AccountId: 011433970860
ContactId: e4393b08-2509-46f1-a1f1-8184f6274242
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238110 ms
Total Talk Time (AGENT): 120865 ms
Total Talk Time (CUSTOMER): 84319 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/e4393b08-2509-46f1-a1f1-8184f6274242_20250416T21:28_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I needed to uh verify benefits and then find out if an office is required for a member to have a service performed.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits and and the authorization. May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, uh, the contact number would be [PII].
[CUSTOMER][NEUTRAL] It's for UCSD Medical Center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then that ID number is gonna be [PII] for [PII].
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's um, date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So there is no prior authorization or preset required for any APO policy because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, um, what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well, it would be medical benefits. Um, he's having a CT done.
[AGENT][NEUTRAL] OK, hold on one moment let me look for.
[AGENT][NEUTRAL] Diagnostic testing. Hold on one second. I'm just waiting for it to come up.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] So for diagnostic test in the policy will pay up to $100 per day with a max of 1 day per calendar year. If an advanced study or follow-up test is needed, the policy will pay up to $25 per day with a max of 1 day per calendar year. Um, did you want me to see if they've used their diagnostic testing benefit for [PII]?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And so far he has not used any of the benefits for this year, so he still has that um diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK, so diagnostic testing benefits.
[CUSTOMER][NEUTRAL] Because we're, I mean, we're a hospital, so you're saying it only pays $100 a day?
[AGENT][NEUTRAL] So this is a hospital indemnity policy, so it's a limited medical policy. It's not like a major medical insurance policy. So, uh, it's just like a list of services and how much you pay towards that service. Um, so yes, for this policy, the most you would pay is 100 per day, one time per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] 100 per day, 1 time per year.
[CUSTOMER][NEUTRAL] One time per year, OK, and then you were saying something about for advanced because the CT scan is is considered advanced imaging so you were mentioning something additional for advanced imaging.
[AGENT][NEUTRAL] So the CT will be under the medical imaging test, but if you need like a follow-up or when this is saying advance like if after the initial imaging something else is needed, then it would pay the $25 per day with a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I understand. OK. OK. Um, all right, so I will make a note of that then. So then the rest would, I guess, fall on the patient then. OK. All right. I just want to make a note of that then. And then, um, I'm sorry, and you said your name again is?
[AGENT][NEUTRAL] My name is [PII] [PII], and what was your name? I'm sorry?
[CUSTOMER][NEUTRAL] It's [PII] Mhm. Is there a call reference number, [PII]?
[AGENT][NEUTRAL] Tea, OK.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. OK, great, thank you so much. I appreciate the help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that'll do it. Thank you so much.
[AGENT][POSITIVE] All right. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK you too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.