AccountId: 011433970860
ContactId: 15895a77-a34a-4a78-aa93-f3e5ef7e26a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345480 ms
Total Talk Time (AGENT): 146688 ms
Total Talk Time (CUSTOMER): 140037 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/15895a77-a34a-4a78-aa93-f3e5ef7e26a4_20250115T14:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], uh, I'm calling in regards to my benefits for the my APO plan, family plan.
[AGENT][POSITIVE] OK. I can help you with your name.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] OK. And do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] So let me see the group number?
[AGENT][NEUTRAL] Uh, go further down, it's a policy er number should start with a 0 maybe.
[CUSTOMER][NEUTRAL] The 0 for the inpatient, the outpatient or the inhospital benefit sir?
[AGENT][NEUTRAL] Give me either or the number before the elm should be the same. Give me that number.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] 0251086
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4 and then ML 8.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Let me pull up your file.
[AGENT][NEUTRAL] And verify your date of birth and mailing address for me please.
[CUSTOMER][NEUTRAL] It's [PII], and the address is [PII].
[AGENT][NEUTRAL] City, state, and zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the city?
[CUSTOMER][NEUTRAL] [PII] for.
[AGENT][NEUTRAL] OK, and what's your, what's your email address on file?
[CUSTOMER][NEUTRAL] I honestly don't know my email address on file. It, it's a family group, so I mean, I don't, I, I assume we maybe put um [PII]. I'm unsure what my father put because he's the one that set everything up.
[AGENT][NEUTRAL] OK, yeah, it is a Gmail account, but it's not the one you gave me. Which one would you like on file?
[CUSTOMER][NEUTRAL] I wouldn't want to put my email on file for sure.
[AGENT][NEUTRAL] OK, all right, all right, well thank you for verifying the information for me. And did you say you're calling regarding your benefits? Did you want benefit information or specifically what did you need?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I wanna get benefit information because I have a CT scan scheduled for my shoulder at [PII] today, so this location they're saying that the full charge would be around 1800, so the outpatient benefit, uh, say it's covered for 2000.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, per calendar year, but say I were to need surgery, for example, there would be basically nothing left over, correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And so this policy is secondary to your major medical plan and so the $2000 is for any amount your primary insurance applies towards your deductible, co-insurance and or co-pay amounts of course up to the $2000 per calendar your benefit and so it's gonna be contingent upon um how your primary insurance pay uh processes the claim based on um.
[AGENT][NEUTRAL] How much of your benefits with APL will be paid? So if they apply $2000 towards your deductible, we would reimburse that amount and then your benefit would be exhausted for the calendar year. So if you had to have a surgery, you, you would not have, will it be outpatient or inpatient?
[CUSTOMER][NEUTRAL] Uh, unsure when, yeah, if it's gonna be officially scheduled, but hopefully in the hospital, so I have more.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Money to like work with, you know, with the 6000 coverage.
[AGENT][NEUTRAL] Right, and so it just depends on how much it just depends on how your primary processes the claim as it relates to the outpatient benefit. It could exhaust the benefit, um, and if it does, then you're done. I mean it's exhausted for [PII], but of course your inpatient benefit is a separate benefit which is up to $6000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would have to be in the hospital 18 hours or greater to be considered inpatient.
[CUSTOMER][NEUTRAL] OK. I just want
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost open. I got you. Alright, I, I just wanted to verify certain things because, you know, 1800 is a little tight for a CT scan, so I was unsure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, any other questions, [PII], I can help out with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you advise maybe calling my primary insurance just to see if, if I were to need surgery for example, what kind of coverage they would.
[CUSTOMER][NEUTRAL] You know, help us out with.
[AGENT][NEUTRAL] Your Oh, definitely. You need to verify what your benefits are under any policy that you have.
[CUSTOMER][POSITIVE] Yeah, for sure. OK, I'm gonna run through, see what's up, and you know I appreciate you for the information. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. Anything else I can help out with today?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you.
[AGENT][POSITIVE] Alrighty, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Uh bye-bye.