AccountId: 011433970860
ContactId: 4891713b-06f7-4f65-a625-83eeb916daab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 607890 ms
Total Talk Time (AGENT): 271446 ms
Total Talk Time (CUSTOMER): 339214 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/4891713b-06f7-4f65-a625-83eeb916daab_20250328T19:23_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, uh, who am I speaking to?
[AGENT][POSITIVE] This is [PII].
[CUSTOMER][NEUTRAL] well. Hi, how are you?
[AGENT][POSITIVE] Hi, I'm good. How about you?
[CUSTOMER][NEUTRAL] OK, thanks. OK, I do have a question. The ATL that we have, um, if you, if you were in the emergency, is that considered, um, a part of
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, where, where it's, it's somewhat covered, if it's just an emergency.
[AGENT][NEUTRAL] It depends on what type of product you have with us. We have many, many products, many policies, and they're all different. Um, so I can check on your policy and see if it say cover service. Uh, do you have the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, is it the policy or the group number or the what what is that?
[AGENT][NEUTRAL] It's gonna be a policy certificate, either inpatient or outpatient er probably in the bottom.
[CUSTOMER][NEUTRAL] Are you uh uh
[CUSTOMER][NEUTRAL] OK, I have that. I have the inpatient and outpatient. I, I have both on it.
[AGENT][NEUTRAL] OK, just give me one of the two.
[CUSTOMER][NEUTRAL] OK. First of all, the, the inpatient in-hospital benefit one?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 018.
[CUSTOMER][NEUTRAL] 658.
[CUSTOMER][NEUTRAL] 92 ML 7.
[AGENT][POSITIVE] Yeah, OK. Thank you. And let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So I think
[CUSTOMER][NEUTRAL] Right there it's a little bit.
[AGENT][NEUTRAL] OK, and Miss um [PII], may I have your date of birth, mailing address and email address on file for verification?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, you were asking, I'm sorry, you were saying?
[AGENT][NEUTRAL] Uh, the date of birth, the mailing address, and the email address on file.
[CUSTOMER][NEUTRAL] me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] And address is [PII].
[AGENT][NEUTRAL] OK. And what's the email address?
[CUSTOMER][NEUTRAL] OK, I'm not sure if you have the work one is that the one with the [PII].
[AGENT][NEUTRAL] Um, no, I, I believe it's your personal one.
[CUSTOMER][NEUTRAL] Alright, so, OK, so it's [PII].
[AGENT][POSITIVE] Yes, that's the one we have. Thank you. All right, and let's see, let me look at your benefits really quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. And you do have an outpatient maximum of $500 daily. It does include an off not an office visit, but an ER visit, ER visit or urgent care visits. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so it does include that. So that would be like an in-hospital. So the ER visit would be included and you said it's $500 a day.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct. Yes, $500 a day. It includes the ER visit or the urgent care visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I just wanted to make sure that that the, the, um, and the outpatient visit is the same thing to the outpatient visit is pretty much the same.
[AGENT][NEUTRAL] Um, no, the outpatient is if you're in the hospital in observation or admitted 18 hours or more, that's when you use that benefit. That benefit is a calendar year maximum of 5500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Yes, and the other one is the daily benefit. Mhm.
[CUSTOMER][NEUTRAL] So the emergencies is, is, is an in in hospital visit, but um.
[CUSTOMER][NEUTRAL] And it's not considered like an outpatient. It's just an in hospital visit. That's what you're saying.
[AGENT][NEUTRAL] It's under the outpatient benefits. The ER is an outpatient benefit. Uh-huh. Anything.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh it's an OK.
[AGENT][NEUTRAL] Yes, anything that you go in and out is outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, it's outpatient, and I thought about that. I said that's probably what it is. OK, so the, the, the, so besides the outpatient has to do with emergency one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Get a monthly allowance.
[CUSTOMER][NEUTRAL] OK, so we pro so whenever we do that we have to use the one that says ML 8 at the end then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we don't really need that email or the 8 or that's just letting us know what product is it and if it's inpatient or outpatient, but it is not really required. We just need the, the first digits starting with the 0 followed by the seven digits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Of that so if they, if it, if it comes into you and it has either one of these, you just you determine um based on what is sent in to you then if we didn't send in the the actual number or the number might not correspond to the one that you're dealing with, then you will still look into which one it is correct for and then go ahead and use that one as and and pay off on that one correct.
[AGENT][NEUTRAL] Well, the policy number is for a whole policy. So, the benefits are based off the information you submit on the itemized bill. The itemized bill will let us know if it's inpatient or if it's outpatient.
[CUSTOMER][NEUTRAL] OK, so when you do that, because sometimes I, because I mean I've given in the number, but I can't remember if it's the number I gave them was it MLA, that was for the uh for the for the emergency visit. So when they send it to you, and you know that when they look at you look at it, you see it's an emergency visit.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, you would just, you would apply, you'd apply it to that situation then just the emergency visit then.
[AGENT][POSITIVE] Correct. Yes, that's correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wanted to be sure about that uh.
[AGENT][NEUTRAL] Yeah, as long as they have the first digits, even if they don't have the email, it's fine.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] In that the ML, OK, so as long as they have the first digits here because all the first digits are involved and all all patients are the same except for the ML, right, except for the.
[AGENT][NEUTRAL] Yeah. Yes.
[AGENT][POSITIVE] The same, correct. That is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, great. Alright, so you determine you can look at it and say, OK, we know that this is an emergency visit, so this will be applied to this, or, you know, if it's it's an outpatient visit it apply to that. OK, alright.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. All right. Well, thank you so much. I really do appreciate um your help.
[AGENT][POSITIVE] You're welcome. No problem. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, that's OK. That, that was what I don't know if you had gotten any claims in as yet, um, for, for me.
[AGENT][NEUTRAL] Um, I can check.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] OK, good, that'll be good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, there was one that I'm looking for.
[AGENT][NEUTRAL] Oh, the last ones.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] You're looking for one in particular?
[CUSTOMER][NEUTRAL] There's one that, that, that I sent to also um it was for the, the hospital emergency was for [PII]. I think it was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um and I just I was sending in for that one so I don't know if you ever received anything on that as yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And most recently that that they they they they submitted it that that one.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do see one here for [PII]. Um, it doesn't really look like it's an ER visit. Let me double check, OK. Bear with me just a second.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, that, that was, that, that, yeah, that was that was yeah that was like a year I visited, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see, I'm just gonna pull the information really quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] savings.
[AGENT][NEUTRAL] OK, so this one.
[AGENT][NEUTRAL] is for
[AGENT][NEUTRAL] Bro [PII] Hi [PII].
[CUSTOMER][NEUTRAL] to
[CUSTOMER][POSITIVE] Girl, yes, growing health, yes.
[AGENT][NEUTRAL] Uh-huh. Yes, it was for that date of service and um, yeah, we went ahead and paid the amount that they applied towards the deductible of 125.
[CUSTOMER][NEUTRAL] You pay the amount of how much?
[AGENT][NEUTRAL] Co-payment. Yeah, we pay the co-payment in 125.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to figure out if that was because they sent, they sent a bill for 750 and that was for the payment for that for for that.
[CUSTOMER][NEUTRAL] So they're submitting the payment.
[AGENT][NEUTRAL] If there's an
[AGENT][NEUTRAL] Yeah, if there's another payment or another balance, they need to submit the claim. Um, the only one we have received as of today is this one.
[CUSTOMER][NEUTRAL] Yeah, they're submitting that
[CUSTOMER][POSITIVE] Yeah, yeah, you can.
[CUSTOMER][NEUTRAL] That one, yeah, because then, yeah, they, they have, they submitted, they're sending another one, so they, um, so they're gonna be sending back, send that to you as well. They're gonna be sending back basically, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK. Yeah, you still have funds because we only pay 125 for that day. So you still have some funds on that one if they need to send it, OK?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][POSITIVE] Good, OK, alright, OK, thank you again. Thank you so much. I really do appreciate your help, so thank you.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome. You're welcome and thank you for calling ATL. Have a good day. All right. Yes.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Oh, it is a soda?
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Solar, OK, solar.
[AGENT][NEUTRAL] So, all right. So.
[CUSTOMER][NEUTRAL] So, it's an SL, right?
[AGENT][NEUTRAL] SOL.
[CUSTOMER][POSITIVE] SOL? OK, OK, alright, thank you so much. I appreciate your help. Alright, God bless thanks.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome. Have a good afternoon. Thank you just now.
[CUSTOMER][POSITIVE] OK. Have a nice day, bye.
[AGENT][NEUTRAL] All right.