AccountId: 011433970860
ContactId: 3c58e8ee-67e8-4be8-950b-f8f0d7d4e8df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301320 ms
Total Talk Time (AGENT): 156154 ms
Total Talk Time (CUSTOMER): 86442 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/3c58e8ee-67e8-4be8-950b-f8f0d7d4e8df_20250404T17:51_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I just wanted to review my policy really quickly because I received something that said, um,
[CUSTOMER][NEUTRAL] Something about not I, I just wanted to review it, this is a new policy for me, so I wanted to just verify something.
[AGENT][NEUTRAL] OK, so you're the insured and you have a question regarding your benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, yes, please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the [PII], what's a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] It is 02581980.
[AGENT][POSITIVE] OK, thank you if you'll give me a moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And then once I do, I will have to verify several things with you first for security and also any information that I provide for you today, Ms. [PII] would be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address please?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same. No, I'm so sorry, it is not the same. What is another contact number that we could have on file for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Is that still a valid number for you?
[CUSTOMER][NEUTRAL] That is that's my cell number, yes, I'm calling you from my office line.
[AGENT][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Oh, OK, that's fine, thank you. And then the last thing is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you very much for verifying all of your information. So how can I help you today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, I received um explanation of benefits and it says office visits are not covered by the policy. And so, looking at what I have, it does say that physician's office visits are not covered by gap insurance. So, I guess my question was,
[CUSTOMER][NEUTRAL] So that I, I thought, so what I put in for was a, it was, I mean, it's a doctor visit, but it's a specialist, so that doesn't count either. Is that correct?
[AGENT][NEUTRAL] OK, so on this supplemental policy, ma'am, office visits as any form are not covered. Now, if you receive some type of treatment rendered in the office, then that is something that we could review under your outpatient benefit, but the visit charge itself is not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sounds good. And then one other question is does my policy cover dental as well?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am. It does not. This is a supplemental medical policy. Um, there are only, and I can pull your specific policy language up and read it to you regarding dental, if you would like. It won't take just a second to pull it up. Um,
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] Well, maybe I was telling you a, a short fib. I didn't think it would take this long to pull it up, so I'm sorry.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK, so on your policy, and I can see that you're set up in the online service center, so you do have access to this, but under your exclusion section, number 15 states dental or vision service services including treatment, surgery, extractions, or X-rays are excluded unless it's resulting from an accident occurring while a covered person's coverage is enforced.
[AGENT][NEUTRAL] And if performed within 12 months of the date of such accident or due to a congenital disease or anomaly of a covered newborn child.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, sounds good well thank you for taking the time to find that. I appreciate it.
[AGENT][POSITIVE] Absolutely, you're very welcome. So is there anything else that I could help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.