AccountId: 011433970860
ContactId: 0f7b50e1-94b2-4275-b3ad-7d310daefdf2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498130 ms
Total Talk Time (AGENT): 140542 ms
Total Talk Time (CUSTOMER): 103843 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/0f7b50e1-94b2-4275-b3ad-7d310daefdf2_20250521T19:57_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling to find out, um, I just spoke, I'm trying to understand what kind of benefits I have under like this plan that I have on my end.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] If there
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, if I can have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Uh, so my medical ID.
[CUSTOMER][NEUTRAL] Is the medical ID number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I believe that's your wellness policy number. Do you have a social?
[CUSTOMER][NEUTRAL] Do you have a social?
[AGENT][NEUTRAL] Yes, that's your um wellness ID number, so I'll need your social please.
[CUSTOMER][POSITIVE] Yeah, I do.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And email address please.
[CUSTOMER][NEUTRAL] It's a [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] And what questions in regards to the policy did you have today?
[CUSTOMER][NEUTRAL] I'm just trying to figure out if there is anything related or included anything uh to possibly um
[CUSTOMER][NEUTRAL] Ultrasound.
[CUSTOMER][NEUTRAL] Or uh lab exams.
[AGENT][NEUTRAL] OK, so you have a limited benefit hospital indemnity plan. So if the treatment is in an office setting.
[AGENT][NEUTRAL] Um, it would just apply to your office benefit which is $75 per visit.
[AGENT][NEUTRAL] And you get
[AGENT][NEUTRAL] Let me see one.
[AGENT][NEUTRAL] Outpatient sickness you get 33 visits per calendar year. Let me see 3.
[AGENT][NEUTRAL] Let me double check that.
[AGENT][NEUTRAL] So being that it's not a major medical plan, it's not going to cover.
[AGENT][NEUTRAL] The bulk of and, and that, and uh it also depends on where you have the treatment.
[AGENT][NEUTRAL] If it's in an office visit, you can just use your office visit um benefit, but if it's in a hospital type setting, it wouldn't be covered.
[CUSTOMER][NEUTRAL] Uh, no, it's in the office visit.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yeah, it's $75 per visit.
[AGENT][NEUTRAL] And it's actually 5 visits per calendar year.
[CUSTOMER][NEUTRAL] So, are you saying it's $75 could be covered per visit for ultrasound?
[AGENT][NEUTRAL] Whatever
[AGENT][NEUTRAL] Treatment you have at that visit. So if they're billing for ultrasound and you have the, they can and they bill it as an office visit, it would just be processed on your office visit benefit, which is $75 per visit. So anything over that $75 would be your responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How would I submit that?
[AGENT][NEUTRAL] OK, so there are 3 ways you can file the claim if you're registered with the online service center you can upload um the billing information there or you can fax it in or mail it in.
[AGENT][NEUTRAL] And you can find the online service center on our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I will just have to
[CUSTOMER][NEUTRAL] Uh, can you repeat this? I just, it just escaped my mind, so sorry.
[AGENT][NEUTRAL] The website is [PII].
[CUSTOMER][NEUTRAL] And how do I submit that?
[AGENT][NEUTRAL] Um, you'll just upload once you've registered with the online service center, you can just go to, um, file a claim and then it'll allow you to upload the documents and file the claim there online.
[CUSTOMER][NEUTRAL] Dot [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Can you send me this website uh by email, by any chance?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I've sent that email. You should receive that within the next 5 to 7 minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I can assist with today?
[CUSTOMER][POSITIVE] OK, I think I got it.
[CUSTOMER][POSITIVE] No, I think this is it. Thank you so much. OK, perfect.
[AGENT][POSITIVE] Thank you for calling APL have a good day.