AccountId: 011433970860
ContactId: 319d3b42-b465-4c79-90e1-bf335506bfa5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227690 ms
Total Talk Time (AGENT): 100503 ms
Total Talk Time (CUSTOMER): 64810 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/319d3b42-b465-4c79-90e1-bf335506bfa5_20250425T19:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, I, my husband has insurance with y'all through his work, and I just need to know what it covers.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01978581.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] My name is [PII] and his name is [PII].
[AGENT][NEUTRAL] And what's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And you were wanting to know what this policy covers?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date was [PII]. Any benefits given over the phone is not a guarantee of payment. This policy coordinates with the primary insurance.
[AGENT][NEUTRAL] Whatever the primary applies to his deductible, co-pay or co-insurance will pay up to.
[AGENT][NEUTRAL] 3000 per inpatient per calendar year.
[AGENT][NEUTRAL] Outpatient would be 20,250 per calendar year.
[AGENT][NEUTRAL] And for outpatient, it has $500 deductible?
[AGENT][NEUTRAL] And it does not cover office visits or anything done in the doctor's office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's just for outpatient, inpatient. It does cover urgent care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, like, uh, does it show that I had anything that like I had surgery in March of last year and then I had surgery in.
[CUSTOMER][NEUTRAL] Sep September.
[CUSTOMER][NEUTRAL] But I mean they're just now sending me a bill for the September bill the hospital is, but I don't think that they.
[CUSTOMER][NEGATIVE] Use this insurance, but I'm not positive.
[AGENT][NEUTRAL] And then this was all for 2024.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, the September was it for outpatient or inpatient?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] OK. Um, let me see, I don't.
[AGENT][NEUTRAL] See, August. I see some stuff for August.
[AGENT][NEUTRAL] That was send in a facility bill.
[AGENT][NEGATIVE] But all of those were denied because the maximum had been met in March.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So we paid out everything for outpatient for uh 2024.
[CUSTOMER][NEUTRAL] OK, all right, I understand that. OK, that's what I was wondering. I was like, I think it paid for my first surgery, but I don't know if it did anything for the second, but that's, I understand why now.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you very much for checking on that for me.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Thank you, Ms. [PII], for calling APA. Have a good day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Bye bye.