AccountId: 011433970860
ContactId: 3e5dc3e1-41bf-4848-a3e3-f90b20f6cfdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205699 ms
Total Talk Time (AGENT): 95083 ms
Total Talk Time (CUSTOMER): 89217 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/3e5dc3e1-41bf-4848-a3e3-f90b20f6cfdf_20250103T14:15_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to see, um, my husband had a biopsy done and I wanted, I don't think the bill was turned into you guys, but before I call them and have them turn it in, I, I don't know if it's even gonna be covered so if it's not covered under our thing, I'm not even gonna worry about it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, I can check your benefits for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that. Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] 02350210
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have you here and I just need you to verify your date of birth and then the mailing address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, hold on one moment, I'm just pulling up your policy documents.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it just came up.
[AGENT][NEUTRAL] So the um hold on one second, let me check one more thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's me. So for the biopsy, was it done like out in an outpatient facility or like was he admitted?
[CUSTOMER][NEUTRAL] No, I mean it was done it was the urologist's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So then, like in the office.
[CUSTOMER][NEUTRAL] So it was a prostate.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so under this policy, I was asking because the policy is broken down into like in hospital if you're admitted and then outpatient, like emergency room, same day surgery. So, but I when looking, I don't see the office treatment rider, so there's no like coverage for in-office settings. It's more like emergency room, urgent care, like if you go to an outpatient hospital, that type of thing.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, yeah, this would have been done in.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Office
[CUSTOMER][NEUTRAL] Their office, yeah.
[AGENT][NEUTRAL] Yeah, so for the secondary policy, there is no coverage for the in-office setting.
[CUSTOMER][NEUTRAL] OK, that's kind of what I figured. So, OK, so we'll just have to our the, the policy, the company changed it this last year. It used to cover all kinds of, it used to basically pay our deductible and now it's basically an emergency and that's it, you know, or like, like you said, you go to the emergency room or you go to the immediate care otherwise it doesn't cover anything anymore, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right, well I guess I won't even.
[AGENT][NEGATIVE] I wish I had better news for you.
[CUSTOMER][NEUTRAL] Yeah, I kind of figured that but I thought before I even call them and have them submitted I'm gonna just ask if it's covered and not wait.
[AGENT][NEUTRAL] Check and make sure, right.
[CUSTOMER][POSITIVE] Yeah, OK, sounds good thank you.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can assist you with today, Mrs. [PII]?
[CUSTOMER][NEUTRAL] No, I don't think so.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a good weekend and [PII].
[CUSTOMER][POSITIVE] Thank you, same to you.
[AGENT][POSITIVE] You're welcome thank you