AccountId: 011433970860
ContactId: 38cf5719-e657-4bd6-aaaf-5aa75b42423a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332079 ms
Total Talk Time (AGENT): 117044 ms
Total Talk Time (CUSTOMER): 203923 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/38cf5719-e657-4bd6-aaaf-5aa75b42423a_20250616T15:09_UTC.wav
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[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to find out um the benefits, like how much I have left on the, on, on the insurance, like the gap insurance.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with your benefits. And first, I'll need your name and a good callback number.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] for those.
[CUSTOMER][NEUTRAL] OK. [PII], that's my name. And what do you need?
[AGENT][POSITIVE] A good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, which one, the group number payer ID?
[AGENT][NEUTRAL] Um, the outpatient certificate number?
[CUSTOMER][NEUTRAL] Like I
[CUSTOMER][NEUTRAL] Outpatient benefit certificate number. OK, got it. 023.
[CUSTOMER][NEUTRAL] 53094 M as in Mary L as in Larry 8.
[CUSTOMER][NEUTRAL] Can.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] The mailing address. I'm not sure which one you have. Is it the [PII] or the [PII]? OK. OK.
[AGENT][NEUTRAL] Yes, ma'am. That's the one that's on file.
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And uh which benefit are you verifying, the inpatient, outpatient, or office visits?
[CUSTOMER][NEUTRAL] It should be
[CUSTOMER][NEUTRAL] Well, just to see, oh, cause there's different ones.
[CUSTOMER][NEUTRAL] So, uh, OK, so I have a question for my son, [PII], cause is it for the whole family? How does it work?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] He's gonna have a colonoscopy tomorrow, but I'm just not sure if we still have benefits left.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And will he be admitted or will it, is it for an outpatient?
[CUSTOMER][NEUTRAL] she doesn't.
[CUSTOMER][NEUTRAL] It's an outpatient.
[AGENT][NEUTRAL] OK, I'm showing that for outpatient, we cover up to $2000 per calendar year per member. And let's see, that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And I'm showing that so far he's he's used $50 of the $2000.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. He, he has only used 500.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] For outpatient, OK, OK, perfect.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And how about, can you tell me for [PII]?
[CUSTOMER][NEUTRAL] For my husband.
[AGENT][NEUTRAL] OK. I'm yes, ma'am. I'm showing that so far he's used $352.80 of the outpatient benefit.
[CUSTOMER][NEUTRAL] Of the outpatient. OK, perfect. So then my son, yeah, because my son, and what's the most recent, uh, because then it's separate, so he had also the other day a ultrasound.
[CUSTOMER][NEUTRAL] So that would have gone under what?
[AGENT][NEUTRAL] Um, where did it take place? Did it take place in office or in an outpatient facility?
[CUSTOMER][NEUTRAL] It was in a, in an imaging center for Baptists, like a diagnostic imaging.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. That would, that would be covered under an outpatient facility.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] And how much what?
[AGENT][NEUTRAL] So we'll go go towards the 2000.
[CUSTOMER][NEUTRAL] But that one, have you received the claim yet or no?
[AGENT][NEUTRAL] Let's see, it was for, it took place yesterday.
[CUSTOMER][NEUTRAL] No, it took place like 2 weeks ago or a week ago, like 1 or 2 weeks ago.
[AGENT][NEUTRAL] OK, and what's the date of service? I can look it up for you to see if we have it on file.
[CUSTOMER][NEUTRAL] No, I don't have it.
[CUSTOMER][NEGATIVE] Yeah, no, I don't have the date of service, like within the last like two weeks.
[AGENT][NEUTRAL] Yeah, I'm sure.
[AGENT][NEUTRAL] OK, well, we don't have it on file. I'm showing the most recent claim was for [PII].
[CUSTOMER][NEUTRAL] Yeah, no, so then you don't have it I'm fine.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. OK, so then.
[CUSTOMER][NEUTRAL] Yeah, I guess there's a couple of claims that are pending to go through.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Thank you. And it's 2000 per person or is it the whole family?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure. I think it's per person, but I'll verify that one moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What you said [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, hello?
[AGENT][NEUTRAL] Yes, I'm still here.
[CUSTOMER][NEUTRAL] Hello. Hi. No, sorry, yeah, that I, I'm gonna need to, I'm, I have to hang up now, sorry that I came into a doctor's appointment.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, actually, it is 2000 per per per person.
[CUSTOMER][NEUTRAL] But that's fine. I think it's, it's.
[CUSTOMER][POSITIVE] Per person. OK, perfect. Thank you.
[AGENT][POSITIVE] Mhm. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye bye.