AccountId: 011433970860
ContactId: 134b5040-2152-458f-b01a-e6edb2f2e17b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745700 ms
Total Talk Time (AGENT): 263131 ms
Total Talk Time (CUSTOMER): 299130 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/134b5040-2152-458f-b01a-e6edb2f2e17b_20250117T14:59_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I'm trying to figure out I have the.
[CUSTOMER][NEUTRAL] Oh, hold on, I'm sorry. I lost the page I was on. I have a couple different policies and of course now because I'm looking for it, it's not there.
[CUSTOMER][NEUTRAL] Um, like I have the accident, cancer, the critical like.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hospital but does it reset per calendar year?
[AGENT][POSITIVE] Yeah, excuse me, I apologize.
[CUSTOMER][NEUTRAL] Or how does that work?
[AGENT][NEUTRAL] Yes ma'am, most policies are calendar year benefits. I apologize, bear with me just one moment.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][POSITIVE] Lovely winter time and allergies. I apologize.
[CUSTOMER][POSITIVE] No, you're totally fine.
[AGENT][NEUTRAL] Yeah, most of our policies are calendar year benefits, which means the benefits start over on January the [PII].
[CUSTOMER][NEUTRAL] OK, is there a way to get a breakdown of like.
[CUSTOMER][NEUTRAL] Just for instance it is accident insurance of what has been maxed out and what hasn't been maxed out.
[AGENT][NEUTRAL] Let's see, let me get you pulled up. What's your last name?
[CUSTOMER][NEUTRAL] Like the calendar year?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Really just like the hospital and the accident just to see like I'm just not sure if I was missing any of that I didn't submit for the last two years or not well last couple years or not.
[AGENT][NEUTRAL] Sure, well it would be my pleasure. And if you don't mind, I need to verify your date of birth and current mailing address, email and phone number, please.
[CUSTOMER][NEUTRAL] [PII]. The mailing address is [PII]. What was the other one?
[AGENT][NEUTRAL] Email and phone number.
[CUSTOMER][NEUTRAL] Email is [PII] and phone number is [PII].
[AGENT][POSITIVE] All right thank you I appreciate that verification.
[AGENT][NEUTRAL] Let's see, bear with me just one second. I can tell you real quick.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] For you
[CUSTOMER][NEUTRAL] Me and my kids go to the doctor's a lot.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Now, your imaging benefit has been maxed out for [PII].
[CUSTOMER][NEUTRAL] Mine and Colton's.
[AGENT][NEUTRAL] I'm gonna check Colton. Let's see.
[AGENT][NEUTRAL] Um, his ER benefit was as maxed out for the year for [PII]. Let me look at this one.
[CUSTOMER][NEUTRAL] Would it be easier to go through like just mine and then his? What's easier for you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you have the OS, the portal access for APL?
[CUSTOMER][POSITIVE] Yeah, yeah, I'm in it right now.
[AGENT][NEUTRAL] OK, when you see a claim that's been processed and it ends in a 17.
[AGENT][NEUTRAL] Like on claim 354-856-9 for you?
[AGENT][NEUTRAL] And you see the P1E0017, that 17 at the end indicates that that benefit is maxed out.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I have no clue where you're seeing that. I have like O's. I don't see like the letter P.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Am I on the wrong page?
[AGENT][NEUTRAL] No, you should be under the claims. It should be fine.
[CUSTOMER][NEUTRAL] So like the confirmation number or the claim number?
[AGENT][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] OK, so which one? I'm sorry if it ends in.
[AGENT][NEUTRAL] For example, on claim number 3548569.
[CUSTOMER][NEUTRAL] 35.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] So it should be at the top.
[AGENT][NEUTRAL] Claim ending in 856 9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We're looking at it on here. Do I see that's been maxed out, or I have to click into it to see.
[AGENT][NEUTRAL] When you, when you view that, is there, can you tell there's a payment without clicking on the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] I can see the amount paid.
[AGENT][NEUTRAL] Do you see a remark code?
[CUSTOMER][NEGATIVE] No, for that I have to open it.
[AGENT][NEUTRAL] OK, yeah, so you would have to open it.
[CUSTOMER][NEUTRAL] Like kind of opening it would tell me, but I'm just trying to see like did I miss anything like with ERs urgent care, imaging.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Surgery.
[CUSTOMER][NEUTRAL] And then for some reason his, it says like.
[CUSTOMER][NEUTRAL] Therapy was covered, but I have been trying to put in his speech therapy.
[CUSTOMER][NEUTRAL] And occupational therapy and none of those had ever like they keep being denied that kids aren't covered. I didn't know if maybe that those weren't covered too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was just making sure I really haven't been missing anything from [PII] to now starting over I'm gonna keep track of this better.
[AGENT][NEUTRAL] Let's see, bear with me just, let me get those benefits pulled up real quick too.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, physical speech or occupational therapy is, is covered, and that is 2 days per calendar year. Mhm.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] It is covered?
[CUSTOMER][NEUTRAL] OK, so I need to go back and submit that. I can do that all the way back to [PII].
[AGENT][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because for him I don't ever remember them being accepted.
[AGENT][NEUTRAL] Yeah, I don't see where we paid any speech therapy for [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He's been in it since he's been born. I don't ever remember doing his.
[AGENT][NEUTRAL] Yeah, OK, so for you, let's see what we've got.
[AGENT][POSITIVE] Give me just a second, I'm getting everything pulled up so we can look at it all for you.
[CUSTOMER][NEUTRAL] No, I'm sorry, I have a crazy request for you this morning.
[AGENT][POSITIVE] No, you're fine. No, that's what we're here for. Don't, don't worry about that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I just have a million 5 medical bills. I'm seeing if there was anything else I miss.
[AGENT][NEGATIVE] And that is so hard too, because medical cost is so high.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's crazy.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] You know what? I'll tell you what.
[AGENT][NEUTRAL] Miss [PII], do you mind holding just one moment? Let me get you to our claims department. They can look this up for you a lot quicker than I can. Would that be OK?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah, that's no problem. Yeah, that's fine.
[AGENT][POSITIVE] All right. Thank you. If you hold just one moment.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][POSITIVE] Hey, [PII], it's [PII]. How are you doing? Happy Friday.
[CUSTOMER][POSITIVE] Yes ma'am, thank you [PII] how are you?
[AGENT][POSITIVE] I'm doing good, thank you. Um, I have an insured that needs further assistance, if you don't mind.
[CUSTOMER][NEUTRAL] Certainly.
[AGENT][NEUTRAL] It's policy number 214.
[AGENT][NEUTRAL] 763 9
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have [PII] on the line, all of her information has been verified.
[AGENT][NEUTRAL] And she is wanting to know, and I, I, I'll be honest with you, I am really struggling, [PII] because I don't know what these
[AGENT][NEUTRAL] Abbreviations are 4.
[AGENT][NEUTRAL] Um, anyway, she's wanting to know if she has maxed out all her benefits for both her and [PII]. Now I did tell her that the diagnostic testing.
[AGENT][NEUTRAL] Has been macel for her.
[CUSTOMER][NEUTRAL] And she's speaking of [PII], is that right?
[AGENT][NEUTRAL] And in [PII], yeah, she wants to know each year, but what is, I'm gonna ask you, what is OASPT?
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Physical therapy.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Why didn't you say physical therapy. I'm sorry.
[CUSTOMER][NEUTRAL] I don't know the deal with the offices that the UT is urgent care, the ER is ER, but that PT is physical therapy.
[AGENT][NEUTRAL] Well, see, that's what I thought, but she was asking about physical therapy for Colton and it looks like she
[AGENT][NEUTRAL] I don't know. Can you help her?
[CUSTOMER][NEUTRAL] I can try certainly because it looks like yeah we paid PT for her in both 23 and 24. I don't see any PT for Colton but.
[AGENT][NEUTRAL] There's
[CUSTOMER][POSITIVE] But sure I'll be happy to talk with her and try to help her figure out what she's needing.
[AGENT][POSITIVE] I really do appreciate it, [PII]. Let me get her on the line. Hope you have a great three-day weekend.
[CUSTOMER][POSITIVE] Certainly, and that's her phone number that's listed. You too. I hope you have a great weekend as well. [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] [PII], yeah, you've got it.
[CUSTOMER][POSITIVE] Got it. OK, thank you, [PII].
[AGENT][POSITIVE] All right thank you one moment.
[AGENT][POSITIVE] Miss [PII], thank you for your patience. I have [PII] on the line and she's going to assist you further with those benefits used.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello. Hi there Miss [PII] my name is [PII] I'm in the claims department so I understand you have some um questions about your benefit maximum for the calendar year. Is there a particular date of service you want me to look at or um. No, I'm kinda just trying to see like what I have maxed out and what I haven't just to see if I was missing any appointments that I didn't put in. OK.
[CUSTOMER][NEUTRAL] I guess the 23 and 24 I see I really didn't do anything at 22, so those were easy to figure out. Yeah.
[CUSTOMER][NEGATIVE] OK, yeah, I don't need 22 because nothing was approve in 22, so really just for 23 and 24 what was maxed out, what wasn't just see like what I was missing for the appointment.
[CUSTOMER][NEUTRAL] She did already confirm
[CUSTOMER][NEUTRAL] My son's therapy has not been paid out for some reason his kids getting denied, so I need to do his, but I didn't know as far as anything else.
[CUSTOMER][NEUTRAL] OK imaging ER.
[CUSTOMER][NEUTRAL] Sure, hold the phone. OK, so what I'm gonna do is kinda go over each benefit with you that was paid out. So in [PII] we'll go over your claims and then we'll go over [PII]'s after. Is that OK? OK, yep.
[CUSTOMER][NEUTRAL] OK, so your office visit, you're, yeah, you're fine. So your office visits for [PII], you're allowed to, I see that we paid to.