AccountId: 011433970860
ContactId: 2412f072-c382-457b-b228-5474526bd4f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308260 ms
Total Talk Time (AGENT): 153785 ms
Total Talk Time (CUSTOMER): 147307 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/2412f072-c382-457b-b228-5474526bd4f8_20250522T20:00_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] Hi, thank you, Ms. [PII]. Um, I'm this is the 2nd time I call you all because I scheduled my husband for an MRI with and without contrast, and, uh, we have a supplemental plan with, with you all, and I just got the letter from the University of Miami where we had made the appointment for the MRI so they're telling us that.
[CUSTOMER][NEUTRAL] Um, we end up having to pay $2000 because, uh, that would be our deductible, you know, our out of pocket because the total fee is $9,491 minus the insurance covering $7,491 so we have to pay $2000 which is an awful lot of amount of money. So now that I have those numbers, I'm calling you all to see um if.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] If they don't uh want to call you all to get your information, I was told that we can file our own claim, but my concern is.
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Would we be getting reimbursed this $2000 that they're they put in the letter here or what?
[AGENT][NEUTRAL] OK, so you have a question on your benefits that you have on the supplemental policy? Yes, ma'am. Well, I can look, I can help you with that. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[AGENT][POSITIVE] OK, thank you, Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][POSITIVE] Thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] Yes, it's uh the outpatient benefit certification number is 02506133 M as in Mary, L as in lady and the number 8.
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. Please give me a moment to get your information pulled up. Once I do, I will have to verify several things with you for security purposes. So one moment.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so first off, I will need to verify, as I said several things with you for security. So first off, if you could please verify Mr. [PII]'s name and date of birth.
[CUSTOMER][NEUTRAL] Sure, it's [PII] and last name is [PII]. His date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So is his name something other than just [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] [PII] ART but yeah, maybe the [PII].
[AGENT][NEUTRAL] OK, [PII]. OK, thank you. And then your date of birth, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the whole mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we would have on file for Mr. [PII]?
[CUSTOMER][NEUTRAL] His number is [PII].
[AGENT][NEUTRAL] OK, thank you. So let's see, so any information that I do provide for you, Miss [PII] will be a verification of your benefits and not a guarantee of payment. So on this supplemental policy, the outpatient benefit maximum per calendar day for covered outpatient services is $200 with no outpatient deductible. That is the maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Again, that is a per calendar day benefit, but that is a daily benefit max of $200 for covered outpatient services.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so they're saying we're responsible for $2000 and then with your $200 we would still have to come up with the $1800 correct?
[CUSTOMER][NEUTRAL] Am I estimating that correctly?
[AGENT][NEUTRAL] Estimating yes ma'am, because again I can't guarantee payments. So for example if there was more than one claim or say for the same data service and we processed one before the other, you know, so that's why we can't guarantee payments but.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, the max per day $200 200 dollars. OK, I, I, OK, that's what I needed to know is the maximum.
[AGENT][POSITIVE] In theory, yes, that is how the plan works.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am, that's it.
[CUSTOMER][POSITIVE] OK, so that, that, that's it. All right, that helps me. Thank you so much.
[AGENT][POSITIVE] Well, you're welcome, Ms. [PII]. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that was it. Thank you.
[AGENT][NEUTRAL] Well, you're welcome and then just make sure to present them with your APL information if you haven't because most providers they will call to verify eligibility and benefits and they will file the supplemental policy but the information you were given as far as if they for some reason do not then yes ma'am you all definitely can file your own claim and if that need comes up you can call us and we'll be happy to give you the information on how to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, very good, thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling ATL. Have a nice evening.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. You too. Bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.