AccountId: 011433970860
ContactId: 64febff9-088f-4e04-823a-cdcf185a1923
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163850 ms
Total Talk Time (AGENT): 78662 ms
Total Talk Time (CUSTOMER): 65434 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/64febff9-088f-4e04-823a-cdcf185a1923_20250331T19:44_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, how are you? Um, I was calling because I have a few questions. Um, so I recently got this, um, insurance with you guys through my employer.
[CUSTOMER][NEUTRAL] Um, and I just wanted to know like how my benefits work when it comes to like co-pays because I was reading a little bit of like the benefit description and I didn't really understand much.
[CUSTOMER][NEUTRAL] Of that aspect. So like, for example, if I go to like a specialist.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does this
[CUSTOMER][NEUTRAL] Insurance cover the copay or does it depend?
[AGENT][POSITIVE] OK, I'd be happy to assist with your policy. May I have your policy number please?
[CUSTOMER][NEUTRAL] Yeah, so I believe that it's 025.
[CUSTOMER][NEUTRAL] 843-88 ML 8
[AGENT][NEUTRAL] And your name, date of birth, and email address please?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth is [PII], and my email is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] Um, now I show that we, you have a gap policy with us. That means we work in conjunction with your major medical.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, so you'll present your card, um, as you know, anytime that you present your major medical card, you'll also present our card to let them know that you have the gap insurance. Now, as far as um treatment in an office or clinic setting, um, we do cover the treatment and procedures at that visit. We would not cover the copay associated with the physician's charges, so you would be responsible for the copay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] So for outpatient it's just treatment.
[AGENT][NEUTRAL] For treatment in an office or clinic setting, if you go to an outpatient fac like say you go to urgent care, ER, um, diagnostic facility, surgical facility, um, anything that's considered outpatient, um, we would just cover your patient responsibility up to your $3500 benefit. But for an office or clinic setting, it's just the treatment and procedures. You're responsible for that co-pay that's associated with the physician's charges.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, got you. OK, alrighty, thank you so much.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Mhm bye bye.