AccountId: 011433970860
ContactId: 83ac0b26-8278-4363-9bb0-c0dcd4ec8426
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300739 ms
Total Talk Time (AGENT): 118625 ms
Total Talk Time (CUSTOMER): 54617 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/83ac0b26-8278-4363-9bb0-c0dcd4ec8426_20250131T16:39_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I'm sorry, your name again?
[AGENT][NEUTRAL] Oh, it's [PII]
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII], first initial last name first initial of my last name is [PII]. I am tired. It's Friday. Um, I am calling to uh verify if the patient has um coverage for infertility with this plan.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, yeah, I can take a look at that for you, Ms. [PII], and do you mind if I snag a good call back number real quick?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and that's a direct line.
[AGENT][NEUTRAL] And the policy number we want to look at, Ms. [PII]?
[CUSTOMER][NEUTRAL] Policy number I have is 02581593.
[AGENT][NEUTRAL] All right. And
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Would you be able to verify for me, please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Perfect. Um, I do see [PII] here. I'm gonna pull up those benefits for you, but I do wanna let you know that any benefit information I give you over the phone is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] And your coverage, yep, got it.
[AGENT][POSITIVE] Perfect and I'm assuming this would be outpatient, is that correct?
[CUSTOMER][NEUTRAL] Oh yep, outpatient office setting.
[AGENT][NEUTRAL] OK, perfect. Let me take a look at this policy document. Give me one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, so.
[AGENT][POSITIVE] They do have outpatient benefits with us it looks like.
[AGENT][POSITIVE] I'm trying to find that page. I'm so sorry.
[AGENT][NEUTRAL] They have a benefit of $250 per calendar day maximum.
[AGENT][NEUTRAL] Um, and that.
[AGENT][NEUTRAL] I do.
[AGENT][NEUTRAL] Not see.
[AGENT][NEUTRAL] I'm not showing.
[AGENT][NEUTRAL] Anything for treatment in an office setting on here?
[AGENT][NEUTRAL] Particularly, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ambulance, cancer labs.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, I'm here in physician's office. OK, so there it is, so they do have um.
[AGENT][NEUTRAL] The outpatient in the physician's office on their policy, um, that would cover that. And then as far as particularly infertility, um, I was looking at the limits and exclusions on this policy, and I'm not seeing anything stated necessarily in the policy that would limit or exclude that. So I'd certainly recommend submitting a claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claims submission to confirm coverage got it.
[CUSTOMER][NEUTRAL] All right, [PII], um.
[CUSTOMER][NEUTRAL] That's all I needed. Uh, can I get a call reference number?
[AGENT][POSITIVE] Yeah, absolutely. It's just my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much you have a great day.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you for calling APL and you have such a fabulous weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] My pleasure bye bye