AccountId: 011433970860
ContactId: b6520ef4-34b5-407d-a41c-04648ddfd728
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537679 ms
Total Talk Time (AGENT): 172157 ms
Total Talk Time (CUSTOMER): 326222 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/b6520ef4-34b5-407d-a41c-04648ddfd728_20250220T16:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, good morning, [PII]. Hi, my name is [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well. How are you doing, [PII]?
[CUSTOMER][NEUTRAL] Good, good, just as well, thank you so much. Um, I'm calling you from a provider's office. It's a group. Our name is Citrus Valley Gastroenterology, and I just got off the phone with the network, which is, uh, multi-plan, and they advise you as our American public life, you're the carrier for this individual's plan. I wanted to just verify some benefit information, if I may, for Mr. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] But it would be my pleasure, my pleasure to assist you. And what is
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Your callback number, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, we'll
[CUSTOMER][NEUTRAL] Would that be the medical ID number because he does have a policy number, but then a medical ID number as well.
[AGENT][NEUTRAL] It's gonna be the policy number, his medical ID is for preventive and wellness only.
[CUSTOMER][NEUTRAL] OK, so that's what I'm, I wanna verify preventative and wellness, OK.
[CUSTOMER][NEUTRAL] Um, but I'll give you the policy number. It's 02576313.
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] And the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Is that [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][POSITIVE] OK, thank you. And I can help you with eligibility and benefits.
[AGENT][NEUTRAL] His policy is active as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And he does have wellness benefits.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that, let me get that benefit on this policy as well. Now that medical ID number is gonna be for your
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] I am so sorry.
[AGENT][POSITIVE] My computer is just taking its sweet time and I do apologize. The medical ID number will provide benefits for wellness and preventive as well, but with APL.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, so on the, uh huh.
[AGENT][POSITIVE] Mhm. With the APL he has wellness benefit as well.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so it's a little so the claim is gonna go to, I'm trying to figure out who the claim is gonna go to, and according to the insurance card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] He, it says uh IMA Inc. What is that abbreviated for?
[AGENT][NEUTRAL] Um, IMA is the wellness and preventive side, so benefits will go to them. The claim will go to them first. They'll send it to multi-plan repricing and process for any wellness or preventive benefits on their side and then forward the claim to us at APL.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] For additional benefits.
[CUSTOMER][NEUTRAL] OK, um, and it's.
[CUSTOMER][NEUTRAL] OK, so then technically speaking I don't have to make the payer APL. It's gotta go to IMA Inc. is that right?
[AGENT][NEUTRAL] That's correct. For it'll go to them for repricing and then they will forward the and then they'll process their side for any wellness or preventive benefits and then for the claim to APL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Oh goodness, OK.
[AGENT][NEUTRAL] It's kind of like a, uh, they have dual coverage for wellness and preventive benefits.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, now, does he have, um, I believe he is, what is his age? What I'm checking for, OK, so I wanna see what age.
[CUSTOMER][NEUTRAL] He is [PII] of age. OK, [PII]. Now what we do here is gastroenterology, um, and so technically speaking he's been having abdominal pain, so I want to verify benefits for gastroenterology, which is a colonoscopy endoscopy.
[CUSTOMER][NEUTRAL] Um, and that could be a a colonoscopy screening, so that would run into his benefits for preventative benefits for cancer screening, um, and so I'd like to check if he has coverage due to his age, um, you guys, uh, follow the, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policies that most uh medical insurances offer, right? I think it's between the ages of [PII] and [PII].
[CUSTOMER][NEUTRAL] For screenings, uh, for colonoscopies.
[AGENT][NEUTRAL] Now with APL.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] Now, if he's been having pain and that does turn into a
[AGENT][NEUTRAL] Diagnostic benefits.
[AGENT][NEUTRAL] Diagnostic benefits as well through APL for a colonoscopy for diagnostic.
[CUSTOMER][NEUTRAL] I'm sorry, repeat that one more time? I cut out.
[AGENT][NEUTRAL] Through his APL, I apologize, through his APL policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that is a, turns into a diagnostic.
[AGENT][NEUTRAL] MRI?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, not an MRI.
[AGENT][POSITIVE] Then, I mean, I'm sorry.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Colonoscopy, not MRI.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it turns into diagnostic, he does have diagnostic benefits under his APL policy for a colonoscopy.
[CUSTOMER][NEUTRAL] OK, so, uh, colonoscopy wouldn't run into um into uh what is it called?
[CUSTOMER][NEUTRAL] Sorry, so it would.
[AGENT][NEUTRAL] So if he, say if you.
[AGENT][NEUTRAL] For example, if
[CUSTOMER][NEUTRAL] It would be surgery.
[AGENT][NEUTRAL] Right. And if, if the colonoscopy, if there's um polyps removed, then that would turn into a diagnostic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And he does have benefits.
[AGENT][NEUTRAL] Through his APL policy for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, so he does have coverage, uh huh.
[AGENT][NEUTRAL] Now for the
[AGENT][NEUTRAL] Yes ma'am
[CUSTOMER][NEUTRAL] You know what, there was a
[AGENT][NEUTRAL] A for his
[AGENT][NEUTRAL] IMA policy.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] To get their benefits.
[CUSTOMER][NEUTRAL] For his.
[CUSTOMER][NEUTRAL] I would have to call who?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] IMA.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh, I thought they were just the payer. Are you there?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello? Hello?
[CUSTOMER][NEUTRAL] this is the.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Are you there? Hello?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then she found out.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] OK, one.
[CUSTOMER][NEUTRAL] I thought she.