AccountId: 011433970860
ContactId: c8f987e4-7e82-425e-a2df-f54f808c2529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449380 ms
Total Talk Time (AGENT): 198915 ms
Total Talk Time (CUSTOMER): 173567 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/c8f987e4-7e82-425e-a2df-f54f808c2529_20250108T18:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. Uh, my name is [PII], and I'm calling to see um how much would you guys pay towards uh a uh endo endoscopy.
[CUSTOMER][NEUTRAL] Uh, it's gonna be done at the um surgical ambulatory.
[CUSTOMER][NEUTRAL] Spenter.
[AGENT][NEUTRAL] OK. Are you the insured or the provider?
[CUSTOMER][NEUTRAL] I'm the insurer.
[AGENT][NEUTRAL] May I have your policy number, please?
[CUSTOMER][NEUTRAL] Um, sure, it's
[CUSTOMER][NEUTRAL] Let's see, mm.
[CUSTOMER][NEUTRAL] Um, I see the group number.
[AGENT][NEUTRAL] It would be the outpatient benefit certification number.
[CUSTOMER][NEUTRAL] I don't see
[CUSTOMER][NEUTRAL] Oh, OK, 0221.
[CUSTOMER][NEUTRAL] 0641
[CUSTOMER][NEUTRAL] M as in Mary, L for love, and the number 8, sorry.
[AGENT][NEUTRAL] And may I please have your date of birth and then the mailing address, please?
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII], and my address is um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Now we don't have an email address on file. Do you have one that you would like for me to enter into the system?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's [PII], your last name?
[CUSTOMER][NEUTRAL] Right. Correct. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I have [PII].
[CUSTOMER][NEUTRAL] Correct. So it's [PII].
[AGENT][NEUTRAL] OK, I
[AGENT][NEUTRAL] I will get that updated in the system and you were calling in regards to outpatient benefits. I'm pulling that up for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, I'm gonna
[CUSTOMER][NEUTRAL] Yeah, it's an endoscopy.
[AGENT][NEUTRAL] OK, so if this is done within an outpatient facility, verification of verification of coverage. Go ahead.
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][POSITIVE] See, I'm so sorry.
[CUSTOMER][NEUTRAL] I'm so sorry, I was sneezing. I didn't hear you. Say it again please.
[AGENT][NEUTRAL] Oh, I said bless you and then um in regards to, you're welcome for your outpatient verification of coverage does not guarantee the payment of the claim. If it's rendered within an outpatient facility, you do have up to $1000 per calendar year. That will go towards your primary insurance deductible, co-insurance, or co-pay.
[CUSTOMER][POSITIVE] Oh, thank you.
[AGENT][NEUTRAL] If your primary insurance does this within an office setting, then it is considered a non-covered benefit.
[AGENT][NEUTRAL] If your primary insurance does not cover it, then we don't cover it either.
[CUSTOMER][NEUTRAL] So, it's gonna be an um surgical ambulatory. Would you, you're gonna pay, would that cover?
[AGENT][NEUTRAL] If it's done within an outpatient facility that is up to the $1000 per calendar year.
[CUSTOMER][POSITIVE] Um, so no problem.
[CUSTOMER][NEUTRAL] So, so what you're saying, it would be covered.
[CUSTOMER][NEUTRAL] Oh, I can get a $1000 coverage, correct?
[AGENT][NEUTRAL] Per, yes, per calendar year. Now, now, if this is due to any type of preventative or wellness that is not covered, it's, we only cover for sickness and injury only.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] So, this is gonna be an endoscopy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it wouldn't cover?
[AGENT][NEUTRAL] As long as it's for sickness and injury, if they're trying to submit it in for anything dealing with preventative or wellness, that's not covered. So I wouldn't know what the provider's gonna submit in as the reason for this endoscopy. So I can only just give you that information that if it's done within an outpatient facility, that is the amount that you have. So.
[CUSTOMER][NEUTRAL] You said preventative or what?
[AGENT][NEUTRAL] Or wellness.
[CUSTOMER][NEUTRAL] So it doesn't cover, right?
[AGENT][NEUTRAL] If it's for preventative or wellness is not covered. If the reason that you're getting this endoscopy is due to a sickness, then that's considered covered under this benefit for that $1000 per calendar year.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So what you may wanna do is contact the provider that is trying to render the services. They can contact us and they will be able to give us more detailed of what this procedure is for and then they would know if it's considered up under that $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK, so preventative.
[CUSTOMER][NEUTRAL] Oh well, it's not covered. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, what, what would be, like, what would you
[CUSTOMER][NEUTRAL] So you said if it's something related to a sickness, we'll cover, correct?
[AGENT][NEUTRAL] If it's due to sickness or injury, yes, it is considered a covered benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That'll be all. Um, what's your name, please?
[AGENT][NEUTRAL] It is [PII]. Would you like for me to spell that for you?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] It is spelled [PII].
[AGENT][NEUTRAL] [PII] last initial of [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much, um, Miss [PII], right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I appreciate your help. um.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][NEUTRAL] So, I'm, I'm sorry. One more thing.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let's say, you know, it's covered, they will accept, you guys will accept what they told you, it's an injury or it's due to sickness, um, you'll pay the whole 1000 or portion of it.
[AGENT][NEUTRAL] It's whatever your primary insurance applies to your deductible co-insurance or copay.
[CUSTOMER][NEUTRAL] And you'll pick up from there.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] All right. Got you. All right. Thank you so much again. Have a great day and happy [PII].
[AGENT][POSITIVE] You're welcome. Same to you and thank you so much for calling American Public Life. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.