AccountId: 011433970860
ContactId: d6f179fc-bb50-4416-aca4-d5457e491e5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 596840 ms
Total Talk Time (AGENT): 179468 ms
Total Talk Time (CUSTOMER): 282880 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/d6f179fc-bb50-4416-aca4-d5457e491e5a_20250220T17:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] again. We got disconnected, I believe.
[AGENT][NEUTRAL] Oh, I have tried to call you back and it went to a uh answering service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Did it? OK, let me give you my direct extension for future reference, um, but I'm glad I got a hold of the same individual because I, I have been, um, I spoke with different the the the multi plan and uh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, me too.
[CUSTOMER][NEUTRAL] Anyhow, just different people but I'm.
[AGENT][NEGATIVE] It's confusing.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, so since we've established that, do we, do you want me to give you the member's information again? Oh, no worries. Yes, uh huh, it is the D for David 43302268.
[AGENT][NEUTRAL] If you don't mind just this policy number.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] So it's gonna be the policy number with APL.
[CUSTOMER][NEUTRAL] Oh, OK, but OK, so then the 02576313?
[AGENT][POSITIVE] Perfect, yes ma'am, thank you.
[CUSTOMER][NEUTRAL] What, what is that, is that what should be on the claim?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes ma'am, you can put that policy on the claim and I'm going to give you, you know, where you can send the claim to.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can also connect you to IMA.
[CUSTOMER][NEUTRAL] Oh no, we, we, I think, I think.
[CUSTOMER][NEUTRAL] Uh-huh, go ahead. I am a what? hello? hello.
[AGENT][NEUTRAL] Did we go over that?
[CUSTOMER][NEGATIVE] It's cutting out.
[AGENT][NEUTRAL] I can also connect you
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm sorry, I didn't hear you. What was that again?
[AGENT][POSITIVE] Oh my goodness, I am so sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I can connect you to IMA for their benefit of the wealth and
[CUSTOMER][NEUTRAL] I'm here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can, can you hear me now?
[CUSTOMER][NEGATIVE] No, it's cutting out. I, I hear the.
[AGENT][NEUTRAL] Here, I'm trying to talk.
[CUSTOMER][NEUTRAL] It's coming in and out. Let me, let me do this. Hold on, are you there?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so you would, you would be, you would, you established that the patient has wellness and preventative, correct? But then I, IMA is gonna give me specific coverage information.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] What is IMA's number?
[AGENT][NEUTRAL] Their phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Option one.
[CUSTOMER][NEUTRAL] But the
[CUSTOMER][NEUTRAL] OK, and you are APL.
[AGENT][NEUTRAL] That's correct, and I can connect you to an IMA representative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well, because you, you are the carrier technically you're the employer, right? American Public Life.
[AGENT][NEUTRAL] Where
[AGENT][NEUTRAL] Yeah, we're the carrier for medical and
[CUSTOMER][NEUTRAL] Oh until they get up.
[AGENT][NEUTRAL] This is a primarily medical policy, but they do have additional wellness benefits on this plan.
[CUSTOMER][NEUTRAL] OK, got it, got it. OK, so you were able to tell me that they do have uh preventative and wellness correct? um.
[CUSTOMER][NEUTRAL] Now, my next question was for can we kind of go, would you be able to give me the benefits for a diagnostic colonoscopy or endoscopy?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I just thought I was afraid we were disconnected. I can connect you with one of their representatives and they can give you their side of their benefits.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Oh it's OK. I already have you so I'll just get this information from you if you don't mind.
[AGENT][POSITIVE] Not a problem at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What other information can I provide for you?
[CUSTOMER][NEUTRAL] Sure, so I wanted to know if the pre-certification would be required for a colonoscopy, endoscopy?
[CUSTOMER][NEUTRAL] And diagnostic ultrasound. I can give you the codes whenever you're ready.
[AGENT][NEUTRAL] Info I provide.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[CUSTOMER][NEUTRAL] Do you need the codes now?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] or anything with this policy, it's a limited and yet uh authorization is not required for any procedures with our policy.
[CUSTOMER][NEUTRAL] So pre I'm sorry, prior authorization is required?
[AGENT][NEUTRAL] It is not with our policy.
[CUSTOMER][NEUTRAL] Oh, OK, no pre-cert required.
[AGENT][POSITIVE] Yes, ma'am. And I'm so sorry for the difficulty. Mhm.
[CUSTOMER][NEUTRAL] So you don't need you
[CUSTOMER][NEUTRAL] Um, so no pre-cert required for the procedures for uh in an outpatient ambulatory surgery center.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you go ahead and repeat that one more time?
[AGENT][NEUTRAL] Authorization is not required. This is a limited indemnity policy.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] It's just we're not major medical so.
[AGENT][NEUTRAL] Authorization is not required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now would you have the same information as.
[CUSTOMER][NEUTRAL] Who is it that you said you could.
[AGENT][NEUTRAL] I M A
[CUSTOMER][NEUTRAL] OK, I am the 1-800 number that you gave me.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, [PII], I didn't get your last name initial. Is it possible to get that?
[AGENT][POSITIVE] Sure. It's [PII], and I'm so glad you got me back. I'm so sorry for getting disconnected.
[CUSTOMER][NEUTRAL] Mhm. Me too. That's OK. That's OK. OK. What about for diagnostic ultrasound, uh, done in office as well?
[AGENT][NEUTRAL] An ultrasound is not a covered diagnostic test under our policy.
[CUSTOMER][NEUTRAL] OK, it's not covered.
[AGENT][NEUTRAL] For diagnostic, that's right. The only diagnostics, uh, tests that are covered is an MRI, colonoscopy, or a CT scan.
[CUSTOMER][NEUTRAL] OK, but would that be covered through IMA is perhaps?
[AGENT][NEUTRAL] They don't cover diagnostic. They only cover preventive and wellness.
[CUSTOMER][NEUTRAL] Oh, I see what you mean. OK, got it.
[CUSTOMER][NEUTRAL] So because it's to kind of screen a fatty liver, so would that, would that be diagnostic?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So if it, if it is considered a screening,
[AGENT][NEUTRAL] It would not be covered, but ultrasound is not not covered regardless on our policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oh, I see. OK, but then if the patient was to have it and it's not covered through you, would they submit that to the IMA for for verification?
[AGENT][NEUTRAL] That's right. You the claims will go to IMA to begin with.
[AGENT][NEUTRAL] And they'll
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Process for any benefits covered by them.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] I see through wellness and then and and then it would go with you.
[CUSTOMER][NEUTRAL] But you're telling me that diagnostic ultrasounds are not a covered benefit. It's either MRI or
[CUSTOMER][NEUTRAL] Ultrasound. I'm sorry, no, what was the other one?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are you there? Hello?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] Yeah, like just.
[CUSTOMER][NEUTRAL] yeah, I, I feel like there's little I could do.
[CUSTOMER][NEUTRAL] Oh