AccountId: 011433970860
ContactId: c53346a9-85b0-4e78-8fec-a5555989d6a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355570 ms
Total Talk Time (AGENT): 138382 ms
Total Talk Time (CUSTOMER): 102145 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/c53346a9-85b0-4e78-8fec-a5555989d6a6_20250321T14:26_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Yes ma'am. Good morning.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] I've just got a few questions. This is new insurance coverage for me, so I've just got a few questions to make sure.
[CUSTOMER][NEUTRAL] I know what I need to know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number Mister [PII]?
[CUSTOMER][NEUTRAL] Yes, my uh group policy number is 02606398.
[AGENT][NEUTRAL] Thank you. And I need a date of birth, mailing address and email address for verification.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK thank you and the first word of that email is [PII]?
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] The first part of the email was it [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. All right, and so how may I help you with your questions?
[CUSTOMER][NEUTRAL] Um, I just need to know, uh.
[CUSTOMER][NEUTRAL] If I go to for doctor visits what my co-pay is.
[AGENT][NEUTRAL] OK. So this one doesn't have any co-pays, coinsurance or deductible because it's not a major medical. This one pays a flat amount. Um, let me go ahead and tell you how much we cover for an office visit and how many visits. Let me pull your benefits. It's gonna be a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee your payment just for verification of coverage.
[AGENT][NEUTRAL] Yeah let's see, so it looks like we cover $75 per visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maximum of 5 per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is for any office.
[CUSTOMER][NEUTRAL] So no co-pays for offices.
[AGENT][NEGATIVE] No, there's not a copay. This is just a flat amount.
[CUSTOMER][POSITIVE] OK, that's great.
[CUSTOMER][NEUTRAL] Um, how about emergency room visits? How does that work?
[AGENT][NEUTRAL] OK, the emergency room is part of that, um, office visit. So the office visit includes urgent care, ER visit, or a specialist or a regular doctor. So it's all $75 per visit.
[CUSTOMER][NEUTRAL] So if I get
[CUSTOMER][NEUTRAL] So if I go to the emergency room, it's only gonna pay $75?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] How about medication.
[AGENT][NEUTRAL] Um, when you say medication, are you talking about pharmaceuticals?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I believe this one, this particular group is with Farmvale. Let me double check. OK, one moment.
[AGENT][NEUTRAL] Yes, um, uh, this group is with Pharmavale, so they're the ones that handles the pharmacy. I can go ahead and give you their phone number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That that's, that's fine, um, but does it matter what pharmacy I go to?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not sure how they work it's a different company.
[CUSTOMER][NEUTRAL] Oh, OK, but it's under the same insurance billing, right?
[AGENT][NEUTRAL] It is through your employer, um, it is through benefits in a card, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me think. Oh.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So, so what you're telling me basically if I go to the emergency room, uh.
[CUSTOMER][NEUTRAL] And I had to
[CUSTOMER][NEUTRAL] Have surgery? What's that cover?
[AGENT][NEUTRAL] OK, the surgery is a little bit different. Let me give you the benefit for the surgery. Surgery and anesthesia benefits if the surgical procedure is cover up to $2000 and then the anesthesia benefits is 25% of the surgical benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're saying if I have surgery and it costs $15,000.
[CUSTOMER][NEUTRAL] I'm gonna pay most of that out of pocket.
[AGENT][NEUTRAL] it only covers 2000, correct.
[CUSTOMER][POSITIVE] OK, well thank you ma'am.
[AGENT][NEUTRAL] You're welcome, Mr.
[CUSTOMER][POSITIVE] Appreciate you for your time.
[AGENT][POSITIVE] No problem. Is there anything else I might help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am, that's fine.
[AGENT][POSITIVE] OK, well, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Mhm