AccountId: 011433970860
ContactId: d7e1cb06-be3d-4403-a4a2-b9df8b7350dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209279 ms
Total Talk Time (AGENT): 89691 ms
Total Talk Time (CUSTOMER): 82869 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/d7e1cb06-be3d-4403-a4a2-b9df8b7350dd_20250602T14:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I had a question, um, if you guys would, if the gap insurance would cover a upcoming outpatient diagnostic test I have.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with your benefits. And first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my number is [PII] and my name is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] OK, do you want the payer ID, the group number, which one?
[AGENT][NEUTRAL] The outpatient certificate number?
[CUSTOMER][NEUTRAL] Sure. Um, it's 02478778 M as in Mary, L as in Luna, and then 8.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] Um, my date of birth is [PII] and my mailing address is [PII].
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] Um, emails [PII].
[AGENT][NEUTRAL] OK, thank you. And yes, ma'am. Well, you said this would be for an outpatient service?
[CUSTOMER][NEUTRAL] Yes, I mean I can get you the exact CPT code if you want, but.
[AGENT][NEUTRAL] Well, where will it take place? Will it take place in a doctor's office or outpatient facility?
[CUSTOMER][NEUTRAL] Um, it's an outpatient hospital center.
[AGENT][NEUTRAL] OK. Well, we can't guarantee payment over the phone, but I can let you know that for all services that are related to an illness or an injury, and a portion of it is covered by your primary insurance, um, that's normally covered. And for outpatient services under your policy, we cover up to $300 per day.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So after your outpatient, well, after your primary insurance processes a claim, it'll come to us and we'll cover the portion that went to the co-pay, the co-insurance, or the deductible up to $300 per day.
[CUSTOMER][NEUTRAL] OK, even if it's like something like pulmonary function testing like that would fall under outpatient diagnostic testing, right?
[AGENT][NEUTRAL] Um, yes, ma'am. As long as um the diagnosis code that's built on the claim is related to an illness or an injury, and it sounds like it does. And your primary um carrier has to cover a portion of it.
[CUSTOMER][NEUTRAL] Yes, so my, um, primary insurance is covering, you know, like $1700 of it, but, um, my estimate is $459 so if I understand you guys would cover up to $300 right?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] So then I would owe 159 essentially.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, that was my main question.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, I'm, I'm good.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You thank you bye bye.
[AGENT][POSITIVE] Mhm. You're welcome. Bye