AccountId: 011433970860
ContactId: a8bf955c-61d3-432f-aae2-815f61842d5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 148960 ms
Total Talk Time (AGENT): 73055 ms
Total Talk Time (CUSTOMER): 59606 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/a8bf955c-61d3-432f-aae2-815f61842d5e_20250519T16:27_UTC.wav
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[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] That's true.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. I'm calling to see if a home sleep study, uh, the patient has benefits for a home sleep study.
[AGENT][POSITIVE] Sure, Miss, I can assist you with that. Can I have a callback number for you?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] And Miss, what is the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] Uh, I'm sorry, 02166573.
[AGENT][NEUTRAL] Thank you. Could you verify the patient's name and date of birth that you're calling to verify benefits for today?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling in regards to, would it be considered as an outpatient study?
[AGENT][NEUTRAL] It's gonna be taken at a diagnostic testing. So the member has, go ahead.
[CUSTOMER][POSITIVE] Yes, it is. It's a yes.
[CUSTOMER][NEUTRAL] Yeah, it's a sleep study.
[CUSTOMER][NEUTRAL] Testing at home, bill for the facility?
[AGENT][NEUTRAL] The member has outpatient benefits?
[AGENT][NEUTRAL] Uh, $4800 per calendar year with a $100 deductible per calendar year and this is not a guarantee of benefit it's just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, it's a percentage, is that correct?
[AGENT][NEUTRAL] No, this is the benefit amount is what I gave you. The the benefit amount is the $4800 per calendar year for outpatient services, but he also has an outpatient deductible per calendar year of $100.
[CUSTOMER][POSITIVE] OK, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guarantee of benefits, just a disclaimer of the policy coverage. No, ma'am, this is a gap insurance.
[CUSTOMER][NEUTRAL] Any pre-cert required for this test?
[AGENT][NEUTRAL] It just assists with the deductible, co-pay and co-insurance to the primary, and he has not utilized any of his benefits for [PII] [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Got you. That's all I needed to hear.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it. Thank you very much. I appreciate it. Enjoy the rest of your day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][POSITIVE] Alrighty bye bye.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And which remained in.