AccountId: 011433970860
ContactId: cada0d54-bfd2-4305-aa10-ba5ca847ecca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197289 ms
Total Talk Time (AGENT): 90203 ms
Total Talk Time (CUSTOMER): 49942 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/cada0d54-bfd2-4305-aa10-ba5ca847ecca_20250210T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm trying to verify benefits for a member.
[AGENT][POSITIVE] OK, yeah, I could check benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, can I get a good call back number from you, [PII] in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is um 02473651.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII] and so this is a limited indemnity medical plan. Um, what, uh, benefits were we needing to check? Was this for office visits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's for a chest X-ray.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Chest X-ray, OK. Is that going to be in a physician's office environment?
[CUSTOMER][NEUTRAL] Uh, it's an out uh hospital outpatient.
[AGENT][NEUTRAL] OK, alright, one moment please. I wanna get that policy pulled up and we will take a look at that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Appreciate your patience. It's thinking about it.
[CUSTOMER][NEUTRAL] That's OK. I'm used to it. It's fine.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so of course I will let you know uh verification of coverage is not a guarantee of payment for claims, um, so they do have again this as this is a limited indemnity plan, it is very limited as to what it covers so they do have.
[AGENT][NEUTRAL] A wellness exam benefit and a diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which let me see if that would fall under the diagnostic test. Let's see.
[AGENT][NEUTRAL] OK, X-ray does not look like it falls under that category. It is very specific as to only covering MRI, CT, and colonoscopy. So it does not look like they have a benefit for X-ray.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, I will let the patient know. Thank you so much.
[AGENT][POSITIVE] Yeah, of course. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, that's it.
[AGENT][POSITIVE] Alright, well thanks for calling APR. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Alright thank you you too bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] OK, do you have