AccountId: 011433970860
ContactId: 49731320-a5cd-474d-9dab-d6965abc0e7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190539 ms
Total Talk Time (AGENT): 125367 ms
Total Talk Time (CUSTOMER): 59577 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/49731320-a5cd-474d-9dab-d6965abc0e7c_20250508T13:28_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning. Thank you for calling APL. Excuse me, this is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, hi, good morning, calling from a provider's office. I need some information in a member, uh, gap insurance.
[AGENT][POSITIVE] OK, I'll be glad to help you. Go and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Uh, the member policy number is 01712335.
[AGENT][POSITIVE] OK, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. Now, your patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all that information, [PII]. It looks like [PII] is the dependent spouse on this medical supplemental plan does show the original effective date. S [PII]. This 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 had a question about benefits. Is that correct?
[CUSTOMER][NEUTRAL] Actually, I need if this is covered for the office visit or ultrasounds done in office, please.
[AGENT][NEUTRAL] OK, so let me get that benefit pad pulled up. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, it looks like she does have office treatment benefits. Now what she has, and of course what we are is just her 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 her co-pay, deductible, or co-insurance, but it has to be applied to one of those three things. Now for her office visit benefits, she has 4 office visit benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Per calendar year and the max we pay is $25 per visit.
[CUSTOMER][NEUTRAL] To see it
[CUSTOMER][NEUTRAL] Music
[CUSTOMER][NEUTRAL] OK. And what about the ultrasounds?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, uh, ultrasound, the, it would still be the same benefit.
[CUSTOMER][NEUTRAL] OK, did she use any of the 4 visits? Yeah, and did she use any of the 4 visits?
[AGENT][NEUTRAL] Anything done in the office?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Check that.
[AGENT][NEUTRAL] As of today, she's not used any of those uh benefits at all, [PII].
[CUSTOMER][NEUTRAL] OK, sweetheart, can you spell your name?
[AGENT][NEUTRAL] I sure can, Ms. [PII]. Is that all I can answer for you today?
[CUSTOMER][NEUTRAL] Yes, your name and the reference number from this phone call. Thank you.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am. We don't give reference numbers, but you can use my name in today's date and my name is spelled [PII]
[CUSTOMER][POSITIVE] [PII] OK, perfect. Thank you. Have a good day, sweetheart.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Well, you as well, [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.