AccountId: 011433970860
ContactId: 24b2e65c-7443-4103-99f3-67fc6774180a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376679 ms
Total Talk Time (AGENT): 136707 ms
Total Talk Time (CUSTOMER): 187161 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/24b2e65c-7443-4103-99f3-67fc6774180a_20250506T21:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Li. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII]. Um, I got a statement from y'all and um I had a question about it. It says on the statement it says office visits are not covered by the above number policy.
[CUSTOMER][NEUTRAL] And I was wanting to try to find out what that exactly means because I wasn't sure on that.
[AGENT][NEUTRAL] OK. May I have your name and then your policy number? I'm sorry, your policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, OK, my name is [PII] and the policy number is 02301 yeah I'm sorry, yeah, 01 and then 027. I'm sorry, so it's 02301027.
[AGENT][NEUTRAL] Thank you. And may I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And could you verify your date of birth for me?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address that is listed on file.
[CUSTOMER][NEUTRAL] Yes ma'am, that is [PII].
[CUSTOMER][NEUTRAL] Again, that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And it does look like we have an email address as well. Would you like to verify that to make sure it's correct in our system?
[CUSTOMER][NEUTRAL] Absolutely, um, email address should be [PII].
[AGENT][POSITIVE] OK, and we do have that and thank you so much for verifying your policy and I'm pulling that information up for you now.
[AGENT][NEUTRAL] And do you happen to have that claim number?
[CUSTOMER][NEUTRAL] Uh yes ma'am I do. The claim number is 3595082.
[AGENT][NEUTRAL] OK, and I'm pulling that information up for you now.
[AGENT][NEUTRAL] So it is showing stating that you do not go ahead.
[CUSTOMER][NEUTRAL] I guess my main thing.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] It's showing that for the office visit, which is the office visit copay that this policy does not cover that procedure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, so, um, what do they cover? I mean, the, the, I mean, I know you couldn't give me all the details, but.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I was trying to figure out what the deal is with this and why it does not cover the um.
[CUSTOMER][NEUTRAL] Standard uh office uh visits.
[AGENT][POSITIVE] OK, I can pull that up for you.
[AGENT][NEUTRAL] So for your policy that was chosen it did cover it does show that you do have the office procedure benefit writer but you don't have the office fee benefit rider.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So, we can only pay for the office procedure or any services rendered within the office, not just the office fee.
[CUSTOMER][NEUTRAL] OK, um, what would I have to do to change that to, I, I mean, would it cost a whole lot, the difference in price to actually change that?
[AGENT][NEUTRAL] I'm not actually sure on the difference in price, but it's based off of your HR department. You will have to speak with them in regards to that and would you like for me to give you the benefits for your office procedure?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, if you can let me grab a pen right quick. I got one somewhere here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, yes ma'am, OK.
[AGENT][NEUTRAL] OK, and so in regards to your benefits, verification of coverage does not guarantee the payment of the claim. For your office procedure, you do have up to $5700 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay for the procedure. You do not have the office fee benefit rider, so that is considered still your responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today Mr. [PII]?
[CUSTOMER][NEUTRAL] OK, so you said we do not have the um I'm sorry, I, I was trying to write that down.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The office visit.
[CUSTOMER][NEUTRAL] The the thing that we do not have.
[AGENT][NEUTRAL] Yes, the office visit benefit writer.
[CUSTOMER][NEUTRAL] OK, office visit benefit writer.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is that spelled R Y D E R?
[AGENT][NEUTRAL] R I D E R.
[CUSTOMER][NEUTRAL] Oh, I, I'm sorry, I'm sorry thank you I appreciate that help there. OK, um, that's all I, I'm just trying to, I know I'm paying out a good bit for insurance and different other things and I'm just trying to narrow down what's going on because I know I keep winding up with um uh issues when I go to the doctor because they keep telling me that that you know they're they're not accepting any or don't have any fees for me so I was trying to figure out what's going on there.
[AGENT][POSITIVE] Yes. That's no problem.
[CUSTOMER][NEGATIVE] And then I wind up getting a bill and I'm like, OK, well if I didn't get to have a fee to pay when I went then you know like a copay, then I was wondering why am I getting a bill if I don't have a copay because that's what they keep telling me when I go to my little my primary doctor.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So I was just trying to figure figure all this stuff out.
[AGENT][NEUTRAL] OK, it's no problem, but you're more than welcome to check with your HR department and see if you do have the option to add that benefit on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, well I sure appreciate your help thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life and is there something else I can assist you with?
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No ma'am that's everything for right now I appreciate it and I hope you have a great afternoon.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Same to you and thank you so much.
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.
[AGENT][NEUTRAL] Bye.