AccountId: 011433970860
ContactId: 44d032c5-3a82-4827-b4af-b2552f53f704
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 659969 ms
Total Talk Time (AGENT): 194329 ms
Total Talk Time (CUSTOMER): 163138 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/44d032c5-3a82-4827-b4af-b2552f53f704_20250324T16:23_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have a question about coverage for my vision therapy. I recently filed a series of claims, and I received a check, and I wanted to go over benefits or I wanted to better understand uh the payment on this.
[AGENT][NEUTRAL] OK, what is your policy number?
[CUSTOMER][NEUTRAL] It's 02600713.
[AGENT][NEUTRAL] OK, give me one moment please sir.
[AGENT][NEUTRAL] And may I have your name and date of birth to start please?
[CUSTOMER][NEUTRAL] My name's [PII]
[CUSTOMER][NEUTRAL] Uh [PII], last name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much sir and may I have your call back number in the minute we are disconnected please?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you, verify your complete mailing address.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] It's called [PII].
[AGENT][NEUTRAL] Thank you. And the last thing to verify, please, Mr. [PII] is your email address.
[CUSTOMER][NEUTRAL] Um, I think I gave you [PII].
[AGENT][NEUTRAL] Yes, that is what is on file. Thank you for the verification process, and you're calling in regards to your benefits, OK, and how a claim was paid. OK, I see the last claim that we processed processed on the [PII]. OK, that one claim, give me one second, this one call.
[AGENT][NEUTRAL] Let me get that pulled up.
[AGENT][NEUTRAL] One moment, so just please bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so that was a payment of $150 that was paid $150.
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] I'm sorry, it's gonna be delayed. Just need to get this pulled up.
[CUSTOMER][NEUTRAL] 9206.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I see, uh, I'm sorry, thank you so much again for your patience. OK, it shows that we made a max well a payment of $150 for this particular claim.
[AGENT][NEUTRAL] And how can I help you in far as far as the um the benefits?
[AGENT][NEUTRAL] 2217.
[CUSTOMER][NEUTRAL] Um, I, when I opened this policy, we went through the provider, the diagnosis, and the pricing for, uh, some of the therapy, and I went over the.
[CUSTOMER][NEGATIVE] All of this with the fellow who had brought the policy from and they told me that this would be 100% covered and there was no max on this and um this person uh Doctor [PII] was in network and now I have uh you know I've got 7 or so visits here and this claim has reached its maximum so I'm just wondering how that's possible.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I place you on hold please, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Ferring.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], uh, I'm not sure how I got you, but I have an insured on the line. He's calling in regards to I was trying to call the HIQ.
[AGENT][NEUTRAL] That's what I was trying to do, but it came to you, um, so I'm not sure if you'll be able to assist the young man, but, um, he has some questions in regards to benefits for an HI-17 policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, yeah.
[CUSTOMER][NEUTRAL] HI 17. OK, and what's his name and policy number?
[AGENT][NEUTRAL] The policy number is 2, I'm sorry, the name is [PII].
[AGENT][NEUTRAL] And the policy number is 2600713.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have verified the information and his callback number is when you're ready for that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, you can go ahead and put him through and I'll, I'll do my best to answer his benefit questions.
[AGENT][NEUTRAL] OK, and also the claim number is 357-7377 which is the only one that was processed. OK, alright, um, again I was trying to call the HIQ, yeah, I'm sorry, I'm so sorry.
[CUSTOMER][NEUTRAL] 353.
[CUSTOMER][NEUTRAL] Uh huh, yeah, so all the, no, it's OK, all the calls roll over to us now, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Unless it's like something special so we get almost everything at and they're gonna open a new queue every month to come to us rather than the queue that it's in.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Oh Jesus, OK. I'm sorry.
[CUSTOMER][NEUTRAL] Yes, so there's some changes. That's why you got it. That's OK. It's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry to. OK, so here he comes, um, again, this is, um, he's trying to realize why we didn't pay or why it wasn't he, he's on the impression there is no limitation on this, um, this policy. He's with BWA, OK, again this HR plan. Alright, OK [PII], alright honey, one moment.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you want to know why his claim parts of his claim was denied is that.
[AGENT][NEUTRAL] Yes, yes, he said on he was on the impression that it would pay for everything, of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh wow, OK.
[AGENT][NEUTRAL] But there's limitations, yeah, OK, OK, [PII], I'm sorry ho[PII], right honey, right, one moment.
[CUSTOMER][POSITIVE] That's all right, go ahead.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Mr. Mr. [PII], sorry about that hold. OK, thank you so much for your extremely patience with me. Um, I have Miss [PII] on the line. She's going to assist you further, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] Alright sir you have a great day and thank you for calling APL.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right thanks so much.
[AGENT][POSITIVE] Take care bye bye.