AccountId: 011433970860
ContactId: 1fe4459a-5263-469e-b219-350c3ec47a78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298250 ms
Total Talk Time (AGENT): 122219 ms
Total Talk Time (CUSTOMER): 140762 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/1fe4459a-5263-469e-b219-350c3ec47a78_20250603T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, it's [PII] in billing. How are you?
[AGENT][NEUTRAL] I'm good, [PII]. How are you?
[CUSTOMER][NEUTRAL] So I have a, a group admin on the phone. She's asking about benefits for an individual. Um, she's talking about deductible and coverage, and I just, I'm billing and I don't know anything. I don't wanna misinform her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. No, no worries, [PII]. Do we have the um insurance policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. So the policy number is 2437875.
[AGENT][NEUTRAL] All right, [PII], I'm sorry. Read that one read it one more time. My, my.
[CUSTOMER][NEUTRAL] For Ms. [PII].
[CUSTOMER][NEUTRAL] Sure. 4 243.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7875. I think there's a slight delay. I apologize.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's OK. My phone's been like delay like all day.
[AGENT][NEUTRAL] OK. [PII]. OK. And um who are we talking to, ma'am?
[CUSTOMER][NEUTRAL] So I have [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] is on the phone with the group and I've already um verified her and everything.
[AGENT][POSITIVE] OK awesome you can go ahead and send him on over.
[CUSTOMER][NEUTRAL] All right, one moment.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Hi this is [PII] over in.
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] This is [PII] in billing. I was just gonna let you know I've got [PII] on the phone with our care team, and she's gonna help you out with those questions.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Thank you. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Hi, this is [PII] over in the customer care department. How are you doing today?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][NEUTRAL] Good, um, so I'm understanding that you needed benefits on the member plan. What sort of benefits were you needing uh to go over?
[CUSTOMER][NEUTRAL] OK, so I have an employee that has a medical policy and her medical policy has $500 deductible.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But her gap insurance is under a $5000 deductible.
[CUSTOMER][NEUTRAL] So my question is because there is, um, you know, a difference in price, my question is, is she, is she covered up to the 5000?
[CUSTOMER][NEUTRAL] On her policy or is, does her policy have to match the deductible on her medical?
[AGENT][NEUTRAL] So it doesn't need to match the deductible on the metal do you know if the um procedure surgery that they're having is inpatient or is it outpatient?
[CUSTOMER][NEUTRAL] No, I, I, she's not having anything. I'm just questioning because I've noticed, I just noticed that our her.
[CUSTOMER][NEUTRAL] Invoice is covered for like $73 a month and that's the price of a $5000 deductible but I know that her her policy only covers up to $5500.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Her medical policy is only a $500 deductible, but her gap insurance is up to $5000.
[AGENT][NEUTRAL] OK, let me double check.
[CUSTOMER][NEUTRAL] So I just wanted to make sure she was OK.
[CUSTOMER][NEUTRAL] I, I was always under the impression that the gap had to had to match.
[AGENT][NEUTRAL] Yeah, let me
[AGENT][NEUTRAL] So yeah I mean our plan picks up the deductible co-pay coinsurance that the primary does not and so the patient's plan it looks like covers up to 5000 inpatient for the calendar year. um I don't see any sort of.
[CUSTOMER][NEUTRAL] But I may, I might be.
[AGENT][NEUTRAL] Deductible though on the plan.
[CUSTOMER][NEUTRAL] Well, it'll cover, it'll cover up to a $5000 deductible and that includes payment and everything?
[AGENT][NEUTRAL] Well, that would be under like their inpatient services. Their benefit max is 5000, so that's the most that it's gonna cover under inpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then anything outpatient it's gonna cover up to 25 so we pick up the deductible co-pay or co-insurance from the primary up to that amount. If their deductible is 50 and it's considered under inpatient, then that would leave their benefit remaining amount $4500 for the year still.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] Anything else I can help with?
[CUSTOMER][POSITIVE] As long as she's she's covered properly. No, that'll be it. Thank you.
[AGENT][POSITIVE] You're welcome have a nice day.