AccountId: 011433970860
ContactId: 786ce208-eb08-4315-bbfe-5426c60311da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259529 ms
Total Talk Time (AGENT): 130109 ms
Total Talk Time (CUSTOMER): 70727 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/786ce208-eb08-4315-bbfe-5426c60311da_20250130T16:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] Hi, this is [PII]. I was just calling back from ideal option. I think I spoke to you earlier, but for some reason the call just disconnected. I think it was a bad connection.
[AGENT][POSITIVE] Yes. OK, yes, that was me. I'm so glad you called because I tried and I couldn't get back. So thank you um for calling back. We don't have to verify anything since we just did that, um, and I still have everything pulled up. Let me go back to the benefits though.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, all right, thanks and did it show that substance abuse is covered?
[AGENT][NEUTRAL] Um, so that's what I was checking on when it dropped because it does have the physician office coverage. It doesn't specify specialists. Usually under physician specialist is included for us.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So now I'm just checking on the substance abuse part, but
[AGENT][NEUTRAL] I don't see anything in the exclusion. Sometimes it's listed in the exclusions. Hold on one second.
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And again, just because it's a new call, all the information provided is a verification of benefits, not a guarantee of payment. No. Do you mind if I place you on just a brief hold? I'm just reading through the policy to make sure.
[CUSTOMER][POSITIVE] All right OK thanks.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I don't know being intoxicated or influence caught it unless.
[AGENT][NEGATIVE] I'm about to call claims.
[CUSTOMER][NEUTRAL] Sing
[CUSTOMER][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I'm doing good. I have a quick question for HR policies, do you need, you want to look at the policy?
[CUSTOMER][NEUTRAL] OK, yeah, what's the policy number?
[AGENT][NEUTRAL] OK, it's um 259-2882.
[CUSTOMER][NEUTRAL] OK, what's going on?
[AGENT][NEUTRAL] So it's a specialist office, but they do substance abuse. I wasn't sure if the specialist is included under the physician office.
[CUSTOMER][NEUTRAL] Yeah, there's no um it doesn't matter if it's primary care or specialist it doesn't matter but it's if it's substance abuse it's not gonna be covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The substance.
[AGENT][NEUTRAL] OK, thank you, that's all I needed because I I knew this the um the specialist was considered with the physician office, but that's the substance part. I was like, wait a minute, and I didn't see anything in the exclusions, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, it's non-covered. Uh, do you have access to the RERMI screen?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If you look at DH 0057.
[CUSTOMER][NEUTRAL] That's the remark code we would use.
[AGENT][POSITIVE] OK. Well, thank you very much. I appreciate you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] See how quick that was? Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I just called over to claims to get a definite answer. So the physician office um does include specialists, but because it's for substance abuse, it wouldn't be covered on the policy.
[CUSTOMER][NEUTRAL] OK, I figured as much usually with these indemnity limited plans, it doesn't usually cover like substance abuse.
[CUSTOMER][NEUTRAL] Um, OK, perfect, and then can I get a reference number or is it just your name and today's date?
[AGENT][NEUTRAL] Sure, sir. Yes, it's my name and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much and I appreciate it.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][POSITIVE] You're welcome bye bye.