AccountId: 011433970860
ContactId: fc6175b4-d5bc-44ab-a2f1-f2b576d95d30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183119 ms
Total Talk Time (AGENT): 85402 ms
Total Talk Time (CUSTOMER): 72068 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fc6175b4-d5bc-44ab-a2f1-f2b576d95d30_20250328T15:36_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 and I'm calling because I needed to verify um benefits on a patient please.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the benefits and may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Of course, my name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] [PII] and [PII], can I have the initial of your last name?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] A member's policy number is 021189.
[CUSTOMER][NEUTRAL] 83 ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] So [PII]'s gonna have a diagnostic colonoscopy. The CPT code is 45,380.
[AGENT][NEUTRAL] Is it done inpatient or is it?
[CUSTOMER][NEUTRAL] Diagnose
[AGENT][NEUTRAL] Or is it going to be, go ahead.
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEUTRAL] Outpatient at an ambulatory service center.
[AGENT][NEUTRAL] Thank you. So for the outpatient benefits, the policy will pay up to $500 per calendar day, which does include diagnostic testing in a hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] OK, so this is a secondary insurance, right?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] $50 per day. OK, so you guys will pick up her, her co-pay and deductible if it's less than $500.
[AGENT][NEUTRAL] Up to 500. Um, so yes, the co-pay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] Of different
[CUSTOMER][NEUTRAL] OK, so if it's over 500, she has to be responsible for the difference, correct?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not the major medical, so it would be between provider and primary.
[CUSTOMER][NEUTRAL] Oh I see OK.
[CUSTOMER][NEUTRAL] OK, can I have a um.
[CUSTOMER][NEUTRAL] So there's no deductible, no copay or nothing.
[AGENT][NEUTRAL] Uh, let me see if the, if it has a.
[CUSTOMER][NEUTRAL] Can I have a reference number for you?
[AGENT][NEUTRAL] Did you want me to check for the deductible?
[CUSTOMER][POSITIVE] Yes, yes, please if you don't mind.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Emergency room. OK, no, this one doesn't have one. So no, there's no deductible.
[CUSTOMER][NEUTRAL] No deductible?
[AGENT][POSITIVE] Correct, for the secondary.
[CUSTOMER][POSITIVE] OK, what's the reference number? OK, perfect.
[AGENT][NEUTRAL] It'll be my name in today's date. Um again, that's [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all for today thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.