AccountId: 011433970860
ContactId: 50642a15-d047-42c1-8871-7398f99606d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516609 ms
Total Talk Time (AGENT): 146918 ms
Total Talk Time (CUSTOMER): 139550 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/50642a15-d047-42c1-8871-7398f99606d6_20250509T16:59_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for patient benefits.
[AGENT][NEUTRAL] OK. May I ask who's calling?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I ask who's calling?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] From
[AGENT][NEUTRAL] What was your name?
[CUSTOMER][NEUTRAL] From doctorsposit.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] What was
[AGENT][NEUTRAL] And how do you spell your name?
[CUSTOMER][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] F
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And do you have a phone number and in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, let me check it's.
[CUSTOMER][NEUTRAL] 02508096
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] L 8.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's that patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And were you needing benefits or claim status?
[CUSTOMER][NEUTRAL] Me
[AGENT][NEUTRAL] OK, I can help you with that. Is it for outpatient, inpatient or doctor's office?
[CUSTOMER][NEUTRAL] Let me check the information.
[CUSTOMER][POSITIVE] Impatient.
[AGENT][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] OK, the effective date is [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment.
[AGENT][NEUTRAL] This policy coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Whatever the primary applies to their deductible, co-pay or co-insurance for inpatient, we pay $2000 per occurrence.
[CUSTOMER][NEUTRAL] It's the
[CUSTOMER][NEUTRAL] Deductible.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] And he has not used.
[CUSTOMER][NEUTRAL] OK, can I get the patient's co-payment?
[AGENT][NEUTRAL] There's no copayment. It coordinates with the primary.
[CUSTOMER][NEUTRAL] OK, is there any deductible?
[AGENT][NEGATIVE] No deductible.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Yes, I just want to know if it's there any.
[CUSTOMER][NEGATIVE] A deductible.
[AGENT][NEUTRAL] No, ma'am, there's no deductible, no copay, no co-insurance on this policy. We pay strictly that $2000 per occurrence, whatever their primary applies to their deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's an authorization needed for an office procedure.
[AGENT][NEUTRAL] Do what now? Uh.
[AGENT][NEGATIVE] I didn't understand you.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] It's an authorization needed for an office procedure.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, it's a referral needed for office visits.
[AGENT][NEUTRAL] Do what? I didn't understand what you're saying.
[CUSTOMER][NEUTRAL] It's a referral needed for office visits.
[AGENT][NEUTRAL] No, ma'am. Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] What is the type of plan? It's HMO, PPO, POS.
[AGENT][NEUTRAL] It's none of that. It's just a gap policy.
[CUSTOMER][NEUTRAL] Can you spell it please?
[AGENT][NEUTRAL] GAP.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Network, is there any visual limitation?
[AGENT][NEUTRAL] Any what now?
[CUSTOMER][NEUTRAL] Visit limitation.
[AGENT][NEUTRAL] Any limitations?
[CUSTOMER][NEUTRAL] Yes, this is limitation.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] Or the doctor.
[AGENT][NEGATIVE] Office visits aren't covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you so much for the information and what about the laboratory?
[CUSTOMER][NEUTRAL] Is there any preference like quest, lab or?
[AGENT][NEUTRAL] Is there any
[AGENT][NEUTRAL] Coverage for lab.
[CUSTOMER][NEUTRAL] Preference.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. They do have a lab writer for independent lab.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and well, can I get the billing address, the PO box?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And can I get your name and reference code?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date. It's M.
[AGENT][NEUTRAL] E
[AGENT][NEUTRAL] L
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] NDA.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Thank you, [PII] for calling APL.
[CUSTOMER][POSITIVE] Well, that's so positive.
[AGENT][POSITIVE] You have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye.