AccountId: 011433970860
ContactId: d990de69-9ef4-4ae6-adf0-2205f526cbc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219039 ms
Total Talk Time (AGENT): 103673 ms
Total Talk Time (CUSTOMER): 88344 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/d990de69-9ef4-4ae6-adf0-2205f526cbc5_20250220T15:16_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I because I need to check some benefits for a patient.
[AGENT][NEUTRAL] I can help with benefits, [PII]. What's that policy number, please?
[CUSTOMER][NEUTRAL] It is 024-04599 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. If I could have a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. You mentioned wanting to know about benefits. This has inpatient and outpatient benefits, as well as treatment within a physician. OK. So what we do is we will pick up the deductible, co-payment or co-insurance up to $500 per calendar day for office treatment or procedures. That's just the verification, the benefits, not a guarantee of payment, but it doesn't cover the office visit co-pay.
[CUSTOMER][NEUTRAL] Outpatient office.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So the office visit co-pay um is not covered.
[AGENT][NEUTRAL] That the that the treatment or procedures within the physician's office is.
[CUSTOMER][NEUTRAL] OK, so just a moment, uh, just a second, so for the specialist office visit it is not covered.
[AGENT][NEUTRAL] Not the, not the office visit co-pay, no. Um, the treatment or the procedures.
[AGENT][NEUTRAL] Within the physician's office is covered. So if she had shots or, or X-rays, um, uh, something like that, yeah.
[CUSTOMER][NEUTRAL] And, and how much they are they covered?
[AGENT][NEUTRAL] Up to $500 per
[CUSTOMER][NEUTRAL] How much the patient needs.
[AGENT][NEUTRAL] Up to $500 per calendar day and that's just a verification not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, $500 maximum per day, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, um, so for the well woman for the wellness exam is going to be the same?
[AGENT][NEUTRAL] No, this is for sickness or accident. So if, if you're uh no wellness visits are going to be covered.
[AGENT][NEGATIVE] This is just sickness and accident.
[CUSTOMER][NEGATIVE] Sickness and accidents.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why the office visit is not covered the co-payment, got it.
[AGENT][NEUTRAL] Well, the offices, yeah, the office visits aren't covered period, but right, but it did, if you, if we did pay for anything, it would be strictly for the uh.
[AGENT][NEUTRAL] Um, sickness or accident.
[CUSTOMER][NEUTRAL] OK, that this patient is going to the office because she needs to have a gynecologic ultrasound, so it is covered $500 maximum per day, right?
[AGENT][POSITIVE] That is that is correct, yes.
[CUSTOMER][POSITIVE] OK, got it, yes, got it, got it. I understand. um OK, so yes, thank you so much for that. May I have the reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] OK, as [PII].
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] And what is the the of your last name, sorry?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] [PII]. OK, and today's date. Thank you so much for that, [PII], have a wonderful day.
[AGENT][POSITIVE] OK, thanks for contacting you too have a good