AccountId: 011433970860
ContactId: 14f2e7e1-1a63-4ec2-bc01-79a6d423d3b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687859 ms
Total Talk Time (AGENT): 192154 ms
Total Talk Time (CUSTOMER): 135510 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/14f2e7e1-1a63-4ec2-bc01-79a6d423d3b9_20250106T16:28_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] So this is a Roundtree. I'm trying to check up on my benefits and see what I have.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits. Um, may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, the policy number is.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Is that the group number?
[AGENT][NEUTRAL] Um, no, it's gonna be the policy certificate number. It's gonna start with the 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Oh, that's for in hospital or outpatient?
[AGENT][NEUTRAL] You can give me either or?
[CUSTOMER][NEUTRAL] OK, uh, this is uh the.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEGATIVE] This is 0.
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 92.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] L as in Larry 8.
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII] and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I have your policy pulled up. I just need to verify for security your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My Gmail is [PII].
[AGENT][POSITIVE] Perfect. Thank you.
[AGENT][NEUTRAL] OK. You have a specific question about the benefits or you need a breakdown of your benefits?
[CUSTOMER][NEUTRAL] I really need a breakdown of it because I just spent $500 out of pocket.
[AGENT][NEUTRAL] Oh, no problem. OK, let's see.
[AGENT][NEUTRAL] All right, and before I give you benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, for outpatient service, you have an outpatient maximum of $500. Um, this is to be used in um for ER visit.
[AGENT][NEUTRAL] For office treatments, urgent care.
[AGENT][NEUTRAL] Diagnostic centers, surgery centers.
[AGENT][NEUTRAL] Um, cancer treatment.
[AGENT][NEUTRAL] Or independent facility.
[CUSTOMER][NEUTRAL] You could that mean an images center too, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, I just had to pay $500 at the images center.
[AGENT][NEUTRAL] OK. Um, they did not take the card or it was more than 500, that's why they charged the 500.
[CUSTOMER][NEUTRAL] Uh, I think it was 500 and something.
[CUSTOMER][NEUTRAL] It was over 500.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Um, yeah, you have two options. When you pay out of pocket, either you can submit your claim for reimbursement, or either, um, whenever they send in the claim, we'll go ahead and process what um you owe to them if there's anything owed. Um, but right now that is your maximum benefit is 5 $500 per year, so, um, that is what you have available right now.
[CUSTOMER][NEUTRAL] OK, and that's outpatient, right?
[AGENT][NEUTRAL] That's outpatient, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do I file that?
[AGENT][NEUTRAL] OK. So if you're gonna file a claim for reimbursement, um, we're gonna need 3 documents that you need to send in.
[AGENT][NEUTRAL] Um, let me know when you're ready so I can give you those, um, instructions.
[CUSTOMER][NEUTRAL] Can you send that to my email and then I can have my daughter pull it down?
[AGENT][NEUTRAL] I can send you the claim form and the claim form in the first um page has instructions. Is that OK?
[CUSTOMER][POSITIVE] Yes, that'll work.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this email to you right now while I got you on the line?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][POSITIVE] OK. All right. OK, thank you so much. One moment.
[CUSTOMER][NEUTRAL] No, I can.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. Do you wanna check and see if you got the email I just sent?
[CUSTOMER][NEUTRAL] Yes, let me check and see if uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Trying to figure out, you still there?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK, I'm trying to figure out how to work this phone because it's kinda.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, came from Care temp.
[AGENT][NEUTRAL] Cain, yes.
[CUSTOMER][NEUTRAL] Yeah, I got.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] OK. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yes, what about the, uh, in-house? Do I have benefits on that?
[AGENT][NEUTRAL] Um, when you say in-house, what do you mean?
[CUSTOMER][NEUTRAL] Yeah, because it gives me, it gave me two numbers. It says in hospitals.
[AGENT][NEUTRAL] Um, yeah, the, the in-hospital is for hospitalization. If you're in the hospital 18 hours or more is considered in hospitals, and that benefit is separate from the outpatient, the in-hospital benefit is 1500 per year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Mhm. You're welcome and thank you for calling APM. Have a good day.
[CUSTOMER][NEUTRAL] Alright, alright.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have any other questions? Oh, OK.
[CUSTOMER][NEUTRAL] I'm trying to hang up
[CUSTOMER][NEUTRAL] No, I'm done. You might have to hang up because I'm trying to figure out how to work this phone.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No problem. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][POSITIVE] You're welcome.