AccountId: 011433970860
ContactId: da423225-760b-4e10-8a0f-1ed49b387259
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230839 ms
Total Talk Time (AGENT): 93545 ms
Total Talk Time (CUSTOMER): 93851 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/da423225-760b-4e10-8a0f-1ed49b387259_20250609T13:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I am calling from uh Flora Women's Care, and I wanted to see if I could get some benefits on a patient, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the policy number for that patient?
[CUSTOMER][NEUTRAL] It is 02627422 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] It looks like this policy is active and effective [PII]. And is this gonna be for outpatient benefits?
[CUSTOMER][NEUTRAL] Um, she is, um, pregnant, so it would be global maternity and uh diagnostic ultrasounds done in the office in a um.
[CUSTOMER][NEUTRAL] Inpatient
[CUSTOMER][NEUTRAL] Provider visit for delivery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it's not a guarantee of payment, basic outline of the policy. Um, so for procedures and treatments rendered in office, um, it has a benefit of 1250 per calendar year payable.
[AGENT][NEUTRAL] And the office visit itself would not be covered, but any treatment and procedure rendered in office would pay up to that 1250.
[CUSTOMER][NEUTRAL] Does that include ultrasound?
[AGENT][NEUTRAL] Yes, any services rendered in office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, um, and this is a secondary policy, so this is after primary processes the claim and we'll pick up, pay up to that amount and then for inpatients, let's see.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So for inpatient benefits, it would be for the facility and it would pay up to 2500.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] This would be for the provider, not the facility.
[AGENT][NEUTRAL] OK, um, the only benefits on this would be for the facility benefits.
[CUSTOMER][NEUTRAL] This is the
[AGENT][NEUTRAL] For inpatients.
[AGENT][NEUTRAL] So there are none for the.
[CUSTOMER][NEUTRAL] Oh, they don't they
[CUSTOMER][NEUTRAL] None for delivery?
[AGENT][NEUTRAL] For the facility there would be covered. So if the hospital bills.
[CUSTOMER][NEUTRAL] Right, but for the physician, she has no coverage.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I mean it's gonna be covered by her first one, but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Doctor delivery next.
[CUSTOMER][NEUTRAL] OK, so, um, how much of this $1,025 has she used?
[AGENT][NEUTRAL] Uh, 1250 on the outpatient. I don't show there's any, um, usage, so she has the full balance.
[AGENT][NEUTRAL] Utilize
[CUSTOMER][NEUTRAL] OK, perfect. OK, great. Um, could I, um, get a reference number, please?
[AGENT][NEUTRAL] A reference is just my name, [PII], first initial to last name, [PII], and then today's date. And anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] No ma'am, that is it thank you so much and I hope you have a wonderful day.
[AGENT][POSITIVE] Thanks for calling APL. I hope you do too. Bye-bye.
[CUSTOMER][POSITIVE] Uh huh thank you bye bye.