AccountId: 011433970860
ContactId: 9144eb75-35b4-44b0-b6fb-11806f54f2c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250059 ms
Total Talk Time (AGENT): 81344 ms
Total Talk Time (CUSTOMER): 79735 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/9144eb75-35b4-44b0-b6fb-11806f54f2c9_20250507T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I, I'm [PII] calling from Orto Florida. I, uh, need to verify if APL covers, uh, uh.
[CUSTOMER][NEUTRAL] The administration of an injection in the specialist office.
[AGENT][POSITIVE] OK, I'm happy to look at the patient's plan. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes it's uh.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 098.
[CUSTOMER][NEUTRAL] 57.
[AGENT][NEUTRAL] All right, let me pull that up here. One moment.
[CUSTOMER][NEUTRAL] You know what I'm thinking
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], uh, date of birth [PII].
[AGENT][POSITIVE] Alright, thank you so much. So, patient is active. The effective date on the plan is [PII]. We are the members secondary insurance, so this will cover deductible, co-pay, co-insurance that the primary does not.
[AGENT][NEUTRAL] And the patient has an outpatient benefit max per calendar day on this of $1000.
[CUSTOMER][NEUTRAL] OK, so, so, uh, I mean, usually APL kind of covers, uh, hospitals and but it, it covers, uh, a provider's office visit and it covers the deductible on co-pay and coinsurance as, as you said.
[AGENT][POSITIVE] For the treatment, correct, yes.
[CUSTOMER][NEUTRAL] For the 3 of them, but not for the visit?
[AGENT][NEUTRAL] Let me see if this member's plan is gonna cover the office visit fee. Some do, some don't.
[CUSTOMER][POSITIVE] Oh, OK, for, for treatment, OK, that's nice.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me just one second here.
[CUSTOMER][POSITIVE] Sure, sure, sure, thank you.
[CUSTOMER][NEUTRAL] I, I just wanna be clear that's all.
[AGENT][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Fucking yeah.
[AGENT][NEUTRAL] OK, so it looks like this one does cover the office visit and the treatment, both.
[CUSTOMER][NEGATIVE] Oh really, so we need to reimburse her money? wow.
[AGENT][NEUTRAL] Or I mean, they can file the claim themselves, it looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, to be reimbursed also.
[CUSTOMER][POSITIVE] OK, so it covers the visit and treatment co-pays for a $1000 max per day. OK, that's fantastic.
[AGENT][NEUTRAL] Yeah, per day. So physician's office visit fee is listed, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, may I have a reference number?
[AGENT][NEUTRAL] Call references by name with my last initial and then today's date. Uh, my name again is [PII], last initial T like [PII].
[CUSTOMER][NEUTRAL] 8.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.