AccountId: 011433970860
ContactId: b85e82b5-fa45-4f50-8d78-e531ce4d8a62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395799 ms
Total Talk Time (AGENT): 148380 ms
Total Talk Time (CUSTOMER): 203145 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/b85e82b5-fa45-4f50-8d78-e531ce4d8a62_20250520T16:05_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, [PII]. Um, I'm trying to find out what coverage I would have. Um, I'm going to, I do have the, um, coverage through my employer. Would you need the group number first? Would that help?
[AGENT][NEUTRAL] Um, or your policy certificate number?
[CUSTOMER][NEUTRAL] Policy certificate number. OK, so I'm looking at some outpatient services and unfortunately, I'm looking at my card now and the last few digits are scratched off. So the outpatient number that I see is 018669.
[CUSTOMER][NEUTRAL] 20 and then I can't make out the next numbers they're scratched off. Can you look it up on my date of birth?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yeah, um, what's your first and last name and your date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] My name is [PII]. Last name is [PII]. It's [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] OK, I've got you pulled up. Thank you, Mr. [PII], and just need to verify, do you have a good callback number in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And then could you please verify your uh address and email address?
[CUSTOMER][NEUTRAL] So the home address is [PII] and um email is [PII].
[AGENT][NEUTRAL] Uh, looks like we might have a work email.
[CUSTOMER][NEUTRAL] Oh, OK. So you probably have my older one. they switched it all around. So perhaps you have [PII].
[AGENT][POSITIVE] Yes, that's right. Do you want to get that changed?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I think it would be better to put it um in my regular, um, so I'll give you that one again. It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, perfect. OK, and then what can I help you with today?
[CUSTOMER][NEUTRAL] So according to my coverage, and I have used this coverage before, that it covers $500 of the co-pay for an outpatient surgery center. Is that correct?
[AGENT][NEUTRAL] Uh, let me pull it up real quick.
[AGENT][NEUTRAL] Um, anything I quote is not a guarantee of payment. It's a basic outline of your policy.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's correct. $500 per calendar day for outpatient services. Yes.
[CUSTOMER][NEUTRAL] Uh, so it's per calendar day. So that kind of answers my question because what I'm getting done is, um, cataract surgery, and they do one eye, and then 23 weeks later, they do the other eye. So I'd be looking at two separate claims because it's gonna be two separate days and I didn't know if it was like per year or per month or something like that.
[AGENT][POSITIVE] Yeah, it's per day, so you would be good on each of those.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, perfect. All right. And other than that coverage, is that, what else does this cover?
[AGENT][NEUTRAL] Um, so, let's see, I believe you have an inpatient benefit. If you're ever inpatient in the hospital, let me double check.
[AGENT][NEUTRAL] Yeah, so if you're ever inpatient in the hospital, it pays up to 3500 per calendar year.
[CUSTOMER][NEUTRAL] OK, so like, in other words, because I had gone to the emergency room last on um last week. So if I get a bill, I could maybe submit it here.
[AGENT][NEUTRAL] Uh, yeah, if you were inpatient, yeah, did you stay more than 24 hours?
[CUSTOMER][NEUTRAL] For that
[CUSTOMER][NEGATIVE] No, no, it was an emergency visit and I didn't stay overnight.
[AGENT][NEUTRAL] OK, yeah, this, the actually the $500 per day also covers emergency room, urgent care facility, um, surgery, diagnostic testing, uh, physical therapy.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Yeah, and then also, um, treatments and procedures performed in office. Not the actual, not the office visit itself, but if you have treatment procedures performed in the doctor's office, this $500 per day benefit covers that as well.
[CUSTOMER][NEUTRAL] Really? So, like, is there a way I can look up on, on a website, what is covered for like different treatments?
[AGENT][NEUTRAL] Yeah, um, have you ever created an account with our online portal?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, but I can go ahead and do that if you give me the info.
[AGENT][NEUTRAL] OK, do you want me to email it over? It must be done from a laptop or desktop.
[CUSTOMER][NEUTRAL] OK, yeah, if you email it to that BabsP I'll, I'll be able to do it from there.
[AGENT][NEUTRAL] OK, I'll get that emailed over it's an instructional guide on how to set it up um along with the link to the website, um, and then you can get that set up it's a place where you can look at your policy certificate you can also upload claims if you want to file those um so just uh get that created if you have any issues at all don't hesitate to give us a call back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful. Thank you so much. I appreciate your time.
[AGENT][NEUTRAL] OK. Anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] You know, now that you say that, I just had a quick question. So when I go to the doctor, I typically, I typically have a $50 co-pay. Are you telling me like, cause that's outpatient going to a doctor's office, is that covered?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Not the actual office visit. Now, if you have any kind of procedure or treatment in office, like say an injection or maybe like a small surgery, something like that, that we would cover under that 500, but not the actual office visit.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] I see. OK, that makes sense. All right. Sounds good. Thank you so much for your help.
[AGENT][POSITIVE] OK, well, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye.