AccountId: 011433970860
ContactId: f7a395ac-cf8e-4cb6-9909-a40d95f6f234
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196100 ms
Total Talk Time (AGENT): 83773 ms
Total Talk Time (CUSTOMER): 94203 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/f7a395ac-cf8e-4cb6-9909-a40d95f6f234_20250425T18:00_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. Hope you're doing well. Um, I'm calling because I am, uh, insured, um, using your, uh, insurance as a Medi Medi gap insurance, and, um, our company, I've never used the APL and I'm just trying to understand cause I have some, have to have some diagnostic tests done.
[CUSTOMER][NEUTRAL] And I want to understand what's covered per day or how does it work?
[AGENT][POSITIVE] OK, I'd be happy to assist with your benefits today. Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, 026.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 416.
[AGENT][NEUTRAL] Alright, if you could please verify your name, date of birth, and email address for me.
[CUSTOMER][NEUTRAL] Sure. Name is [PII] My date of birth is [PII] and my email address is [PII].
[AGENT][POSITIVE] Thank you for that information, Ms. [PII]. If you can please also give me a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, please be advised the verification of coverage is not a guarantee of payment. I do show the policy is active and I do show for outpatient, your calendar year maximum is $6500. So after the claim is sent to your primary insurance and they have assigned your patient responsibility which is either the copay, co-insurance, um, or deductible, then we would pay that amount up to that $6500 maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright. I understand. Is there a limit per day? Like, could you have two tests in one day? It doesn't matter as long as it's, it's per year, so.
[AGENT][NEUTRAL] It's per year.
[AGENT][NEUTRAL] It's a $1. I'm sorry, go ahead.
[CUSTOMER][NEGATIVE] No, so if I did 3 tests in one year and they were up to $6500 and I did a 4th 1, that wouldn't be covered.
[CUSTOMER][NEUTRAL] Correct, because if I did 3 tests and they added up to 65.
[AGENT][NEUTRAL] I guess take the number of tests out.
[AGENT][NEGATIVE] Yeah, I guess what was throwing me off was the number I said I guess what was throwing me off is that the number of tests. Take the number of tests out we're only gonna pay $6500 per year for your outpatient costs, whether that's one test, one whether one test eats that up, or 10 separate tests eat that up.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The maximum we'll pay is $6500.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Does it have to be in a certain facility or it could be, I, I think it, it could be in a hospital or a, I guess diagnostic facility, independent, whatever it may be, either or?
[AGENT][NEUTRAL] Yeah, it doesn't, yeah, it doesn't matter where it is.
[CUSTOMER][POSITIVE] It, it doesn't matter. OK. OK. All right, I got it. Well, thank you for your help.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mhm.