AccountId: 011433970860
ContactId: 47003fb1-77c5-4436-8fbb-a0ef26c168eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274309 ms
Total Talk Time (AGENT): 100348 ms
Total Talk Time (CUSTOMER): 117954 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/47003fb1-77c5-4436-8fbb-a0ef26c168eb_20250610T15:28_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII]. I'm calling to see what kind of benefits I'm eligible for.
[AGENT][POSITIVE] I'd be happy to assist with your benefits if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] Ah, um.
[CUSTOMER][NEUTRAL] That might be an issue. One second here.
[AGENT][NEUTRAL] Um, we can use your social, that's fine.
[CUSTOMER][NEUTRAL] Yeah, that's just let's just do that. My social is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, and if you can please verify your date of birth and email address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] Alright, please be advised the verification of coverage is not a guarantee of payment. I do show the policy is active, effective date [PII].
[AGENT][NEUTRAL] And I do show that we are your gap insurance. We work in conjunction with your major medical to cover your patient responsibility, and I'm showing for outpatient your percurrence maximum is $500 and for inpatient the per occurrence maximum is $2500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yes, what I'm, I'm having an outpatient surgery done on my wrist.
[CUSTOMER][NEUTRAL] And I, I'm, I'm taking like 12 or 8 to 10 weeks off, so, um, now that, that 500, what is that for? Is that to pay a doctor bill?
[AGENT][NEUTRAL] Correct if we um I guess.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess
[AGENT][NEUTRAL] For like, once um they file the claim with your major medical?
[CUSTOMER][POSITIVE] Absolutely
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they assigned the pay whatever your co-pay or co-insurance or deductible is, um, we would pay up to $500.
[CUSTOMER][NEUTRAL] Right, OK, yeah, because I owe like I think I have a $1300 down payment before my surgery.
[CUSTOMER][NEUTRAL] Uh, would you, and that's what you were, and, and you would give $500 towards that, is that what you're saying?
[AGENT][NEUTRAL] It will be right after the fact, um, cause we won't get the claim until after it goes to your major medical, but yes.
[CUSTOMER][NEUTRAL] Right, right, right, right.
[CUSTOMER][NEUTRAL] Right, it would be, it would be I pay it and then you guys would give me pay me back, right?
[AGENT][NEUTRAL] Um, yeah, if they don't file it, then yes.
[CUSTOMER][NEUTRAL] At a at a at a later date at a later date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So that's the uh that's my maximum benefit would be $500 towards my uh co-payment.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, OK, and.
[CUSTOMER][NEUTRAL] When, OK, so I, uh, OK, so what do I do now to be able to, is that something that would just happen later on?
[AGENT][NEUTRAL] Right, because
[CUSTOMER][NEUTRAL] Like I
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We get the claim last, so it has to go through your major medical first.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] He's the
[AGENT][NEUTRAL] And then once you get the EOB back from your major medical showing what your patient responsibility is, then you can file the claim with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For reimbursement.
[CUSTOMER][NEUTRAL] OK, OK, and
[CUSTOMER][NEUTRAL] And how do I file the claim against I just go through the system. I think it had uh to file claim press 3 or whatever it was.
[CUSTOMER][NEUTRAL] Is that what you're talking about?
[AGENT][NEUTRAL] Um, or online, uh, you can register with the online service center and upload your, um, claims there at [PII].
[CUSTOMER][NEUTRAL] OK, OK, alright, uh.
[AGENT][NEUTRAL] Or you can mail them or fax them in.
[CUSTOMER][POSITIVE] OK. All [PII]. Thank you so much for your time.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] Alright you too bye.