AccountId: 011433970860
ContactId: c59b2aed-aca6-4736-b8e4-ed9d4ceaa51b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393549 ms
Total Talk Time (AGENT): 149155 ms
Total Talk Time (CUSTOMER): 146010 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/c59b2aed-aca6-4736-b8e4-ed9d4ceaa51b_20250205T17:10_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. Today, I'm checking on eligibility and benefits for the member.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and benefits, Mr. [PII], and may I have your contact number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Callback number, that would be [PII], sorry, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. And where are you calling from?
[CUSTOMER][NEUTRAL] Uh, it's from the doctor's office. It's from Doctor [PII].
[AGENT][NEUTRAL] How do you spell the last name?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Policy number, that would be.
[CUSTOMER][NEUTRAL] 021 007801
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] Mhm. Well, the member's name, it's uh
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Hm, that's not what I pull. Can you repeat that number one more time?
[CUSTOMER][NEUTRAL] 021007801.
[AGENT][NEUTRAL] Yeah, that has too many numbers. Um, do you have the copy of the card?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 021 07801.
[AGENT][NEUTRAL] OK, so take one of the zeros off. Let me try that one moment.
[AGENT][NEUTRAL] OK, repeat the name and date of birth one more time.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] All right. And you said you need eligibility and benefits, and what type of service is being rendered for benefits?
[CUSTOMER][NEUTRAL] For this member, I'm checking on eligibility benefits for colonoscopy. I do have the procedure code. Place of service, it's an outpatient hospital bill for the professional charges.
[AGENT][NEUTRAL] OK. And the colonoscopy, is a diagnostic colonoscopy or is it a preventative colonoscopy?
[CUSTOMER][NEUTRAL] Preventative.
[AGENT][NEUTRAL] OK, if it's a preventive colonoscopy, we do not cover preventative service. We only cover for sickness or injury.
[CUSTOMER][NEUTRAL] Preventive colonoscopy is not covered under the member's plan?
[AGENT][NEUTRAL] Correct. And this is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK. It's a secondary supplemental plan?
[AGENT][POSITIVE] Mhm, correct.
[AGENT][NEUTRAL] To the major medical. Mm.
[CUSTOMER][NEUTRAL] OK. Uh, you have any
[CUSTOMER][NEUTRAL] OK. What's, uh, what's the major medical plan on this one for this member?
[AGENT][NEUTRAL] Uh, let me see which one is the major medical on this one.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, Aetna. Aetna is the major medical.
[CUSTOMER][NEUTRAL] OK. Aetna is major medical and this one is secondary, right?
[AGENT][NEUTRAL] Correct. We are the secondary, and we do not cover preventative. Mhm.
[CUSTOMER][NEUTRAL] And what's the policy effective date?
[AGENT][NEUTRAL] OK, the policy effective date for this one is going to be [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] [PII] and what's the plan name? Is it like a PPO or HMO plan?
[AGENT][NEUTRAL] This is a commercial plan, but it's a secondary supplemental plan.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So does this plan uh like cover the coinsurance from the primary or not?
[AGENT][NEUTRAL] If it's for sickness or injury, it will cover. If it's preventative, it doesn't cover any preventative service. We only cover diagnostic testing. So if it's a diagnostic colonoscopy due to a sickness, like a stomach sickness or any type of sickness that needs a colonoscopy, then it will be considered under that benefit, but um if not, if, if it's preventative only, then it will not be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][POSITIVE] OK, great. Got it. Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, preventive colonoscopy is not covered under the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Great. Got it. One moment.
[CUSTOMER][NEUTRAL] And uh is the provider is the network with the member's plan? Would you be able to check this?
[AGENT][NEUTRAL] The there's no network because we're just the secondary, so you need to follow primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no network.
[AGENT][NEUTRAL] You need to follow the primary network.
[CUSTOMER][NEUTRAL] OK. Is there any deductible and out of pocket under this plan?
[AGENT][NEUTRAL] No, we're not the major medical. We're just the secondary.
[CUSTOMER][NEUTRAL] OK, great. So, only diagnostic and surgery benefits are covered. Uh, screening or preventive services are not covered under the member's plan, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, screening and preventative are not covered, only significant injury. Mhm.
[CUSTOMER][POSITIVE] Great, got it.
[CUSTOMER][NEUTRAL] Got it. And your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] [PII] and the reference number?
[AGENT][NEUTRAL] We don't have refe[PII] numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK. What's your local time?
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] The central or eastern?
[AGENT][NEUTRAL] Central.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Mhm. Uh, that's all, that's all I have for today. Thanks for your assistance. Bye now. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. You're welcome bye bye.