AccountId: 011433970860
ContactId: ac44ab3c-fb99-47aa-a7c3-fbef82c5bc74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274279 ms
Total Talk Time (AGENT): 92901 ms
Total Talk Time (CUSTOMER): 93562 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ac44ab3c-fb99-47aa-a7c3-fbef82c5bc74_20250108T20:46_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi to check benefits for a patient please.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. Give me one second, [PII].
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 02496274.
[AGENT][NEUTRAL] Can I get a callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. Thank you for that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's for [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you for that information, [PII] and you said that you're wanting to verify eligibility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that information. I'm showing an effective date of [PII]. The policy is active at this time. Any other questions?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh yes, because the patient is going to have a.
[CUSTOMER][NEUTRAL] Um, let me see, hold on one sec.
[CUSTOMER][NEUTRAL] Uh, she's gonna have, uh, the patient's going to have like a preventative colonoscopy.
[CUSTOMER][NEUTRAL] You guys follow uh primary insurance, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Well, if it's a if it's, it's a poor screening, it's not covered under this policy.
[CUSTOMER][NEUTRAL] Uh, screening.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK and then if it's not screening.
[CUSTOMER][NEUTRAL] It's covered
[AGENT][NEUTRAL] If it's for a medical concern, yes.
[CUSTOMER][NEUTRAL] OK, and also if the patient is going to have a follow up appointment, um, you guys, uh, because the patient has primary insurance which is United Healthcare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy is secondary. Mhm.
[CUSTOMER][NEUTRAL] And if the patient
[CUSTOMER][NEUTRAL] OK, so if the because the patient, uh, primary insurance has large deductible. So if they're going, if the insurance primary will never will not go, uh, cover the deductible, you guys gonna shoulder that or?
[AGENT][NEUTRAL] OK. Is it for a screening or is it for a medical concerns? Because if it's for a screening, it's not covered. What's the diagnosis?
[CUSTOMER][NEUTRAL] Um, I do sir.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Um, let's see, give me one second, let me just go to the, to the patients.
[CUSTOMER][NEUTRAL] It's the first screening isn't it?
[CUSTOMER][NEUTRAL] Um, let's say for a diagnosis called R19.4.
[AGENT][NEUTRAL] And what is that for?
[CUSTOMER][NEUTRAL] R 19.4 um it's changes in bowel habits.
[AGENT][NEUTRAL] Is that what the patient's being seen for?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so under this policy for covered charges, the maximum outpatient benefit is up to $8000 and actually the outpatient and inpatient benefit is combined for a benefit of up to $8000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and like I said, that includes inpatient and outpatient benefits combined, and then the maximum of 24,000 per calendar year for all covered persons combined.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that is for covered treatments and the information provided is verification, not a guarantee of payment, [PII], and I don't show any claims on file for this patient at this time. Did you have any other questions we can help out with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh no, that'll be all thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh you too bye.
[AGENT][NEUTRAL] Bye-bye.