AccountId: 011433970860
ContactId: a305a662-7090-4af3-bb5b-ee53f9170dd9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268859 ms
Total Talk Time (AGENT): 112958 ms
Total Talk Time (CUSTOMER): 89581 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/a305a662-7090-4af3-bb5b-ee53f9170dd9_20250220T20:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi I was calling uh regarding this plan. I wanted to know what would be the mailing address for the claims?
[AGENT][NEUTRAL] Um, it depends on the type of policy. Um, do you have the policy number and your name is? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from a doctor's office.
[AGENT][NEUTRAL] OK, and Miss [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] Um, is that the policy slash cert number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 02571784
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, it is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] Hold on, [PII], what is her date of birth?
[CUSTOMER][NEUTRAL] [PII], sorry.
[AGENT][NEUTRAL] Oh, no, you're fine. Um, yeah, with this uh policy, I can give you that address when you're ready.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, so this is the correct address to send the claims.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, because the patient was giving us a whole another address. She said it's a different [PII], so that's why I was a little concerned.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, that's our other mailing address for claims. Uh, like I said, it kind of depends on the type of policy and with her policy, it's that [PII] address.
[CUSTOMER][NEUTRAL] OK and then um let's see, are you able to give me the benefits of this for this?
[AGENT][NEUTRAL] Sure. Uh, what benefits are you needing?
[CUSTOMER][NEUTRAL] Um, this is for gynecology.
[AGENT][NEUTRAL] OK, and I forgot to ask you, Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Awesome, thank you. I'm showing her effective date is [PII]. She is active on the policy.
[AGENT][NEUTRAL] And see.
[AGENT][NEUTRAL] And this is for wellness or sickness?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, give me one second and I can see.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, might be both.
[CUSTOMER][NEUTRAL] Like I mean, if she's coming in so that way we just know if we need to collect, you know, co-pays what her deductible is.
[AGENT][NEUTRAL] Oh, got you.
[CUSTOMER][POSITIVE] Obviously the wellness, yeah.
[AGENT][NEUTRAL] Well, under the plan, uh, with us, there is no deductible or co-pay. Uh, it's just a limited hospital indemnity plan that she has with us. Um, she has benefits for an office visit for sickness, but I don't believe she has any wellness benefits. Give me one moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And she doesn't.
[CUSTOMER][NEUTRAL] OK, so no wellness benefits only, um, so just regular office visits?
[AGENT][NEUTRAL] Right, for a sickness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um do you guys cover those at 100% or?
[AGENT][NEUTRAL] No, it's just a max benefit payable like for the office visit for sickness, the max we pay is up to $50 per visit and they have a total of 4 visits per year, and this is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, and then I think that might be it, but um I just needed to confirm that address, so that's good and then the payer ID is the 64556.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, that is all I needed. Thank you so much.
[AGENT][POSITIVE] Alright, you're welcome and thank you for calling APL Ms. [PII]. You have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.