AccountId: 011433970860
ContactId: 9468c44c-4dd2-4522-8699-aa34c19a4d3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214589 ms
Total Talk Time (AGENT): 83952 ms
Total Talk Time (CUSTOMER): 111389 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/9468c44c-4dd2-4522-8699-aa34c19a4d3c_20250527T17:43_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] How can I assist you today? Hi [PII], good afternoon. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm doing well, thank you. I have an upcoming procedure on [PII] and the um.
[CUSTOMER][NEUTRAL] Office has called me to tell me that my out of pocket cost was $1,256.
[CUSTOMER][NEGATIVE] Can you please let me know if um the gap insurance that I have will cover that portion of it or if I need to cancel the appointment because I definitely don't have the funds.
[AGENT][POSITIVE] OK, I'll be happy to assist with your benefits if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, it is 024.
[CUSTOMER][NEUTRAL] 653
[CUSTOMER][NEUTRAL] 88 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and if you can verify the date of birth and email address on the account.
[CUSTOMER][POSITIVE] Thank you for that
[CUSTOMER][NEUTRAL] I'm sorry, repeat that if I can verify what?
[AGENT][NEUTRAL] Date of birth and email address?
[CUSTOMER][NEUTRAL] Date of birth and email address? uh.
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] And my email address, um, I'm not sure if it's my work email or my personal email. There's one it's [PII] or it's [PII] OK, that's it.
[AGENT][NEUTRAL] That's what we have.
[AGENT][NEUTRAL] Alright, thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. Now this is an outpatient procedure.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so I'm showing that your outpatient calendar year maximum for outpatient procedures is $5000. Now this is gonna be in an outpatient facility, not a doctor's office, correct?
[CUSTOMER][NEUTRAL] That's correct, it's at an outpatient facility.
[AGENT][NEUTRAL] OK, so we would cover up to 5000. Just call them back, let them know you have gap insurance that way they can call us and verify the coverage that way once they bill your um primary and they get the EOB back from the primary, they can bill us and then we can pay that 1000 whatever that number was you said.
[CUSTOMER][NEUTRAL] 1,256 I believe that's what they quoted me.
[AGENT][NEUTRAL] Correct, because you haven't used any benefits, you have that full 5000 available.
[AGENT][NEUTRAL] Well, wait, let me see.
[CUSTOMER][NEUTRAL] And then can I ask you another question?
[AGENT][NEUTRAL] Alright, I'm sorry, one moment, let me check because we did process some claims this year. OK, well, yeah, you've only used $920 of that $5000 so yeah.
[AGENT][NEUTRAL] We would cover the full amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, another question is, does this only work for, um, like I have also a dentist, um, appointment. My cavity fell out and they have to put a crown over it.
[CUSTOMER][NEUTRAL] And they told me that it's gonna be $441 for that. Can I use the gap insurance towards that as well, or does it not include dental?
[AGENT][NEUTRAL] No, only medical.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK, is there anything else I can assist with today?
[CUSTOMER][POSITIVE] Thank you so much. I appreciate your help.
[CUSTOMER][POSITIVE] No, this is all. I appreciate it. Thank you.
[AGENT][POSITIVE] Thank you for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] OK.