AccountId: 011433970860
ContactId: 2843051f-615a-474c-bbd1-d77687322eba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302880 ms
Total Talk Time (AGENT): 119610 ms
Total Talk Time (CUSTOMER): 146163 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/2843051f-615a-474c-bbd1-d77687322eba_20250304T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there my name is [PII] and um we're new to APL and I've been filing some claims and I'm trying to understand um what things are covered in our policy and where I could look to find it should I have questions in the future.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with your benefits. Um, first, can I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need your policy number, please.
[CUSTOMER][NEUTRAL] 025725
[CUSTOMER][NEUTRAL] 06.
[AGENT][NEUTRAL] Thank you. Now, please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And I'm showing that you have, yes, several um benefits. Is there a particular um benefit that you would like to verify?
[CUSTOMER][NEUTRAL] Sure, I, I think I know like most of the ones, but the ones that I have kind of questions about which I appreciate you asking is um are there um are prescription drugs out of pocket covered?
[AGENT][NEUTRAL] Um, no, ma'am. Not under this policy.
[CUSTOMER][NEUTRAL] OK, um, I think the answer is gonna be a no to all these, but I just wanted to check how about durable medical equipment for things like CPAP.
[AGENT][NEUTRAL] Yes, ma'am. DME is covered. Um, that's covered under your outpatient benefit and for outpatient um services, we cover up to 3000 per calendar year.
[CUSTOMER][NEUTRAL] OK, and, and CPAP equipment does uh qualify for that.
[AGENT][NEUTRAL] Um, yes, ma'am. It does.
[CUSTOMER][POSITIVE] Perfect. OK, and what about um any dental? Do we, is dental covered?
[AGENT][NEUTRAL] Um, there's no dental coverage under this policy. It's only for medical.
[CUSTOMER][NEUTRAL] OK, um, I saw a note about independent lab tests. What does that mean?
[AGENT][NEUTRAL] Um, for services like at Quest or LabCorp.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about other ones that that might be like not a quest or lab cop but um if I was seeing a functional medicine doctor and they wanted to order a special a lab from a specialty place, you know, like um a GI test or something like that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. That's included as well. All independent labs are covered under the outpatient benefit for 3000, up to 3000 per calendar year. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] I think that's what I was and and doctor's visits out of pocket, right? Like a regular doctor visit out of pocket would be covered.
[AGENT][NEUTRAL] Office treatments are covered. The service for the co-pay for office visits is not covered, but the charges that go towards the co-insurance and the deductible for office visits, that's covered again under outpatient, up to 3000 per calendar year.
[CUSTOMER][NEUTRAL] OK, so the copay isn't, so if I, if I put something in and I was, uh, and it was for the, the copay included you would separate out you would pay.
[CUSTOMER][NEUTRAL] Everything but the copay.
[AGENT][NEUTRAL] Right, for office visits only. Um, other outpatient services like your DME or any outpatient hospital services, the co-pay is covered under those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Clients.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On my um on my benefit.
[CUSTOMER][NEUTRAL] I hm I see like I'm looking at my what I submitted, is there a summary page that shows you in summary what's been paid or how you are, uh, going, you know, towards your $3000 out of pocket?
[AGENT][NEUTRAL] Yes, ma'am. Every time you file a claim, we'll send you an explanation of benefit and it'll give you a reason code um for every service with an explanation of why the um code paid or did not pay.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, I'm just wondering is there anything on the website that shows like total to date so I know how I am against my deductible my uh max.
[AGENT][NEUTRAL] Um, yes, ma'am. Let me give you, um, our website so you can go online and set up your policy, and from there, you'll have access to all of your claim and policy information.
[CUSTOMER][NEUTRAL] OK, I, I have the website and I'm logged in. I just was looking for, I guess I see it I'm not paid. I see amount paid in here. I don't see a total, but that's alright, OK.
[CUSTOMER][POSITIVE] I'm good. I think I got what I need thank you so much you've been fantastic.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, no, I appreciate it.
[AGENT][POSITIVE] OK. Well, I thank you again for calling APL. You have a great rest of your day.
[CUSTOMER][POSITIVE] OK thanks bye bye.
[AGENT][POSITIVE] Thank you, [PII]. Bye.