AccountId: 011433970860
ContactId: f1f5bca4-1deb-4828-92d1-3aa71f8ad07b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509739 ms
Total Talk Time (AGENT): 186202 ms
Total Talk Time (CUSTOMER): 216161 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/f1f5bca4-1deb-4828-92d1-3aa71f8ad07b_20250326T16:06_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] Hi [PII], my name is [PII]. I'm calling from Associated Financial Consultants. Let me give you the group number I'm calling about.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 20920943.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And [PII], may I have a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And are you calling with the group or the agent or broker office?
[CUSTOMER][NEUTRAL] Broker.
[AGENT][NEUTRAL] OK, and I have the group pulled up here. I just need you to um verify your email address and then the name of the group and their mailing address.
[CUSTOMER][NEUTRAL] My email is [PII].
[CUSTOMER][NEUTRAL] The group is Massey Quain and King, and their address is [PII].
[CUSTOMER][NEUTRAL] [PII]. Oh, I think they moved. Oh, I have to change our address. No, yeah, you guys, they moved, uh, [PII].
[AGENT][NEUTRAL] OK, so we're going to need, um, we had that first uh um address that you gave the [PII]. If you all need to change that, just send an email to care team with your new address and we can update that for you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] They hold on hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, hold on.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, OK, I see, uh, OK, so let me.
[CUSTOMER][NEUTRAL] I thought it was changed already, but I guess it wasn't. I just needed to confirm it.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Their coverage would allow for um a CT for uh calcium score.
[AGENT][NEUTRAL] Oh, wait a minute. So, is this for a particular, I need to get into a policy. Is this for a particular member so I can see what type of benefits they have?
[AGENT][NEUTRAL] Or
[CUSTOMER][POSITIVE] Oh, they have the same, everyone has the same benefit. Doesn't matter.
[AGENT][NEUTRAL] OK, well, let me pull someone from the group. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] you could full [PII] and last name [PII]
[AGENT][NEUTRAL] Alright, so all the information provided is a verification of benefits, not a guarantee of payment. And then you said what, what type of, well, is it inpatient or outpatient?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Because the policy is outpatient, OK. So it's um up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] So it doesn't matter, um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It doesn't, so this would is the CT it doesn't matter what kind of CT she's having, it will be covered, right?
[CUSTOMER][NEUTRAL] Doesn't matter you cover any any CT.
[AGENT][NEUTRAL] Well, the policy isn't really broken into the services they're receiving. It's where it's done. So, because it's outpatient and that's the max, is it in office or is it like in a
[AGENT][NEUTRAL] Like an outpatient facility.
[CUSTOMER][NEUTRAL] Outpatient it's no it's it's outpatient I mean um.
[AGENT][NEUTRAL] Right, but outpatient, is it like a hospital facility or is it an outpatient office? It's a different and it's a different benefit, that's why I'm asking.
[CUSTOMER][NEUTRAL] OK, so what would be the what would be the difference?
[AGENT][NEUTRAL] So if the facility was to bill for a facility charge, then the the claim could be denied because she doesn't have coverage for that in-office setting or the outpatient office setting, but she does have the office treatment rider, so that treatment could be covered up to the $500. If it's in an outpatient facility, then that's just the $500 per day. So it depends on where she's going, but, but
[CUSTOMER][NEUTRAL] You know the case would be.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Great thank me.
[CUSTOMER][NEUTRAL] But what
[CUSTOMER][NEUTRAL] What if she's doing it in the hospital?
[AGENT][NEUTRAL] Well, if that, if she's doing it in the, in the outpatient hospital, it would just be the $500 a day for diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] It just gets sticky when it gets to the office.
[CUSTOMER][NEUTRAL] But inpatient.
[AGENT][NEUTRAL] Impatient is
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Different than outpatient. If it's inpatient, like in the hospital, that's $4000 a calendar year.
[AGENT][NEUTRAL] That she can use towards.
[CUSTOMER][NEUTRAL] Right, so whatever er so if she's, she goes to a hospital and she has it done in the hospital, whatever, regardless of anything, if it's run, if, if it's run, if the claim is run through major medical, right?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And major medical, what if major medical doesn't cover it? Does, and, and they get an EO.
[AGENT][NEUTRAL] If major medical doesn't.
[AGENT][NEUTRAL] If major medical doesn't apply, we can't apply because we're second to them.
[CUSTOMER][NEUTRAL] Right, so if, if they, if the EOB says it they don't cover it, that means you, that means, uh, you guys won't cover it either because there's no, there's no claim that was run through major medical, right?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] OK dokey. Thank you for your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, no, no, thank you.
[AGENT][NEUTRAL] You sure? Because it's tricky with those offices.
[CUSTOMER][NEUTRAL] I know it is it is oh thank you for for for double checking it is very tricky with those offices it's like.
[CUSTOMER][NEUTRAL] But, but I'm only, I'm, I'm only getting, I need to speak to her. What can you, uh, well, actually it's $500 a day, so there's no limit, uh, just the $500 a day, but the outpatient is $4000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the year, right?
[AGENT][NEUTRAL] Wait, it's flipped inpatient it's 4000. Mhm.
[CUSTOMER][NEUTRAL] In inpatient inpatient, right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Has, um, has she used any of that benefit yet? Would you be able to tell me?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, I can look for you. Hold on one second.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Um, OK, so for inpatient, she hasn't used any of the benefits, and for outpatients, she's used $95 but that's particular to that day, so it because it resets each day, so that wouldn't really affect you all.
[CUSTOMER][NEUTRAL] Right, got it.
[CUSTOMER][POSITIVE] OK, got you, thank you so much appreciate it.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] Um, no, no, I think I'm good, thank you.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] All right, take care.
[CUSTOMER][POSITIVE] You too. Thanks. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.