AccountId: 011433970860
ContactId: b3cfe732-2234-4ef3-9fe5-96cbe6950ba8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462880 ms
Total Talk Time (AGENT): 210858 ms
Total Talk Time (CUSTOMER): 256880 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/b3cfe732-2234-4ef3-9fe5-96cbe6950ba8_20250123T18:00_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hi, I'm at the, I'm at a doctor's appointment and I gave them my card and they called all the different numbers that are on my card, and none of them were available. They all were like busy for some reason. So, um, they just needed to verify my, um, verify my insurance and stuff like that. Do you think I could give you the phone to talk to them?
[AGENT][NEUTRAL] OK, um, before.
[CUSTOMER][NEUTRAL] Give them the phone to talk to you.
[AGENT][NEUTRAL] Uh, before you do that, let me have your information so I can have it ready for them. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the policy number.
[CUSTOMER][NEUTRAL] Um, is 02299380.
[AGENT][NEUTRAL] OK. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and my call back number is [PII].
[AGENT][POSITIVE] OK, thank you, Mr. [PII].
[AGENT][NEUTRAL] OK. And I need to verify your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Um, email address is [PII]. Mailing address is um [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, was that it?
[AGENT][NEUTRAL] Yes, and who am I speaking with who you're transferring the call to?
[CUSTOMER][NEUTRAL] It's me. Yeah, it's, it's, it's [PII]. I'm like, I'm gonna give the phone to the um
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The uh the person at the front desk for to verify.
[CUSTOMER][NEUTRAL] At the doctor's office.
[AGENT][NEUTRAL] OK. All right. OK. Doctor's office. OK, I'll go ahead and make a note. OK, thank you. Go ahead.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK. Hello?
[AGENT][NEUTRAL] Hello, may I have your name? Yes.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and this is the Doctor [PII]'s office. Hi, how are you?
[AGENT][POSITIVE] I'm good. How about you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Very good, thank you, thank you for asking. Hey, I'm trying to be the, yeah, I tried to get the benefits for Mr. [PII], but I'm not respectful. All the numbers are sounds like a busy. I don't know if you can help me with that, please.
[AGENT][NEUTRAL] Yeah, yeah, this is so with APL uh-huh, go ahead.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Sure, I can assist you with benefits. What type of service is being rendered, Ms. [PII]?
[CUSTOMER][NEUTRAL] Is office specific for primary care physician.
[AGENT][NEUTRAL] OK. All right. Let me go ahead and get this information for you. And this is not a guarantee of payment, just a verification of coverage. And um this particular policy is, uh, let's see, a hospital indemnity plan, um, so it pays a flat amount and it looks like we cover $75 per visit, maximum of 5 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Yeah I'm also sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I was about all that.
[CUSTOMER][NEUTRAL] Oh we'll see, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 5 office visits for calendar year.
[AGENT][NEUTRAL] Correct, yes, and we pay $75 per business.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how many visits he still have available?
[AGENT][NEUTRAL] Uh, I believe all 5. Let me double check that it started all over again this year. So let me just check on that one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My last my urgent care visit was in November of last year, so it should be the first one.
[AGENT][NEUTRAL] Yeah, I don't see that he has used the benefit this year, so um he still have all 5 available.
[CUSTOMER][NEUTRAL] Right, I.
[CUSTOMER][NEUTRAL] OK, and can you tell me another benefit please for preventing for routine physical exam?
[AGENT][NEUTRAL] We do not cover preventatives. Um, preventatives are usually covered by another company. Um, let me see if he has that company listed on the card, one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oops
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] What's the what's the prevented it for.
[CUSTOMER][NEUTRAL] Uh, for routine physical exam, to want exam to do, uh, every year to check, uh, your blood work to check cholesterol, triglycerides, A1C, all these tests.
[CUSTOMER][NEUTRAL] Do I need to do that?
[AGENT][NEUTRAL] I'm still waiting for the information to pull up, bear with me.
[CUSTOMER][NEUTRAL] OK, thank you. Um, you're supposed to have to do the physical.
[CUSTOMER][POSITIVE] Yeah, it just to check how is your help if it's nothing at normal, everything is good, yeah.
[AGENT][NEUTRAL] OK. So, uh, usually the preventative services covered by IMA, um, I can go ahead and give you their number so you can verify with them to see what type of benefits he has. But yeah, it is handled by IMA for the preventative. We only cover sickness or accidents, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 7575 I should say.
[CUSTOMER][NEUTRAL] OK, um, can I have the phone number, please? I'm ready.
[AGENT][NEUTRAL] Sure, yeah, I'm looking for it. One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. OK, the numbers to IMA um is [PII].
[CUSTOMER][NEUTRAL] We'll see you later.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I will repeat back. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] It's gonna be [PII]. The last four is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. OK, perfect. Thank you. And what is your uh phone number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our number for [PII] is [PII].
[CUSTOMER][NEUTRAL] OK, perfect. So he has also the benefits for uh preventing help or uh just to verify with he is uh.
[AGENT][NEUTRAL] Not, yeah, not, not with us. Um, we can um give out the benefits for preventative because we do not handle preventative. Um, so you can call that number to see what benefits he has for preventative. We only cover sickness or accident.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And while we're sending the claim, uh, we have to add in the ID number or the policy number.
[AGENT][NEUTRAL] OK, when you submit a claim, um, you can use the ID number. Um, it goes to IMA before it comes to us because they handle the preventative and they do the repricing through multi-plan. So, uh, all claims will go to IMA. So you can either use the the number, which is the ID number for IMA, or you can use the policy number which is the number that he provided to me, um, but it goes to uh the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK, perfect. Thank you very much. Appreciate your help. Have a wonderful day.
[AGENT][POSITIVE] You're welcome. You as well, Miss [PII]. Have a good day.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK. Thank you very much. Yeah, no problem.
[AGENT][NEUTRAL] Mr. [PII], is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Oh no, that's it thanks so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, no problem.
[CUSTOMER][POSITIVE] Thanks.