AccountId: 011433970860
ContactId: cebb6cf6-2168-4a7b-a1f1-1a02644905d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352559 ms
Total Talk Time (AGENT): 126020 ms
Total Talk Time (CUSTOMER): 122822 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/cebb6cf6-2168-4a7b-a1f1-1a02644905d3_20250221T21:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, hi. I'm calling to uh see if you can help me verify my uh benefit and see, cause I'm gonna have a procedure done.
[AGENT][NEUTRAL] OK, I'm happy to check on your policy. Do you have a number, a policy number?
[CUSTOMER][NEUTRAL] Uh, yes, um.
[CUSTOMER][NEUTRAL] It's uh 01.
[CUSTOMER][NEUTRAL] 86
[CUSTOMER][NEUTRAL] 87
[CUSTOMER][NEUTRAL] 82
[AGENT][NEUTRAL] OK, let me pull this up here. Give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then if I can get your first name, last name, date of birth?
[CUSTOMER][NEUTRAL] Uh yes, my name is uh [PII].
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][NEUTRAL] Thank you [PII] and then what is the address and email address we should have on file?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. So I have uh [PII]
[CUSTOMER][NEUTRAL] Uh, this is [PII].
[CUSTOMER][NEUTRAL] And then my email is uh I'm sorry?
[AGENT][NEUTRAL] We have our
[AGENT][NEUTRAL] OK, we, we have a [PII] address, is that old?
[CUSTOMER][NEUTRAL] Yeah, it is a personal address. Which one do you have?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, then I haven't changed it with you. No, I just, I moved.
[CUSTOMER][NEUTRAL] From there.
[AGENT][NEUTRAL] OK, so if you'll give me the current address I'll update that for you.
[CUSTOMER][NEUTRAL] OK. Mhm. So it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And then it's uh uh [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright and then the email is the [PII] account that's still good for you?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah, the same one. It's uh [PII].
[AGENT][NEUTRAL] OK, great. All right. So I've got your policy pulled up here. Yeah, no problem. What sort of questions did you have today?
[CUSTOMER][POSITIVE] Mhm. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I actually gonna have, I don't think I have used my APL for this year. So I wanna know, I'm gonna have a colonoscopy done uh on [PII].
[CUSTOMER][NEUTRAL] And I wanted to see how much of that is gonna be covered, if possible.
[AGENT][NEUTRAL] OK, let's see what your outpatient benefit is on this plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it looks like your outpatient benefit max for the calendar year is 2550.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's the most as far as outpatient charges that it would cover.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it looks like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Testing and all of that stuff is let's see.
[AGENT][NEUTRAL] Yeah, so outpatient benefits, we will pay out of pocket amounts whenever you have um treatment in the hospital. It says diagnostic or testing that's performed in an outpatient hospital facility or an MRI facility if you were to, you know, that's totally different, but yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's the most that it's gonna pay, so they would need to bill your primary insurance first and then bill us for anything that they don't pick up and we should cover the rest up to the 2500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, OK, so I can just let them know just to be able to uh the first one and then the secondary as well, right?
[AGENT][NEUTRAL] Mhm, yeah, just let them know that we're secondary and that they can bill us after the primary, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I am gonna have the procedure done in one of the surgical places, Brownsville Surgery Center. I don't know if that's an outpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that would be considered like an outpatient, yeah, like a surgery center, yeah. Mhm.
[CUSTOMER][NEUTRAL] It is?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK. Oh OK, then I'm gonna call them to see if they can just run it.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, sounds good. Anything else I can check, check on for you?
[CUSTOMER][NEUTRAL] So they can check it. Uh-huh.
[CUSTOMER][POSITIVE] Uh, no, no, thank you so much. I just wanna make sure that I did have funds that might help, uh help me cover this, uh huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Not a problem. Have a good day, [PII].
[CUSTOMER][POSITIVE] OK, thank you so much you too bye bye sir thanks.
[AGENT][NEUTRAL] Bye bye.