AccountId: 011433970860
ContactId: 34d89f18-92a4-4851-aefa-b39c26d3d45c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 202550 ms
Total Talk Time (AGENT): 109300 ms
Total Talk Time (CUSTOMER): 59964 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/34d89f18-92a4-4851-aefa-b39c26d3d45c_20250604T19:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], can you help me with the AI policy?
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] It is 02623153.
[CUSTOMER][NEUTRAL] Gave her the office visit.
[AGENT][NEUTRAL] For Marcos.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I gave her the office visit benefit but I do not know about the outpatient benefits she's asking about.
[AGENT][NEUTRAL] OK, let me take a look.
[AGENT][NEUTRAL] So, for outpatient, the plan only covers outpatient accident and sickness in the ER which it covers.
[AGENT][NEUTRAL] In urgent care, physician's office, and then physical speech, occupation therapy.
[AGENT][NEUTRAL] It pays emergency room, it pays at $50 urgent care is $50 physician's office is $50.
[AGENT][NEUTRAL] Um, and then the physical.
[CUSTOMER][NEUTRAL] Yeah, I gave her the physician office benefit. I know, I know the office visit benefit, but not the outpatient.
[AGENT][NEUTRAL] So that this would be the outpatient services.
[CUSTOMER][NEUTRAL] For ER.
[AGENT][NEUTRAL] Yes, for the emergency room, it covers $50 per day. It's a max of 2 days per calendar year, and then the urgent care is $50 per day, they get a max of 4 days for calendar year.
[CUSTOMER][NEUTRAL] Urgent care.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 4 days per calendar year for what now?
[AGENT][NEUTRAL] Urgent care.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's $50 also.
[AGENT][NEUTRAL] Yes, it's 50 for emergency room, it's 50 for urgent care, it's 50 for physician's office, and then it's 30 for physical therapy, speech, and occupational therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do they have a surgery benefit if it's outpatient surgery?
[AGENT][NEUTRAL] No. Well, yes, they do have the surgery benefit. It's all on the PIBFT screen. Do you have that pulled up? They have the accident sickness surgery benefit. It covers 500 per day. They get 1 per calendar for the surgery, and that's surgery in a hospital, hospital outpatient surgery facility or freestanding outpatient surgery center.
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] And they also have surgery in the physician office and it covers 250 per day, and they get 2 per calendar year.
[CUSTOMER][NEUTRAL] That ASS is surgery.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But yes.
[CUSTOMER][NEUTRAL] Is that what that is?
[AGENT][NEUTRAL] Mhm. Are you looking at the new, new screen cause it tells you exactly what it is. The new PIBFT screen.
[CUSTOMER][NEUTRAL] Accidental sur oh, OK, I see surgery benefit facility.
[AGENT][NEUTRAL] Yeah, accident, sickness, surgical benefit. Mhm.
[AGENT][NEUTRAL] And then on the policy certificate it shows it too.
[CUSTOMER][NEUTRAL] OK, I'll tell her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Mm bye.