AccountId: 011433970860
ContactId: 42f31301-3806-40a8-ae27-bb80e88fc289
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184449 ms
Total Talk Time (AGENT): 103898 ms
Total Talk Time (CUSTOMER): 52420 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/42f31301-3806-40a8-ae27-bb80e88fc289_20250210T19:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I am just calling to see if I can get a breakdown of benefits for my patients.
[AGENT][NEUTRAL] You're just needing a benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 02559324.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured?
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan. So of course it is a bit limited in its benefits. Uh, it's set to pay like set to, excuse me, pays a set dollar amount uh per covered office visit or procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there anything in particular you were looking at was covered?
[CUSTOMER][NEUTRAL] So does he get like um a certain amount to use for the year like an annual max or anything?
[AGENT][NEUTRAL] Yes, depending on the.
[AGENT][NEUTRAL] Benefits, um, give me just a moment, let me go to that schedule. I'm gonna get the policy pulled up here. Give me just a moment. I'll give you all that information.
[AGENT][NEUTRAL] OK, so essentially it's gonna be more limited to uh how many uh a set calendar days uh per year so it's um like just for example, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims. So a physician's office visit would be uh would pay $100 max per day, and that would be limited to one calendar day per covered person per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and so we're a dental office, so is this also dental have dental benefit as well?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, let me see if they've got a dental policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] No, they don't have a dental policy with us. Uh these typically don't have dental coverage. Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, so under the exclusions it does state dental treatment, so this is not going to have any dental coverage.
[CUSTOMER][NEUTRAL] Any dental at all, OK, let me let him know that then, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Perfect well thank you so much for looking into that.
[AGENT][NEUTRAL] Of course, was there anything else I can help you with?
[CUSTOMER][POSITIVE] That was it thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too mhm bye bye.
[AGENT][POSITIVE] Thank you, bye bye.