AccountId: 011433970860
ContactId: c4a3b90c-92a3-49b6-8a45-5e7bcf52d828
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429230 ms
Total Talk Time (AGENT): 164092 ms
Total Talk Time (CUSTOMER): 141704 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c4a3b90c-92a3-49b6-8a45-5e7bcf52d828_20250415T17:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Citrus Valley Gastroenterology. I'd like to verify um benefits for an ultrasound visit and if it is a um
[CUSTOMER][NEUTRAL] Uh, if it's covered under this APL plan. Thank you.
[AGENT][NEUTRAL] OK, well, I can help you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Um, it's area code [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] All right, numbers um number is 0257.
[CUSTOMER][NEUTRAL] 631-3.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. You said you need ultrasound benefits.
[CUSTOMER][NEUTRAL] Yes. Um, do you need the CPT codes on it?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Mhm. Would it be outpatient?
[CUSTOMER][NEUTRAL] Well, it's an inpatient um ultrasound cause it would be done in an office.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So this policy so this policy specifies what what it considers a diagnostic testing. So for this policy will only cover MRI, CT scans, and colonoscopies.
[AGENT][NEUTRAL] Um, so the ultrasound under the diagnostic testing, um, wouldn't be one of the covered benefits. They also have the, um, hold on, let me go back up to it.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] From that one.
[AGENT][NEUTRAL] They also have the outpatient sickness rider, which covers like office visits. It will pay up to $75 per visit with a max of $5 per calendar year. So depending on how it comes over, if it's um like in an office, that could be applied, but the only way we know for sure is to let it process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, an ultrasound is not a covered benefits for the plan, right?
[AGENT][NEUTRAL] No, that's not what I'm saying. So there's two benefits that could be applied. The diagnostic testing, the ultrasound can't be used, but for the outpatient sickness and rider, it could be, but I can't guarantee that because I'm not an examiner, but they do have the $75 for the, you said office and it covers $5 per visit, so that could be applied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't want to say no because there's a benefit that could possibly be used.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So this could be for like a $75 and covers um maximum of 5 visits, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah, OK. I'm just gonna add this note on.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] For, yeah, for the $75 it's like a co-pay visit, right?
[AGENT][NEUTRAL] No, this is a hospital indemnity policy, so there's no copays or deductibles. The $75 is what we can apply to the claim that comes in.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, for this, for the ultrasound, is the, uh, is pre-certification is a need for this?
[AGENT][NEUTRAL] Um, no, since American Public Life is not a major medical, there's no prior author or pre-cert required.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. Um, um, for, just for a clarification, the ultrasound is, um, is not a guarantee of a covered benefits, but for the diagnostic testing ultrasound, it has a $75 which can apply to the claims that um has a 5 visit maximum, right?
[AGENT][NEUTRAL] So you're mixing both of them. The, the diagnostic testing, it does not apply, but for the outpatient sickness benefit rider, that's the $75 per um $75 per visit with the 5, visit max per year.
[CUSTOMER][NEUTRAL] All right. Outpatient benefits.
[CUSTOMER][NEUTRAL] So there's no information regarding ultrasound, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Only the information I've provided.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. Can I ask for the call reference number and the initial of your last name, please?
[AGENT][NEUTRAL] Sure, there's no
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. Um, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much for that [PII].
[AGENT][POSITIVE] You're welcome [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that would be all for now. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.