AccountId: 011433970860
ContactId: 734e8d0b-ea2c-4bda-89f9-8c3e1a6e2f32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249240 ms
Total Talk Time (AGENT): 112439 ms
Total Talk Time (CUSTOMER): 69742 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/734e8d0b-ea2c-4bda-89f9-8c3e1a6e2f32_20250522T22:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good evening, um, my name is [PII]. The initial of my last name is [PII], and a good callback number is [PII].
[AGENT][NEUTRAL] OK, what can we help you with today, [PII]?
[CUSTOMER][NEUTRAL] And I'm calling from the.
[CUSTOMER][NEUTRAL] Yeah, I was just calling from the provider's office um regarding a mutual member. I just wanted to verify the general benefits with you guys for an urgent care facility.
[AGENT][NEUTRAL] OK, I can check those urgent care benefits. Um, do you have that policy number one?
[CUSTOMER][NEUTRAL] I do it's going to be.
[CUSTOMER][NEUTRAL] I um I have it here 971-058.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] So yes, the first name is [PII], the last name, um, I'll spell it. So it's gonna be [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And separate [PII]
[AGENT][NEUTRAL] OK, and then do you have his date of birth?
[CUSTOMER][NEUTRAL] I do. It's for [PII].
[AGENT][POSITIVE] OK, thank you for verifying that.
[CUSTOMER][NEUTRAL] Oh sorry, [PII]. I'm sorry.
[AGENT][NEUTRAL] Oh, I thought that's what you said. No, it's OK. I was looking right at it. I could sworn that's what she said. OK, well, thank you. Um, so the policy is active, uh, effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so urgent care is listed uh as a benefit, and let's see.
[AGENT][NEUTRAL] The outpatient benefit is on a per calendar day basis if you'll give me one moment, I'm going to get their policy pulled up um to get the actual amount for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, yes, uh, so per calendar day, uh, this policy pays up to $4250.
[AGENT][NEUTRAL] And this, uh, there's no deductible.
[CUSTOMER][NEUTRAL] OK, and you guys cover the the copay as far as from their primary insurance?
[AGENT][NEUTRAL] Uh, yes, it goes towards co-pay, deductible and co-insurance.
[CUSTOMER][POSITIVE] OK, perfect. Alrighty, and has anything been
[AGENT][NEUTRAL] And I will say, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, um, well, it is a daily maximum, uh, so it's not a yearly maximum. So every day it would, um, replenish. Um, I will say it does state that there are a maximum of 3 urgent care visits per covered person per calendar year. So I will go ahead and double check that for [PII]. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so none has been used so far this year.
[CUSTOMER][POSITIVE] Got it, perfect. And um I'm so sorry, what was your name again?
[AGENT][NEUTRAL] OK, it's [PII]
[CUSTOMER][NEUTRAL] And the initial of your last name?
[AGENT][NEUTRAL] It's [PII] and was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] No, that was it. The reference call on the reference number, sorry, for the call is your name and today's date.
[AGENT][NEUTRAL] That's OK. Uh, my first name and last initial, and today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much you have a great night.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK.