AccountId: 011433970860
ContactId: 23f9b286-7aea-4019-a841-90f08061fc01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307839 ms
Total Talk Time (AGENT): 128917 ms
Total Talk Time (CUSTOMER): 85942 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/23f9b286-7aea-4019-a841-90f08061fc01_20250113T20:19_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], this is [PII] calling. I had a question or I have a question um regarding whether a procedure is covered under APL or not.
[AGENT][NEUTRAL] OK, I can check to see if the procedure is covered. Um, are you the insured, [PII], or are you with the provider?
[CUSTOMER][NEUTRAL] I am the insured.
[AGENT][NEUTRAL] You are OK. What was your last name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I have the group number um 21361.
[AGENT][NEUTRAL] OK, give me just a moment let me try to find you here.
[AGENT][NEUTRAL] Is that uh Muse and Hoffman Inc.
[CUSTOMER][POSITIVE] Yes it is yeah.
[AGENT][NEUTRAL] OK, just a moment, let me try to find you here.
[AGENT][NEUTRAL] OK. Do you believe I found you. I'm just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your uh mailing address?
[CUSTOMER][NEUTRAL] Yes, [PII], that's [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is an [PII] account.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] Perfect. Alright, thank you so much for verifying that information, [PII]. OK, so you're going to be having a procedure, we're just wanting to see if it's covered under this policy?
[CUSTOMER][POSITIVE] Yes, yes, I did wanna find out mhm.
[AGENT][NEUTRAL] OK, is it a surgery?
[CUSTOMER][NEUTRAL] Well, I, I believe so. It's gonna be outpatient, but it is a biopsy. Mhm.
[AGENT][NEUTRAL] A biopsy, OK.
[CUSTOMER][NEUTRAL] For a dermatologist. Uh-huh.
[AGENT][NEUTRAL] OK, bear with me just a moment.
[AGENT][NEUTRAL] OK, so would this actually, um, do you know where this would take place? Would it take place in a hospital outpatient facility or would it be in a physician's office?
[CUSTOMER][NEUTRAL] Physician's office I believe.
[AGENT][NEUTRAL] It would be a physician's office, OK.
[AGENT][NEUTRAL] OK, I don't see surgery in a physician's office being covered under this policy. What I recommend though, [PII], just so that we can be absolutely sure, if you don't mind, uh, having that facility or that provider reach out to us and we'll be able to verify that with them.
[CUSTOMER][NEUTRAL] OK, alright, so basically you're, uh, did you say that you thought it would be covered?
[AGENT][NEGATIVE] I don't see any sort of uh surgical uh benefits being covered in a physician's office environment on this policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, so the things that are covered under this particular policy are outpatient facilities.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For your outpatient benefits, it's going to be um hospital emergency room, urgent care facility, um, yeah, hospital outpatient facility, and outpatient surgery center, um, and then you do have, uh, let's see.
[AGENT][NEUTRAL] Physical therapy benefits as well, but it's mainly going to be in a hospital environment for the other benefits.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] So uh you're recommending that this particular facility or doctor reach out to you just to um confirm.
[AGENT][POSITIVE] Just so we can make absolutely sure, yes.
[CUSTOMER][POSITIVE] OK all right very good well thank you much, I appreciate it.
[AGENT][NEUTRAL] Alright, yeah, did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] Not, not today, thank you.
[AGENT][POSITIVE] Alright, yes, sir, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You bet you you too yeah bye now.
[AGENT][POSITIVE] Thank you bye bye.