AccountId: 011433970860
ContactId: f7f516ee-ada5-4d37-8b3e-46c9a5fa6f4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468200 ms
Total Talk Time (AGENT): 287654 ms
Total Talk Time (CUSTOMER): 98799 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/f7f516ee-ada5-4d37-8b3e-46c9a5fa6f4f_20250227T15:04_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, uh, my name is [PII]. I'm calling from Kelsey C Bo. I need eligibility and benefit, please.
[AGENT][NEUTRAL] OK, I'm sure I can assist you with eligibility and benefits, and I'm sorry I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Really.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's um policy number?
[CUSTOMER][NEUTRAL] 023-38914
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure, [PII] [PII].
[AGENT][NEUTRAL] Thank you. And what type of services do you render for benefits?
[CUSTOMER][NEUTRAL] Um, patient is coming in for sick, um, sick office visit. No, no, I'm sorry, Pa is coming in for a wellness exam.
[CUSTOMER][NEUTRAL] Uh, preventative and diagnostic labs and X-rays, please.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm, OK. Um, let me check its benefits really quick, OK? Because this is a limited policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, while I wait for this information, let me just give you the effective date of the policy. [PII]. It is active at the moment, and again, this is one of our limited hospital indemnity policies. Um, in this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so, um, the only preventative um benefit that this one has is a preventative elective surgery like a colonoscopy. Um, it is, if it, if it is a colonoscopy, then it is um covered under a $500 per day maximum of 1 day per cover person per calendar year. If it's done in the outpatient facility or hospital, if it's done in an office setting, it's $250 per day, maximum of one day.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is not a guaranteed payment, just a verification of coverage. Um, for the diagnostic testing and under medical imaging test, we cover $100 per day. If it's an advanced study, it's $25. And let me give you the ones under that because I'm not sure if the one that you're just.
[CUSTOMER][NEUTRAL] OK, repeat that for me once.
[AGENT][NEUTRAL] Uh-huh, yeah. For the um diagnostic testing benefit, for medical imaging test, it's $100 per day, maximum of 1 day. If it's an advanced study, it's $25 per day, maximum of 1 day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and let me give you the list of which ones are covered under that benefit, which is limited, OK? Um, um, so the medical imaging is just for MRI, CT scan, thyroid intake, PET scan. Um, those are the only ones covered under the imaging test. Under the advanced study, um, is sleep study, TEE, upper GI, um.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nuclear stress test.
[AGENT][NEUTRAL] And grams
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mylogram.
[AGENT][NEUTRAL] Um, no GI.
[AGENT][NEUTRAL] And it looks like that those are the only ones covered under that advanced study.
[CUSTOMER][NEUTRAL] OK, so for.
[CUSTOMER][NEUTRAL] Uh, diagnostic labs and X-ray, minor diagnostic labs and X-rays. It's a $25 limit. Oh, you said no coverage?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no cover.
[AGENT][NEUTRAL] No, it's only the ones that I just mentioned.
[CUSTOMER][NEUTRAL] OK, so not covered and MRI CTs, etc. etc. is $100 with one, OK.
[AGENT][NEUTRAL] $100. Mhm, 1 per year. Mhm, yes.
[CUSTOMER][NEUTRAL] OK, not covered.
[AGENT][NEUTRAL] Mhm. And anything other than a colonoscopy is not covered for preventative.
[CUSTOMER][NEUTRAL] OK, this is a male.
[CUSTOMER][NEUTRAL] Not immunizations or any of that, right?
[AGENT][NEUTRAL] Mm. No, no. Um, let me check his, um, policy really quick and see if he has, um, IMA. If he has IMA then you probably need to contact them to get preventative um benefit information because usually they're the ones that cover the preventative, um, but let me check and see if that's the case with this one.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, so, yep, he has the VIP plan, um, but I don't see an ID.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I don't see an ID, so more than likely when there's no ID, there's no benefits to IMA. You can check, I guess with the personal information, check and see um if there's any coverage but it doesn't look like it. Do you need the numbers to IMA?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, let me get that for you.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Alright, um, that number is, which is 90 degrees, 1800-833-4296. That's [PII] and that will be option one.
[CUSTOMER][NEUTRAL] Alright, and do they have coverage for uh sick offices?
[AGENT][NEUTRAL] Oh yes, for the office visit, um, let me get that.
[AGENT][NEUTRAL] For physicians, PCP or specialists, we cover $50 per day, maximum of 4 days per calendar year, and that's a flat amount.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, and what's the electronic payer ID number?
[AGENT][NEUTRAL] Alright, for this one, let me go.
[AGENT][NEUTRAL] Oh, let's see
[AGENT][NEUTRAL] Are you? OK.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Bear with me, I'm so sorry.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Payer ID is 64556.
[CUSTOMER][NEUTRAL] OK, and is um.
[CUSTOMER][NEUTRAL] Is one the policy holder?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright great and your name again please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] May I have a caller reference number?
[AGENT][NEUTRAL] We don't have a reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright great thank you very much for your time ma'am.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.