AccountId: 011433970860
ContactId: 21a07e73-fa06-4bb5-a7da-a5ee628b5634
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461959 ms
Total Talk Time (AGENT): 278839 ms
Total Talk Time (CUSTOMER): 158483 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/21a07e73-fa06-4bb5-a7da-a5ee628b5634_20250331T18:32_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Who's this? [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], um, hi [PII], this is [PII]. I'm a member and I wanted to find out if [PII] is in office today, please.
[AGENT][NEUTRAL] I'm sorry, of whom is in office, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Uh, I can check for you. What's a good callback number for you, Mr. [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Sure, I do. It's 01867004.
[AGENT][NEUTRAL] OK, thank you. So let me get your policy information pulled up first because I will have to verify some things with you for security and then I'll be happy to see if she's available. So first off, Mr. [PII], can you please verify your date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mr. [PII], are you still there?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, I don't know what happened a while ago. I didn't.
[AGENT][NEUTRAL] OK, and your home mailing address, I, I wasn't able to hear anything you said, Mr. [PII]. What is your, that's OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And the phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, thank you. And then the last piece of information is gonna be your email.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you, Mr. [PII] for verifying all of your information. OK, so [PII] is out of the office today.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] OK, all right, maybe you can help me, yeah.
[AGENT][NEUTRAL] Is there something I could possibly help you with?
[CUSTOMER][NEUTRAL] I'm doing um a surgery next week outpatient for my eyes.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I think um they said they had contacted you guys already but I just want to verify that um there's a payment of $500 I guess they I guess they would have to submit it to you guys but I just want to verify that with you guys. They say that they called you guys and verified it already.
[AGENT][NEUTRAL] OK. So any information, yes, sir. So you have a question as to about an outpatient surgery you're having, is that right?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] That is correct, correct.
[AGENT][NEUTRAL] And the benefit, OK, yes, I can help you, and any information that I provide for you on that would be a verification of benefits and not a guarantee of payment, Mr. [PII]. So you do have an outpatient benefit maximum on this policy of $500 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] With no outpatient deductible. Now they will obviously, as you just stated, they do have to file the claim, you know, in order for us to review it to determine the eligibility of it, um, and they will file it with your primary insurance company first and then with APL because we always have to have a copy of your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When reviewing claims, now, I
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] I'm looking on your history of your notes.
[AGENT][NEUTRAL] And I don't see that they're um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Give me just a moment to look through, but I don't see where we've spoken to anyone recently.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Look again.
[CUSTOMER][NEUTRAL] Well, [PII] said that they spoke to you guys, so I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's that.
[AGENT][NEUTRAL] Uh, let me see, just a moment.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It's a I institution [PII].
[AGENT][NEUTRAL] Now, the last, yes, I, I.
[AGENT][NEUTRAL] I don't know. There was someone who called from a provider's office to verify your outpatient benefits that was done back on [PII].
[CUSTOMER][NEUTRAL] [PII]. That, that's probably there, from a doctor's office, you said?
[AGENT][NEUTRAL] Mhm. So that may be.
[AGENT][NEUTRAL] Yes, yes, sir. Uh-huh. I just don't know which do I don't.
[CUSTOMER][NEUTRAL] Did they say what doctor? Is it Doctor [PII]?
[AGENT][NEUTRAL] I don't have that information.
[AGENT][NEUTRAL] Looks like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], yeah, that's her. Mhm.
[AGENT][NEUTRAL] [PII], is that her? OK. So yes, so she did call back in on [PII].
[CUSTOMER][POSITIVE] Mm mhm that's right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now one question for you, Mr. [PII], have you ever set up your profile in our portal called the online service center?
[AGENT][NEUTRAL] That's where you can have access to your information online and be able to see claim status and have access to your ID cards and your policy information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know, I don't remember.
[AGENT][NEUTRAL] OK, well, I have a
[CUSTOMER][NEUTRAL] I have this for so many years.
[AGENT][POSITIVE] Yes, sir. Well, I have a user guide for our portal, Mr. [PII], that I'll be happy to email to you and that way if you would like to set that up you'll have the instructions on how to go about doing that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That'd be good. Thank you so much.
[AGENT][POSITIVE] Well, you are very welcome. Yes, indeed. So is there anything else that I can help you with this afternoon?
[CUSTOMER][NEUTRAL] That's it. Is, is there anything pending in my.
[CUSTOMER][NEUTRAL] Anything pending on.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] On you guys' side to be paid out and.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Thing I've been submitted, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The Latin, let's see.
[AGENT][NEUTRAL] Uh, give me just a moment.
[AGENT][NEUTRAL] No, sir, not at this time. We have processed anything that has been received as of now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] And yes sir and once you set your profile up to in your portal you'll have access to the most, you know, recent claims that we have and your explanation of benefits for APO will also be in there.
[AGENT][NEUTRAL] And that email that I'm gonna send to you, Mr. [PII], which I am gonna send in just a couple of minutes, it will come from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will put APL uh in your subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else I can help you with?
[CUSTOMER][POSITIVE] That sounds good.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, Mr. [PII]. Well then, thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yes, sir. You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.