AccountId: 011433970860
ContactId: 329ecd15-ef4c-454c-b1f2-203d1be41bf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286200 ms
Total Talk Time (AGENT): 138108 ms
Total Talk Time (CUSTOMER): 131758 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/329ecd15-ef4c-454c-b1f2-203d1be41bf7_20250131T22:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hi, this is, uh, [PII]. How are you today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] Really well thank you um I was wondering uh can we look up my claim for a moment if you don't mind please?
[AGENT][POSITIVE] Yeah, absolutely happy to help with the claim. What's the policy number?
[CUSTOMER][NEUTRAL] Uh, let's see, oops, OK, policy number 2150207. I have you on speaker since I'm at home. Is that alright or do you prefer that I pick up the phone? What works for you?
[AGENT][NEUTRAL] Oh no, I can, I can hear you all right. You're fine.
[CUSTOMER][POSITIVE] OK, all right, super, thank you, um.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let's see, uh yes, policy number.
[AGENT][NEUTRAL] Let me just get
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me just get your date of birth please [PII] and address.
[CUSTOMER][NEUTRAL] Yes, absolutely [PII]. I live at [PII].
[AGENT][POSITIVE] Alright, thank you so much and it looks like we have an MSN email address. Is that still good for you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Great, thank you.
[CUSTOMER][NEUTRAL] And it's the same telephone number I'm calling you from [PII].
[AGENT][POSITIVE] Perfect. All right.
[AGENT][NEUTRAL] So it looks like our last claim that I see here under your policy was submitted on the [PII]. Does that sound about right?
[CUSTOMER][NEUTRAL] Yes ma'am, yes, it's a continuation of the other claim because we were waiting for the explanation of benefits.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And that is um was pending and they told me that just that I didn't have to submit a brand new claim just the explanation of that.
[AGENT][NEUTRAL] Yeah, absolutely. OK, great. So yeah, it looks like the claim was processed today and so a benefit payment is being sent in the amount of $350. Um, it looks like you have direct deposit set up, so just give it a couple days to post towards your account.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK, great, so it is uh 350, that is the benefit amount, is that right?
[AGENT][NEUTRAL] Uh huh, that was the payment amount that's correct, uh huh.
[CUSTOMER][NEUTRAL] Can I ask you one more thing on my actual policy if you don't mind?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Or do I need? OK, great. Now let's suppose that later on in the year I have to have another procedure um since I already filed a claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is it only once a year, once for.
[CUSTOMER][NEUTRAL] Um, for, um, the rest of my life, or, uh, do you know, can you tell?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely. So let's see here.
[AGENT][NEUTRAL] Um, so every plan, yeah, every plan is gonna have like a limit as far as outpatient or inpatient, so your, um, member plan Arturo looks like the outpatient, which is what this was, um, benefit is 350 a calendar day.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So your plan will pay a max for outpatient services of 350 per day, so that would be every day throughout the year. Uh, you don't have an annual limit it looks like it's a daily limit.
[CUSTOMER][NEUTRAL] Oh, OK, alright, well that's good. I was panicking. I thought, oh my gosh, only one here, it's crazy, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, just the, the, uh, the inpatient is different, it's a different amount. Um, inpatient is defined as being in a facility for over 18 hours and your benefit amount for that is based off of the calendar year which is 3000. So once that 3000 was exhausted for inpatient costs, then, you know, any claims going forward of course would not be paid because that amount had been exhausted.
[CUSTOMER][POSITIVE] Got it, got it. OK, perfect. Alright, well, listen, I, that's what I needed to know. Most importantly, you told me that it is, uh, in process, so I will look forward to that money appearing in my account sometime next week then.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yeah, should be there shortly. Is there anything else I can help with today?
[CUSTOMER][POSITIVE] You've been absolutely wonderful thank you so very much and you have a wonderful evening and a great weekend.
[AGENT][POSITIVE] Oh my pleasure you too take care.
[CUSTOMER][POSITIVE] Likewise, thank