AccountId: 011433970860
ContactId: cf906804-811c-4947-9983-b226720114e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343339 ms
Total Talk Time (AGENT): 116376 ms
Total Talk Time (CUSTOMER): 120540 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/cf906804-811c-4947-9983-b226720114e6_20250205T15:02_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII] and I want to verify benefits.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] OK, sure. I can assist you with benefits, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] OK. And where are you calling from?
[CUSTOMER][NEUTRAL] What do you mean where I'm calling from? My cell phone?
[AGENT][NEUTRAL] Um, yes. No, no, you're calling from a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] 00 yeah, I know, it's my personal policy. I'm in a provider's office in a dermatology office specialist, and my understanding is I have 4 specialists a year that you guys cover.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And she's saying that you guys said something different, so I'm calling to verify.
[AGENT][NEUTRAL] OK, and may I have your date of birth for security?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. And may I have the mailing address and email address on file for verification.
[CUSTOMER][NEUTRAL] [PII] and the email address is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me pull up your benefits one moment.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So I'm supposed to get 4 office visits a year specialists that you guys need.
[CUSTOMER][NEUTRAL] And the year just started.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK, let me check the certificate, OK?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see that. Yes. Um, and this is the specialist that we cover up to $50 maximum of 4 visits.
[AGENT][NEUTRAL] Yes, um, do, do you want me to, do you wanna get the representative on the line? Yes, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I do. She's great. I'm gonna hold on.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] She may have uh given the wrong.
[CUSTOMER][NEUTRAL] Since there's an inpatient number and an outpatient number, she may have given the wrong one, and that's why they told her something different.
[AGENT][NEUTRAL] OK, that's fine. Yeah, I can go ahead and let her know.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm so sorry someone got in front of me, so no, just a second.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, because I'm.
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] OK, so you guys don't need it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but I can.
[CUSTOMER][NEUTRAL] OK, she's on speaker.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, this is So with APL. Um, Miss, um, [PII] just called because we have given information about her benefits, and I do see she has an additional office visit rider that does allow $50 per visit for the co-payment up to 4 visits per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you, the secondary does cover for um specialist office visit um.
[AGENT][NEUTRAL] Yes, up to $50 per visit, maximum of 4 visits per year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Give me 1 2nd, let me pull up her chart.
[AGENT][NEUTRAL] Right, one month.
[CUSTOMER][NEUTRAL] We can
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, up to $50 per office visit, right?
[AGENT][NEUTRAL] Yes, uh, this is a specialist, correct, because it's a dermatology. So, um, yes, it's $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maximum 4 visits per calendar year.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] All right, thank you. I'm not sure why I had a different information.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] It's OK, no problem. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][NEUTRAL] Mhm. You're welcome. Thank you for calling APL. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] No, ma'am, thank you very much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Yeah.