AccountId: 011433970860
ContactId: 7ff8b97d-0b18-4120-8019-ed4fe5f72033
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191990 ms
Total Talk Time (AGENT): 98791 ms
Total Talk Time (CUSTOMER): 72551 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/7ff8b97d-0b18-4120-8019-ed4fe5f72033_20250203T18:42_UTC.wav
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[CUSTOMER][NEUTRAL] a momento.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to see what you guys cover on um the patient that gave me this policy.
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and callback number is [PII].
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] Oh yes, 18635.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers.
[CUSTOMER][NEUTRAL] Is this not America?
[AGENT][NEUTRAL] Do you have the card?
[CUSTOMER][NEUTRAL] I have the card here with me. It says that American Public Life, uh, it says group number but like member ID.
[AGENT][NEUTRAL] Do you see outpatient benefit certification number?
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] May I have that please?
[CUSTOMER][NEUTRAL] I see that, yes, 02359532 ML8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, her name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] And thank you so much, [PII] for verifying the policy. You were calling in for assistance on benefit and eligibility. Is there a specific benefit that you're calling in for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I wanted to know what you guys cover. We're OBGYN. We're a specialty office. I wanted to know what you guys cover for specialty offices as well as she has to do ultrasound.
[AGENT][NEUTRAL] OK. I'm pulling that information up for you now.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. For the office visit fee, the member does not have that benefit rider, but for a procedure that is rendered within an office setting, the member has up to $3500 per calendar year. That amount will go towards the primary insurance deductible, co-insurance, or co-pay.
[AGENT][NEUTRAL] This policy is for sickness and injury only. It will not cover any type of preventative or wellness. Is there anything else I can assist you with? Go ahead.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I'm sorry, um, so, so it won't cover her her ultrasound or her a copay.
[AGENT][NEUTRAL] It doesn't cover the office visit benefit. So if, if it is for the office visit co-pay, this is not, this does not cover it. But if there's anything rendered within an office setting, and it is for sickness and injury, she do have up to $3500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have your name please?
[AGENT][NEUTRAL] Yes, that is [PII], that is spelled [PII] Last initial of [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much [PII]. I hope you have a wonderful day, OK?
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][POSITIVE] Thank you bye bye.