AccountId: 011433970860
ContactId: f5f5409d-7012-429a-a62c-99a049bb0880
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 201399 ms
Total Talk Time (AGENT): 86544 ms
Total Talk Time (CUSTOMER): 49965 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/f5f5409d-7012-429a-a62c-99a049bb0880_20250619T17:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to check um eligibility on a member please.
[AGENT][NEUTRAL] OK, I can check eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] 01708211 M as in Mary.
[CUSTOMER][NEUTRAL] L as in Larry 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] First name is [PII] Last name [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK, so do you guys cover the specialist copayment?
[AGENT][NEUTRAL] for an office visit?
[CUSTOMER][NEUTRAL] Yeah, specialist office visit.
[AGENT][NEUTRAL] OK, give me just a moment, let me see if that is covered under this policy.
[AGENT][NEUTRAL] OK, bear with me just a moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, I appreciate your patience and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy, office visits nor treatment received in office is going to be covered.
[CUSTOMER][NEUTRAL] So it only covered for outpatient hospital or ambulatory?
[AGENT][NEUTRAL] Uh, hospital facilities, MRI facilities, uh, physical therapy facilities, and urgent care.
[CUSTOMER][NEUTRAL] OK, and you guys will cover copay, coinsurance, and deductible?
[AGENT][NEUTRAL] And deductible, correct, uh, after major medical pays.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, what's the max um.
[AGENT][NEUTRAL] Sure, so the mhm so for outpatient, uh, this policy pays on a per calendar day basis, so it pays up to $500 per calendar day.
[CUSTOMER][NEUTRAL] I mean you guys will
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and your first name is?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Do you have a reference number for the call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial [PII]'s date, uh, so my last initial is A, it's A.
[CUSTOMER][NEUTRAL] What's your last name is [PII]?
[CUSTOMER][POSITIVE] OK, thank thank you so much for your help.
[AGENT][POSITIVE] Of course, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.