AccountId: 011433970860
ContactId: bf174679-b8b6-420b-bd46-ab109ca36f9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264320 ms
Total Talk Time (AGENT): 93517 ms
Total Talk Time (CUSTOMER): 155095 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/bf174679-b8b6-420b-bd46-ab109ca36f9d_20250122T14:29_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for calling thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Uh, my name is [PII]. I'm actually calling because I have a couple of questions about my insurance plan and what's covered.
[AGENT][NEUTRAL] OK, what is your policy number?
[CUSTOMER][NEUTRAL] My policy number is 021 7.
[CUSTOMER][NEUTRAL] 0148
[CUSTOMER][NEUTRAL] ML 7
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] But it's not a lot of yeah.
[AGENT][NEUTRAL] I need your last name and date of birth please to start.
[CUSTOMER][NEUTRAL] Yeah, my last name is [PII].
[CUSTOMER][NEUTRAL] And my birthday is [PII].
[AGENT][NEUTRAL] Thank you sir and your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and verify your complete mailing address.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email address.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][POSITIVE] OK, thank you very much for that verification process, Mr. [PII], and how can I help you please?
[CUSTOMER][NEUTRAL] Oh, yeah. So, I have a couple of questions. Uh, am I covered for, for any procedures that I've done uh last year for dental?
[AGENT][NEUTRAL] For dental, OK. Now, this policy is actually a supplemental medical policy. It does not cover dental. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, it doesn't. OK, OK. I just wanted to make sure cause um.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, I was, because I had a procedure last year and I wasn't sure if, if I was able to make a claim for that, um, and related to um.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, bone loss that I had on my jaw, but, uh, now, the question I have for, for how the plan works, like I have a procedure done tomorrow. Um, uh, the person that's, that's, uh, working on the pain, the, you know, trying to get, uh,
[CUSTOMER][NEUTRAL] See if, if I have to pay for anything with the insurer. Um, they did say that for this year, uh, I was able to use all of.
[CUSTOMER][NEUTRAL] Uh, what's covered for the deductible, um, for the procedure because it's the procedure the deductible is about $5000. Um, my question is, uh, when does the fisc, when does the year end or how, you know, how does the plan reset, yeah, if you can explain that to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Of course, it's a calendar year policy, so it began as of [PII] as far as benefits and your outpatient benefits for the year. Um, please note verification of benefits provided does not guaranteed payment. We will pay up to $5000 for the calendar year again, it began as of [PII], um, this month, um, and of course we help with your major medical deductible co-pay and or co-insurance based on fees that they apply to those particular.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, services.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh, and, and that would just be for the calendar year. So at the at this after [PII] that will pretty much just get reset, right? Um, is there anything else that that applies for the benefits as well other other than that?
[AGENT][NEUTRAL] Well, you have both
[CUSTOMER][NEUTRAL] Or that's pretty much it, yeah.
[AGENT][NEUTRAL] You have both inpatient and outpatient benefits and both um inpatient and outpatient have a $5000 calendar year max.
[CUSTOMER][NEUTRAL] OK, OK, is that, uh, are there, are, are those are joined or they're both separate?
[AGENT][NEUTRAL] They're separate.
[CUSTOMER][NEUTRAL] The separate? OK, and then the one that I'm using for the procedure that I have tomorrow, would that be considered as um.
[CUSTOMER][NEUTRAL] Uh, outpatient
[AGENT][NEUTRAL] Yes, and inpatient, it becomes inpatient when it's 18 hours, 18 hours or more consecutive hours.
[AGENT][NEUTRAL] So if it's less than that, yes, if it's less than that then it's outpatient.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. That makes sense. And um and what you mean by 18 hours or more for inpatients like pretty much to stay out of hospital, right?
[AGENT][NEUTRAL] Correct, that's when it becomes inpatient, yes.
[CUSTOMER][POSITIVE] OK, that makes sense. OK, yeah, I think that's everything. Thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. You have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Take care. Bye.
[AGENT][POSITIVE] Take care, take care, bye.