AccountId: 011433970860
ContactId: d5467084-0782-4332-a4d5-df0a120f76d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277190 ms
Total Talk Time (AGENT): 123376 ms
Total Talk Time (CUSTOMER): 115348 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d5467084-0782-4332-a4d5-df0a120f76d8_20250124T14:38_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning. I'm trying to verify benefits uh for patients.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with those benefits this morning. May I ask your name and a callback number?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. It has in and outpatient benefits um number.
[AGENT][NEUTRAL] That's either one of those is fine.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. 023007.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 08 M like Mary, L like Laura number 8.
[AGENT][NEUTRAL] All right, thank you. And what is the patient's name, [PII], and date of birth?
[CUSTOMER][NEUTRAL] So [PII], birthday [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. And I can certainly help you with those benefits for Mr. [PII]. I am showing that his policy is active. Effective date is [PII]. This is a secondary policy to his major medical insurance.
[AGENT][NEUTRAL] And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the, um, this plan cover office visit or just, uh, for procedures?
[AGENT][NEUTRAL] Well, actually, the only services covered in a doctor's office is for cancer treatment on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for the outpatient, uh, the same?
[AGENT][NEUTRAL] For the outpatient, it does cover sickness and injury.
[AGENT][NEUTRAL] But it would have to be in an outpatient facility.
[AGENT][NEUTRAL] Are you needing those outpatient benefits as well?
[CUSTOMER][NEUTRAL] Yeah, I think the patient.
[CUSTOMER][NEUTRAL] Yeah. Patient is gonna have a um colonoscopy.
[AGENT][NEUTRAL] If it is for diagnostic colonoscopy and it is billed as an outpatient ambulatory facility, he does have coverage up to $2500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. And then office visit is only for cancer treatment.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And then for the outpatient, you have to be in the ambulatory surgical center and you will cover up to $2500.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Do we need any authorization or um referral?
[AGENT][NEUTRAL] It's, oh, there's no authorization or referral required. We do follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] OK. Perfect. And um let me see. And can you verify the address of this uh plan?
[AGENT][NEUTRAL] Sure, to submit a claim, it would be to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And this is American Public Life.
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][POSITIVE] OK, perfect. And I'm sorry, your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK. Do you use any reference number for this call?
[AGENT][NEUTRAL] The reference number would be my name and today's date.
[AGENT][POSITIVE] And [PII], it's been a pleasure to go over those benefits. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[CUSTOMER][POSITIVE] No, thank you very much.
[AGENT][POSITIVE] Um, thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.