AccountId: 011433970860
ContactId: 29abe1c9-1bee-4a9d-9ec1-7f95de0f27cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870440 ms
Total Talk Time (AGENT): 356172 ms
Total Talk Time (CUSTOMER): 221235 ms
Interruptions: 4
Overall Sentiment: AGENT=2.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/29abe1c9-1bee-4a9d-9ec1-7f95de0f27cd_20250106T23:02_UTC.wav
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[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] So the question, can you tell me what the um
[CUSTOMER][NEUTRAL] Uh, gap 3000 option 2 is.
[AGENT][NEUTRAL] Um, yeah, let me take a look for you, you said gap 3000 option two?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, and do you know um the name of your, it's it's I'm assuming being offered through your employer?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] San [PII] and Poey under Questco.
[AGENT][NEUTRAL] Alright, give me just a minute. I'm gonna see if I can pull up the brochure for their benefit offer. One second.
[AGENT][NEUTRAL] And one more time the name of that group.
[CUSTOMER][NEUTRAL] Um, [PII] and [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, I'm not seeing any copies of the brochures for that one on file. I'm so very sorry, um.
[AGENT][NEUTRAL] I am really sorry I guess I I don't have any way to see what the offer is um to be able to talk you through it or help you through it but somebody in your HR should have a contact number for somebody who can't because every time we we have enrollments go out um there's somebody who knows all of the product information that should be working with your group and they might be able to get you in contact with that individual.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I mean, so it's.
[CUSTOMER][NEUTRAL] It's something that you just don't have an explanation. I don't understand, I guess.
[AGENT][NEUTRAL] Yeah, so like what I can do is if you already have a policy with us and a policy number, I can pull up your policy and I can talk to you through your benefits for policies that are like going out to new groups and they're getting offers and signing up for those policies. They're not in my system yet because like no it hasn't been signed up for and so I don't have access to what we offer different insurances to every group, so no group is the same, no set of insurance is the same.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I guess if that makes sense like every employer gets a different package than the next employer than the next employer so I can't know without being able to see it and at this stage.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yeah, I got you.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um, at this stage, I don't have it in my system to see it, but there is somebody, every time we offer insurance with somebody and you're in this stage, there is a dedicated person who is set to be working with your group who can go over all of those benefit information, and your group representative, your HR representative should be able to get you in contact with that individual.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, I wish I could see like a copy of it so I could talk to you about it.
[CUSTOMER][NEUTRAL] I, I'm asking I was just, I, so.
[CUSTOMER][NEUTRAL] Well, there's a gentleman at work that I do all of his stuff. They don't have the home computer. They don't have an email, him and his wife, so he's a little, you know.
[CUSTOMER][POSITIVE] So I just, I do like his Aflac and stuff like that and I found out the other day that he has this gap insurance he's been paying for since [PII] I think.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] And so he was just uh.
[CUSTOMER][NEUTRAL] Attacked by a dog and they had to redo his lip and everything. So anyway, I submitted those forms.
[CUSTOMER][NEUTRAL] And they didn't pay on it because it was outpatient so I thought, well, I don't know what I have the 5000.
[CUSTOMER][NEGATIVE] APL gap. I, I use that one quite often, but um he doesn't um I don't know what the 3000 is or what it pays because I'm paid for hospital and all that so I don't know.
[AGENT][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEUTRAL] But my HR should be able.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] His particular benefit is, is that it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, unfortunately, so it, so it sounds like he already has a policy and we're trying to figure out what the difference between the two policies is, or at least why his policy didn't pay on it. Is that correct?
[CUSTOMER][POSITIVE] Correct, that is correct.
[AGENT][NEUTRAL] OK, OK, I'm understanding you a little clearer now. I'm so sorry. I thought this was for a new policy that you were signing up for and you just weren't sure exactly what it was. OK, I understand. So, um, I would need to, I could definitely help you with that, but what I would need is I would need to be on the phone with you and the insured long enough for him to give me his information, allow me to verify him, and then to give me verbal authorization to speak to you on his account.
[CUSTOMER][NEUTRAL] I'm sorry. I should have started with that, I guess.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] And then once he verifies his information and gives you gives me permission to speak to you I would be able to go over any of that with you but I would have to speak with him first. Is that OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's fine. Yeah, yeah.
[AGENT][POSITIVE] Perfect, is that something we could set up right now or um do we need to like arrange a time to like call back and do it? OK, perfect.
[CUSTOMER][NEUTRAL] You want
[CUSTOMER][NEUTRAL] Yeah, let me
[CUSTOMER][NEUTRAL] Let me get him on the line, hold on.
[AGENT][POSITIVE] OK, perfect. Thank you, thank you.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Go to yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just to get this
[CUSTOMER][NEUTRAL] I hang up at you. I'm sorry.
[AGENT][POSITIVE] No worries, um, I will, do you have a good callback number if I did I get one from you? Can I get a good callback number from you in case we get disconnected?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, this is [PII] and whom am I speaking with my friend?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] All right, [PII], I hear we're trying to help you sort out some information on a recent claim. Um, do you happen to have your policy number handy?
[CUSTOMER][NEUTRAL] Oh, he doesn't. I probably have.
[AGENT][NEUTRAL] OK, yeah, um.
[AGENT][POSITIVE] If you have it, ma'am, I can definitely take it that way.
[CUSTOMER][NEUTRAL] Yeah, let me pull over real quick. Sorry, I'm driving like, uh, let me just start.
[AGENT][POSITIVE] No, no worries.
[CUSTOMER][NEUTRAL] Alright, hold on.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, his policy number is 165.
[CUSTOMER][NEUTRAL] 35997.
[AGENT][NEUTRAL] All right, I do see that, [PII], thank you. And if you could verify for me, I know, I'm sure you just said this. I'm so sorry if I didn't remember it, but your last name and your date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] [PII].
[AGENT][POSITIVE] Wonderful, [PII], and I'm gonna have you just verify your mailing address with me if you can as well.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and lastly if you could just verify that phone number on file with me.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Perfect. And do you give me permission and then ma'am, I never caught your name. I'm sorry.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I'm sorry, I'm [PII].
[AGENT][NEUTRAL] [PII], thank you. Uh, [PII], do you give me permission to speak to [PII] um on your behalf for this account?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, perfect. Um, all right, and then I really appreciate that, [PII]. You're welcome to stay on the line if you'd like to. Um, if not, that's OK. I can also speak to just [PII] now at this point, um, whatever you prefer. And Ms. [PII], let me
[AGENT][NEUTRAL] Let me pull up that claim. It looks like it was from Mission Trail Baptist Hospital. Is that the right one I'm looking at?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] You need to get back to work. Yes, I got a customer waiting on me. Thank you [PII]. Thank you, ma'am.
[AGENT][POSITIVE] My pleasure. Thank you, [PII]. You take care.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] All right, so it looks like all we need is just a little more information, um, so we're needing just a copy of the explanation of benefits from the primary insurance carrier and then we're needing a diagnosis code, um, and I'm so sorry about that. um, and once we have that information, the diagnosis code, and then the explanation of benefits, we'll be able to continue, uh, processing the claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK. I wasn't sure. Usually they tell you that, but.
[CUSTOMER][NEUTRAL] I don't know. It just said uh out outpatient.
[AGENT][POSITIVE] Yeah, I'm so sorry that wasn't clear, but absolutely.
[CUSTOMER][POSITIVE] So his is good for.
[CUSTOMER][NEUTRAL] Anything that pretty much.
[AGENT][NEUTRAL] It looks like he has outpatient benefits, yes, um, his, let me pull it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] And his wife is on there, [PII] as well.
[AGENT][POSITIVE] Yes, it is a couple's account, yes, absolutely, and they definitely have outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, cool. I didn't know you could do that. I had my husband on it.
[AGENT][POSITIVE] Oh my goodness, yeah, well, I think you can go ahead if you call your your.
[CUSTOMER][NEUTRAL] What's what's that?
[AGENT][NEUTRAL] HR person they might be able to add him in. I don't know if you have to wait for open enrollment or if they'll just do it for you but.
[CUSTOMER][NEUTRAL] Oh yeah, and my husband.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And then was there anything else I could help you out with today, my friend?
[CUSTOMER][POSITIVE] No ma'am, thank you so much for all your help though.
[AGENT][POSITIVE] Oh, it's my pleasure. Thank you so much for your patience while I took too long to realize what you had needed, but I'm so glad I was able to help you, [PII].
[CUSTOMER][NEUTRAL] And you. Bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] They tell me at work I always start in the middle of a conversation.
[AGENT][NEUTRAL] That's OK. You gotta, you gotta get us on a hook, like you, that's how you write a novel.
[CUSTOMER][NEUTRAL] They always tell me that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alright well you have a good evening.
[AGENT][POSITIVE] Oh, it's my pleasure. You take care. Thank you, [PII].
[CUSTOMER][NEUTRAL] Alright you too uh huh bye.
[AGENT][NEUTRAL] Bye bye.