AccountId: 011433970860
ContactId: 1d1af3f9-dd05-40c0-bd05-5f25ca05c2bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275660 ms
Total Talk Time (AGENT): 123937 ms
Total Talk Time (CUSTOMER): 146260 ms
Interruptions: 3
Overall Sentiment: AGENT=3.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/1d1af3f9-dd05-40c0-bd05-5f25ca05c2bc_20250219T16:40_UTC.wav
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[CUSTOMER][NEUTRAL] Getting a trip.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] How are you?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good, thank you for asking, [PII]. I'm calling because I needed to get the outpatient benefits from Mrs. [PII].
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with benefits this morning. Can I have your callback number, please?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] That's not to have it.
[CUSTOMER][NEUTRAL] Policy number 01762203 M like Mary L as in Larry and the number 8.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] And [PII], [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with eligibility and benefits for [PII]. I'm showing her policy is active. Effective date is [PII]. This is a secondary policy to the policyholders' Major Medical.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what type of benefits are you needing, [PII]?
[CUSTOMER][NEUTRAL] In order to get
[CUSTOMER][NEUTRAL] Um, what is her outpatient benefits, please?
[AGENT][NEUTRAL] She has outpatient coverage up to $500. That is a per calendar day benefit. And if you would please note that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] So if she had a procedure, let me see when she had her procedure. She had a procedure [PII], you guys will cover her up to $500?
[AGENT][NEUTRAL] The benefit amount is $500 per calendar day of course I can't guarantee payment without the claim in house, but that is her benefit amount on the policy.
[CUSTOMER][NEUTRAL] OK, and would that cover her for in office procedures or just for hospitalization? Outpatient hospital.
[AGENT][NEUTRAL] Services and the doc, yes, it's gonna be the hospital. Services in the doctor's office are not covered.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] If your family member, she wants to have a drink, she befriend. OK. Can I please have a call reference number?
[AGENT][NEUTRAL] The call reference number is my name and today's date, and I spell my name [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] Yes, really quick. So let's say she had it already, um, she used the services already. So is it gonna be, let's say she did, she did a surgery, let's say my procedure was in hospital, then she's gonna have another procedure in hospital. Would it cover that second procedure as well if it already maxed out the $500 or would that just be one time uh or, or that would be each time?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's each day. It's per calendar day. So we could cover the first procedure as well as the second if it is a different day.
[CUSTOMER][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Quickly back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But question, that's for outpatient benefits? What are her inpatient benefits?
[AGENT][NEUTRAL] She has inpatient hospitalization benefits up to $2000 per calendar year. Inpatient is considered when it's over 18 hours in a hospital facility.
[CUSTOMER][NEUTRAL] You can have 100.
[CUSTOMER][NEUTRAL] Got you. OK, perfect. Is, is, does she have a group number under her policy?
[AGENT][POSITIVE] She does. I can provide that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] 23524
[AGENT][NEUTRAL] You need the group name as well?
[CUSTOMER][POSITIVE] No, that will be all. Thank you.
[AGENT][POSITIVE] It's my pleasure, [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that will be all. Thank you so very much. Oh, let me confirm really, really quick, my apologies. The claims mailing address would that be [PII]?
[AGENT][POSITIVE] And thank you for calling A sure.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][POSITIVE] Wonderful. That will be all then. Thank you so much. You have a great day.
[AGENT][POSITIVE] Uh thank you for calling APL. You have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.