AccountId: 011433970860
ContactId: 431c719d-55b2-400b-84da-78c1cdcc7eab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367640 ms
Total Talk Time (AGENT): 190281 ms
Total Talk Time (CUSTOMER): 125652 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/431c719d-55b2-400b-84da-78c1cdcc7eab_20250304T17:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hello, good afternoon. This is [PII]. Last initial [PII], and I would like to check benefits information, please.
[AGENT][POSITIVE] Alrighty, [PII], I'll be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Um, sure. It's um 025.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 88 M as in Mary, L as in Lima followed by the number 8.
[AGENT][NEUTRAL] Alright, [PII], give me that number one more time. I think I have a number missing somewhere.
[CUSTOMER][NEUTRAL] OK, no problem. So it's 02517188 M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] And the number 8.
[AGENT][NEUTRAL] Alrighty, I see my missing number now. OK, [PII], thank you for that. Now, while I'm pulling this up, go ahead and give me a good return telephone call just in case we get disconnected. We're having bad weather here right now.
[CUSTOMER][NEUTRAL] Um, sure, so it's [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] Alright [PII], thank you for all that information. Now, your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Looks like [PII] is a dependent child on this medical supplemental plan. I do show the original effective date is [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want some type of benefit. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Alright, yes.
[AGENT][NEUTRAL] Yeah, and what type of benefit are you needing today, please, sir?
[CUSTOMER][POSITIVE] OK, so thank you. So I would like to check the benefits for PCP office visit, well visit and child immunizations.
[AGENT][NEGATIVE] Alrighty, nothing routine here is covered at all, and they do not have any type of office visit benefit here at all, but nothing routine here is covered, period.
[CUSTOMER][NEUTRAL] Alright, and what about the outpatient benefits?
[AGENT][NEUTRAL] Uh, for outpatient. Now what we are, of course, is the medical supplemental plan. So the only thing that we would pick up and pay on for sickness and injury is anything that is applied towards the patient's deductible, co-pay, or co-insurance at the primary insurance carrier, but their outpatient benefit here is a zero deductible, no pre-cert, and a $750 benefit payable per calendar day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. Thank you. So, OK, so you told me that uh this insurance will cover just for sickness but not for routine visits, right?
[AGENT][NEUTRAL] Right. Nothing routine here is covered no matter what.
[CUSTOMER][NEUTRAL] OK, no matter what. OK, so, but for 6 visit, it will be under the outpatient benefits $750.
[AGENT][NEUTRAL] Yes, but no office visit benefits covered here at all. Nothing office visits period is covered.
[CUSTOMER][NEUTRAL] OK, nothing offices it.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] Including sickness.
[AGENT][NEUTRAL] Right, even for sickness, they don't have any office visit. Anything done in the office would fall under that $750 per calendar day benefit for sickness and injury done in the office like X-rays, any kind of lab that applied towards that deductible copay or co-insurance would be what we would consider.
[CUSTOMER][NEUTRAL] OK, so I'll consider like office visit is not covered.
[AGENT][NEGATIVE] Right, the actual office visit charge itself is not covered.
[CUSTOMER][NEUTRAL] OK, thank you. um OK, so can you please provide me the claims billing address?
[AGENT][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Yes, our claims mailing address for all claims is to APL claims department.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And our zip is [PII].
[AGENT][NEUTRAL] Would you like our electronic payer ID number as well?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Uh, no thank you. I really appreciate it. So, um, now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What else can I help you with?
[CUSTOMER][NEUTRAL] OK, so lastly, may I have the uh your first name, last initial, and the card reference number, please?
[AGENT][NEUTRAL] OK, yes sir, [PII], if that's all I can help you with, we do not give reference numbers, but you can use my name in today's date, and my name is [PII]
[CUSTOMER][NEUTRAL] Alright, and what is your last initial? I'm sorry.
[AGENT][NEUTRAL] Oh, that's OK.
[CUSTOMER][POSITIVE] OK, uh, [PII]. OK, thank you so much for the information. It's, it's all right.
[AGENT][POSITIVE] Alrighty, well, you're so welcome, [PII], and thanks for calling APO. You have a great rest of your day.
[CUSTOMER][POSITIVE] OK you too take care.
[AGENT][NEUTRAL] You as well. Bye bye.
[CUSTOMER][NEUTRAL] Bye.