AccountId: 011433970860
ContactId: 819ee18e-4e69-4844-b483-5a64f3e1bf30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244889 ms
Total Talk Time (AGENT): 103606 ms
Total Talk Time (CUSTOMER): 128635 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/819ee18e-4e69-4844-b483-5a64f3e1bf30_20250403T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from my GYN care. I wanted to just see what a patient's benefits are for surgery.
[AGENT][NEUTRAL] I can verify benefits, [PII], may I have a policy number?
[CUSTOMER][NEUTRAL] Sure. It is 0211.
[CUSTOMER][NEUTRAL] 89888 M as in Mary, L 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um [PII], do you want me to spell it?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK. And [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. Would this treatment be inpatient, outpatient, office visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient in the office.
[AGENT][NEUTRAL] OK, so let's see if they have the office.
[AGENT][NEUTRAL] They do not have the office visit, nor do they have the office treatment benefit.
[CUSTOMER][NEUTRAL] Oh, for surgery in the office? It's the same thing?
[AGENT][NEUTRAL] Correct. Yes, they do have outpatient, but not the actual office visit, nor the office treatment benefit.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So when you say office um treatment, does that include the actual surgical procedure? Like your, is it, are you talking about follow-up visits and surgeries?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Neither one would be covered under this policy. Yes, ma'am.
[CUSTOMER][NEUTRAL] With anesthesia? OK.
[CUSTOMER][NEUTRAL] I'm trying to ask in many different ways. So if she does it at, uh, if she does it at a hospital, then it would be covered.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Correct. Outpatient per calendar day would allow $500 if she did it at outpatient hospital.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so no coverage.
[CUSTOMER][NEUTRAL] For in office, even office visits, you said so like uh like she was here the other day, OK, for in office visits or treatments.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Now, she doesn't have a cancer diagnosis, does she?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, because.
[CUSTOMER][NEUTRAL] No, so then, um, hospital.
[CUSTOMER][NEUTRAL] Hospital is covered $500.
[AGENT][NEUTRAL] Per calendar day. Yes, ma'am. Outpatient hospital.
[CUSTOMER][NEUTRAL] Her calendar.
[CUSTOMER][NEUTRAL] Per calendar.
[CUSTOMER][NEUTRAL] OK, she hasn't met that, I guess.
[AGENT][NEUTRAL] It's per calendar day.
[CUSTOMER][NEUTRAL] Day 00 OK so each day she's in the hospital so that's inpatient though, not if she goes to an ambulatory center?
[AGENT][NEUTRAL] If she goes to an ambulatory surgical center, the benefit allows $500 per calendar day for outpatients. So each day she has a $500 benefit for outpatient.
[CUSTOMER][NEUTRAL] OK, OK. I didn't think they stayed more than one day in the ambulatory, but OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, ambulatory and hospital, OK. Um.
[CUSTOMER][NEUTRAL] OK then I guess that answers that. Can I get a reference number? And you said your name and it quickly went out of my head.
[AGENT][NEUTRAL] Yes, the reference number will be my name, which is [PII] Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it you've been helpful, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you.