AccountId: 011433970860
ContactId: dcf64d06-3f50-4898-bb84-502f9c708895
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 189440 ms
Total Talk Time (AGENT): 90488 ms
Total Talk Time (CUSTOMER): 68329 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/dcf64d06-3f50-4898-bb84-502f9c708895_20250127T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling to get information about our plan. My husband's payer ID number is 60801.
[AGENT][NEUTRAL] OK, that's the, that's the payer ID number. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] Yeah, you need the policy?
[AGENT][NEUTRAL] What's
[AGENT][NEUTRAL] Yeah, the policy er number.
[CUSTOMER][NEUTRAL] 02560769
[AGENT][NEUTRAL] And give me your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], are you on the policy?
[CUSTOMER][NEUTRAL] Yes, I'm a spouse, and we have family coverage.
[AGENT][POSITIVE] OK. Give me a good
[AGENT][NEUTRAL] OK, can I get a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, give me one moment.
[AGENT][NEUTRAL] And the and the your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And how can I help you, Ms. [PII]?
[CUSTOMER][NEUTRAL] We're calling to find out what exactly does this cover because I'm at the doctor's office right now and they say this doesn't cover doctors. This is only for outpatient things.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me look at the policy for you and then I can help you with that.
[CUSTOMER][NEUTRAL] And he, HR is telling my husband, no, it's for everything, doctors, labs.
[CUSTOMER][NEUTRAL] Everything.
[AGENT][NEUTRAL] OK. Give me one moment to pull your policy, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it, it can we can consider covered treatment in a physician's office, but the physician visit fee, which would be the co-pay, is not covered under this policy. And so there is, there is an in-hospital benefit. um, there is an ambulance benefit, um, outpatient benefit which would include um emergency room, outpatient hospital or facility, um, service and a diagnostics.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about X-rays?
[AGENT][NEUTRAL] So if, if, if X-rays are.
[CUSTOMER][NEUTRAL] So like CAT scans, stuff like that?
[AGENT][NEUTRAL] Well, X-rays can be done in a physician's office and so um we can consider the.
[CUSTOMER][NEUTRAL] Now this would be an outpatient um in a different private facilities that does uh diagnostic.
[AGENT][NEUTRAL] So is it a diagnostic test?
[CUSTOMER][NEUTRAL] It's a CAT scan, yeah.
[AGENT][NEUTRAL] OK, yeah, so that's covered under this policy as well under the outpatient, under the outpatient benefit and that amount is, one moment.
[CUSTOMER][NEUTRAL] How much does it cover?
[AGENT][NEUTRAL] The maximum
[CUSTOMER][NEUTRAL] Oh, and I'm actually gonna tell you.
[CUSTOMER][NEUTRAL] I'm gonna have to let you go cause my doctor just came in.
[CUSTOMER][NEUTRAL] So you can give me that real quick and then I'll just call back.
[AGENT][NEUTRAL] It's up, it's up to 5 it's up to $5000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and of course the information provided is.
[CUSTOMER][POSITIVE] OK. I'll call back or look online. Thank you. OK. Thank you. Bye.
[AGENT][NEUTRAL] Verification, not a guarantee of benefit and thanks for calling APL [PII]. Have a good day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you. You too, bye.