AccountId: 011433970860
ContactId: f785ac85-f3ac-4aee-b149-25f9268c1cb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214369 ms
Total Talk Time (AGENT): 76432 ms
Total Talk Time (CUSTOMER): 70361 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/f785ac85-f3ac-4aee-b149-25f9268c1cb2_20250416T16:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm with the provider's office, and I was just wanting to make sure that a plan is active. I see that his card says it's not major, major medical, so I guess I need to check that as well.
[AGENT][NEUTRAL] Hey [PII], I can help you with the eligibility and benefits. Do you have a good, uh, callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah my direct line is gonna be [PII].
[AGENT][NEUTRAL] OK, and the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, it says 02506289.
[AGENT][NEUTRAL] OK, thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII] and his date of birth is not on the screen, and let me go back to the screen, uh, [PII].
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, basic outline of the policy. I show the policy is effective [PII]. It's currently active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, this is a secondary policy, so, uh, we do require primary explanation of benefits, and it will pick up, um, after the primary processes, deductible, co-pay and co-insurance. Is this for outpatient services or what type of services?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, he's coming in for an office visit for a specialist, and then he is scheduled for a colonoscopy, yes, a colonoscopy.
[AGENT][NEUTRAL] And is that a diagnostic or is that routine?
[CUSTOMER][NEUTRAL] He is let me see if the order is in here.
[CUSTOMER][NEUTRAL] They have marked it as a screening.
[AGENT][NEUTRAL] OK, looks like the benefit is um let's see.
[AGENT][NEUTRAL] 7500 per calendar year um for inpatient and outpatient benefits combined.
[AGENT][NEUTRAL] Um, the office visit itself, um, there's no coverage for that, um.
[AGENT][NEUTRAL] But treatment performed in the office, procedures or treatment would be covered under that, um.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] So, um, after primary processes, anything that's left over would apply towards that um maximum payout.
[CUSTOMER][POSITIVE] OK, uh, perfect. And can you tell if anything has been, um, applied towards that maximum?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, don't show anything's been used this year.
[CUSTOMER][NEUTRAL] Uh, perfect. And do you guys require any kind of authorization or pre-cert for procedures?
[AGENT][NEUTRAL] No, nothing's required.
[CUSTOMER][NEUTRAL] OK perfect and do you have a reference number?
[AGENT][NEUTRAL] A reference number is just my name, [PII], first initial to last name, [PII] as [PII], today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, great, thank you so much for your help.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.