AccountId: 011433970860
ContactId: b803db63-c3bd-4816-be40-3eba7bf05954
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385869 ms
Total Talk Time (AGENT): 209785 ms
Total Talk Time (CUSTOMER): 119117 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/b803db63-c3bd-4816-be40-3eba7bf05954_20250521T17:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hey, [PII], I needed to verify benefits for a patient.
[AGENT][NEUTRAL] Yeah, I can check on if it's for you. Uh, what was your name please?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII] option 0.
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do, um, it is.
[CUSTOMER][NEUTRAL] D as in dog 43731408
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers, [PII], that is through, uh, they're called 90 Degree benefits. Um, I can either give you their information and transfer you to them, or if you have the member's social, I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] Um, I do have the social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is uh.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the name for the member?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and just to confirm was this for um medical or dental, [PII]?
[CUSTOMER][NEUTRAL] It's for medical.
[AGENT][NEUTRAL] Medical, OK. Um, so I did find her policy with us. It is currently active. Uh, whenever you're ready I can give you that policy number.
[CUSTOMER][NEUTRAL] Oh yeah, what is the policy number I'm reading?
[AGENT][NEUTRAL] That is 02513068.
[CUSTOMER][NEUTRAL] OK, and so even though um on her card it has that the policy number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, so that's not you guys or?
[AGENT][NEUTRAL] No ma'am, so it is a bit confusing, um, this is part of a multi plan, so the number that you gave me, she most likely has a policy through them, uh, and again they're called 90 degree benefits, um, and again if you'd like their information I can get that for you from what I understand those are going. OK, oh yeah, one of the prompts can lead you to us I think um I think their prompt is uh option 3 or excuse me, option one,
[CUSTOMER][NEUTRAL] I have, I have it already.
[AGENT][NEUTRAL] But this policy she has with us is a limited indemnity medical plan, so it's gonna be more for um.
[AGENT][NEUTRAL] Uh, sickness, injury, uh, surgical benefits, things like that.
[AGENT][NEUTRAL] Whereas I believe the policy with 90 degrees is going to be more um wellness benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, so could I get benefits from you or would I need to get benefits from them?
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] I can absolutely give you the benefits that she has with us under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And of course I will let you know verification of coverage is not a guarantee of payment for claims. So this one is not very extensive. She does have a hospital admission benefit, hospital confinement, um, surgical benefits for uh accident or sickness, and then diagnostic testing benefits. Do any of those apply to what she's gonna be seen for?
[CUSTOMER][NEUTRAL] Uh, let me give you the, uh, CPT code because it's gonna be a screening colonoscopy.
[AGENT][NEGATIVE] I can't unfortunately look.
[AGENT][NEGATIVE] Unfortunately I can't look with uh CBT codes um but you said it was a colonoscopy?
[CUSTOMER][NEUTRAL] Yes, it's a screening.
[AGENT][NEUTRAL] OK, I believe that's gonna be covered under the diagnostic testing benefit. Let me confirm that though.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, unfortunately it is not going to be a covered benefit under this policy.
[AGENT][NEUTRAL] That diagnostic testing benefit only covers benefits for um medical imaging tests.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Would she have
[CUSTOMER][NEUTRAL] Uh, out of pocket and deductible.
[AGENT][NEUTRAL] So not for this policy. Again, it is very limited as to what is and is not covered, um, and it pays a set dollar amount per covered procedure or office visit. So no co-pays or anything like that for this policy.
[CUSTOMER][NEGATIVE] But, however, the service that she's having to uh coming up is not covered.
[AGENT][NEUTRAL] Correct. Colonoscopy is not going to be a covered benefit under this policy.
[CUSTOMER][NEUTRAL] So would she be put in as a sales pay patient? I'm just so confused. I, I'm, I'm sorry. I'm very confused.
[AGENT][NEUTRAL] No, no, not your fault. It is very confusing, trust me, um, if you would like, um, you can unless you've spoken with them already, I would try to check with 90 Degree to see if she has any additional benefits that might help cover that. Um, as for this particular policy she has with us though, we would not be able to offer any coverage.
[CUSTOMER][NEUTRAL] OK, alright, um.
[CUSTOMER][NEUTRAL] OK, this is very confusing. Uh, [PII], how do you spell your name?
[AGENT][POSITIVE] It's [PII] and trust me, I understand.
[CUSTOMER][NEUTRAL] What's that and you should say your last name?
[AGENT][NEUTRAL] Last initial is [PII]
[CUSTOMER][NEUTRAL] And is there a reference for our call?
[AGENT][NEUTRAL] Reference number would be my first name, last initial, and today's date. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that is it. Um, I will try to get in contact with 90 Degrees, um.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEGATIVE] I just looked on the website for her information and they're not finding her so um I'm gonna give a call.
[AGENT][NEUTRAL] Oh, they should with that, uh, that the number is, uh, policy number of theirs.
[CUSTOMER][NEUTRAL] Yeah, it's not finding her. I just typed it in and it's, it's not finding her, so.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, but you said that she is active. Yeah, this is very confusing.
[AGENT][NEUTRAL] It it is, and I apologize, you have to go through all that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, it's OK um I'll give them a call. Thank you so much.
[AGENT][NEGATIVE] Listen, it's even worse, uh, explaining it to the members.
[CUSTOMER][NEUTRAL] I can only imagine.
[AGENT][POSITIVE] Yes ma'am. Alrighty, well I hope you have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] OK, well you have a great day and I appreciate it.
[AGENT][POSITIVE] Absolutely thank you bye bye.
[CUSTOMER][POSITIVE] All right you too bye bye.