AccountId: 011433970860
ContactId: 368ce46c-9197-4cda-bdfa-6b2ba6a70885
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298540 ms
Total Talk Time (AGENT): 84269 ms
Total Talk Time (CUSTOMER): 73471 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/368ce46c-9197-4cda-bdfa-6b2ba6a70885_20250407T22:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from Doctor [PII]'s office. I'm calling to see if patients, um, she has benefits for her gap plan.
[AGENT][NEUTRAL] OK, could I get your name and a good callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] My name is [PII], that's [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] It's 1245048 ML 8.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] And you needed benefits correct?
[CUSTOMER][NEUTRAL] Yes, I need to know if she has benefits for procedures registered in the doctor's office. Last year she did not. Her name is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I'm pulling up our policy. Give me one moment.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's a basic outline of our policy.
[AGENT][NEUTRAL] Um, OK, so this is for treatment in the doctor's office, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see here.
[AGENT][NEUTRAL] Making sure nothing's changed, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has a.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For treatments and procedures rendered in the doctor's office, that's covered. The office visit itself is not a covered benefit.
[CUSTOMER][NEGATIVE] I don't think that the the procedures will be covered. They weren't covered last year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she has, she, they're covered this year?
[AGENT][NEUTRAL] Well, we've got
[CUSTOMER][NEGATIVE] Because she had a procedure done in the office last year and she wasn't covered.
[AGENT][NEUTRAL] So for physicians cover charges do not include, this is what's not covered under the policy, durable medical equipment, cancer treatment, physical therapy, or the office visit.
[AGENT][NEUTRAL] Do you have ad service?
[CUSTOMER][NEGATIVE] Right, she had a procedure, she had a procedure rendered in the office and it was not covered.
[AGENT][NEUTRAL] What data service was that?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Yeah, it was nothing was paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For $258.02.
[AGENT][NEUTRAL] Well, the opposite
[CUSTOMER][NEUTRAL] So we were told last year that she did not.
[AGENT][NEUTRAL] Go go ahead.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] We were told last year that she did not have benefits for procedures rendered in the office, and she had a procedure done in August and it was not covered.
[AGENT][NEUTRAL] OK, I'm pulling up what we received. Hold on one moment.
[CUSTOMER][NEGATIVE] She doesn't have benefits for for procedures rendered in the office.
[CUSTOMER][NEUTRAL] For the office setting she doesn't have that.
[AGENT][NEUTRAL] OK, I'm, I'm just looking at what's the definitions defined under this policy.
[AGENT][NEUTRAL] Um, so the physician's office visit is not covered.
[AGENT][NEUTRAL] Um, let me look one more place.
[AGENT][NEUTRAL] Making sure nothing's changed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, sorry about that. Yes, that's correct. So sorry about that. So, no, it's not covered.
[CUSTOMER][NEUTRAL] All right, great, um, may I have a reference number please?
[AGENT][NEUTRAL] My first name is [PII], last initial is [PII], and today's date. That will be the reference number.
[CUSTOMER][POSITIVE] OK, thank you. Bye bye. Thank you.
[AGENT][POSITIVE] Thank you.