][NEUTRAL] Alright, so is, so is low tech not covered at all low tech imaging?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Alright, so not covered for low tech image.
[CUSTOMER][NEUTRAL] Alright, is there a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Miss [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] What's the first initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright thanks.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.