AccountId: 011433970860
ContactId: ccc81d42-121b-4202-bba6-09622f5a3727
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260200 ms
Total Talk Time (AGENT): 102407 ms
Total Talk Time (CUSTOMER): 99952 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/ccc81d42-121b-4202-bba6-09622f5a3727_20250508T17:40_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um, I am trying to, I guess, get a pro a procedure quoted, um.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] I just spoke with the hospital and they had told me that they um pro processed the estimate for procedure there based on my primary insurance, um, but they couldn't run the secondary as well, so they had suggested calling you with the procedure code just to verify if you all would be picking it up after.
[CUSTOMER][NEUTRAL] They process with the primary I guess.
[AGENT][NEUTRAL] Um, what is your policy number?
[CUSTOMER][NEUTRAL] Something you can help me with?
[CUSTOMER][NEUTRAL] Yeah, um, I guess I'd give you the outpatient one, right? Let's see.
[CUSTOMER][NEUTRAL] It is 019.
[CUSTOMER][NEUTRAL] 35501
[CUSTOMER][NEUTRAL] ML 8
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] And verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email address.
[CUSTOMER][POSITIVE] Mm, that's a good question. Uh [PII] would be my preferred one.
[AGENT][NEUTRAL] OK, that is what we have on file.
[CUSTOMER][NEUTRAL] Or do you have a different one?
[AGENT][NEUTRAL] The, no, OK. Um, give me one second, please. You want to know what your benefits are. OK. Um, give me one second.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Well, I just wanted, they said I could give you the same procedure code.
[CUSTOMER][NEUTRAL] And what they had suggested and and basically run that procedure code to see if you would be able to process it it's an outpatient procedure.
[AGENT][NEUTRAL] Your policy helps with, um, it has been due to a sickness or an injury. Um, there are no pre or pre-authorizations, but what is the procedure code?
[CUSTOMER][NEUTRAL] So 58558.
[AGENT][NEUTRAL] 58558. 1 moment.
[CUSTOMER][NEUTRAL] 585-58 yes ma'am.
[AGENT][NEUTRAL] And it shows a biopsy. Um, that should be covered as long as it's due to sickness or injury. And of course, we would not know how much we would pay towards that until we receive that claim from the provider that has attached to that, the explanation of benefits for your major medical.
[AGENT][NEUTRAL] Now what your outpatient benefits cover for the year, um, I'm sorry, for the year, you have a $2000 max that we will help with your major medical deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, give me one second please.
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] I'm just gonna check to see if anything has been used for that towards that.
[AGENT][NEUTRAL] And please note verification of benefits provided does not guarantee payment because we have to actually have the claim in office to um process it now currently you have used $100 out of the $2500 for the year.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And that's per person?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Or is it like the whole family? OK, OK, um, all right, thank you. I appreciate that. So theoretically it will be covered up to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A certain amount
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Correct, and it has to be due to a sickness on entry. You're welcome. You're very welcome. Anything else I can help you with, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't think so. I appreciate your help.
[AGENT][POSITIVE] Thank you for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] All right bye bye.