AccountId: 011433970860
ContactId: dbec5b65-8e27-4041-86ac-0e20c57359b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453109 ms
Total Talk Time (AGENT): 137531 ms
Total Talk Time (CUSTOMER): 105178 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/dbec5b65-8e27-4041-86ac-0e20c57359b2_20250312T22:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is.
[AGENT][NEUTRAL] [PII], how may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from [PII]. I just a business consultants, and I just need uh to double-check some benefits for a member, please.
[AGENT][POSITIVE] OK, [PII], I can help you with benefits for the patient. Can I please get your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] Go 3.
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please give me a second. OK. The date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number, it's 02280020.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy, and the effective date of his policy is [PII].
[AGENT][NEUTRAL] And this is just to verify that it's it's not a guarantee of payment. He has a supplemental insurance policy that is billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He has an inpatient benefit amount per calendar year of $3500 but then he also has an outpatient benefit per calendar year of $3500.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 35, OK.
[CUSTOMER][NEUTRAL] OK. So the, in this case, the plan will not cover your face, is it?
[CUSTOMER][NEUTRAL] Or in the case of the supplemental?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] It won't cover for what was the question again please? Hi, what was the question again?
[CUSTOMER][NEUTRAL] Hi?
[CUSTOMER][NEUTRAL] I, sorry, I can't hear you.
[CUSTOMER][NEUTRAL] OK. So in the case of a specialist office visit, that plan will cover or not?
[AGENT][NEUTRAL] Let me look and see if he has office visits on this policy.
[CUSTOMER][NEUTRAL] Mhm. Oh, OK.
[AGENT][NEUTRAL] I'm gonna pull up his policy real quick and read it and see what he has as far as office visits go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, this policy does not cover office visits.
[CUSTOMER][NEUTRAL] Well, I think that.
[CUSTOMER][NEGATIVE] Not covered OK.
[CUSTOMER][NEUTRAL] Um, and just to double check, in the case of outpatient surgical benefits.
[AGENT][NEUTRAL] OK, let me check to see if he has surgical benefits on this policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let's see.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's gonna be just a second while I pull up the policy certificate again and look at it.
[AGENT][NEUTRAL] Could be just a little bit it's um loading the policy for me now so I can read it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you did say it was out, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still looking.
[AGENT][NEUTRAL] It's a big policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, he does have a rider for surgery in a hospital.
[AGENT][NEUTRAL] outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] Uh, an outpatient facility. Yes. Mm.
[AGENT][POSITIVE] Good. Yes, that's on the policy.
[AGENT][NEUTRAL] OK, is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Mm, no, I think that that's all.
[AGENT][POSITIVE] OK. All right, Ms. [PII]. I hope you have a wonderful night and we thank you for calling APL.
[CUSTOMER][POSITIVE] OK, thank you so much. Bye-bye.
[AGENT][NEUTRAL] You're
[AGENT][NEUTRAL] Welcome. Bye-bye, ma'am.