AccountId: 011433970860
ContactId: 4c9a4800-f113-4473-9395-d9670b567afd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385170 ms
Total Talk Time (AGENT): 178509 ms
Total Talk Time (CUSTOMER): 141973 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/4c9a4800-f113-4473-9395-d9670b567afd_20250203T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hey, [PII], it's [PII]. How are you doing?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing this morning?
[CUSTOMER][POSITIVE] Good. I'm doing good, thank you. Um, so I hope you can help this lady on the phone. Um, her name is [PII] and her policy number is 256-6205 and I did verify her information.
[CUSTOMER][NEGATIVE] And so she's calling because she received a letter and she didn't she doesn't have the letter with her but she said that it said something about she had exhausted funds. Now I tried to look up a letter here like on the customer service side and I couldn't find anything so I don't know if it could even respond to maybe like something claims related she does also OK she does also want to know what her policy covers and how often she can go to the doctor.
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] Perfect. I would be more than happy to assist her and did, is her callback number the number on file?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It is, yes it is.
[AGENT][POSITIVE] Perfect. Thank you, [PII]. It'd be my pleasure to assist. Have a great day.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] Thank you so much [PII]. You too. Here she comes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Good morning, Ms. [PII]. My name is [PII]. I'm in the care team. How are you doing this morning?
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] I'm OK and you?
[AGENT][POSITIVE] I'm doing well, thank you. Ms. [PII] was telling me that you received a letter regarding a claim stating that you maxed out your benefits. I'm wanting more information on that as well as what your policy covers.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I will be happy to assist you with that. Now, this, um, the letter that you received was for a screening benefit on your policy that paid $150.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and that was for your screening and that maxed out your screening benefit.
[AGENT][NEUTRAL] Because we, we do pay a screening benefit of $150.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So for a screening that's it for the year?
[AGENT][NEUTRAL] For your um screening, yes, ma'am.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, that's just for your wellness screening.
[AGENT][NEUTRAL] Now, um.
[AGENT][POSITIVE] You do have benefits for hospitalization, of course.
[AGENT][NEUTRAL] And you have surgical benefits?
[AGENT][POSITIVE] Um, you have intensive care benefits, you have physical therapy benefits.
[AGENT][NEUTRAL] You have a doctor's office visit for sickness or accident?
[AGENT][NEUTRAL] Now all this, now we do have a provider portal.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] If you're ever interested, you can go to secured or [PII] and log in as a new user.
[AGENT][NEUTRAL] And click on your policy number and that will, you can view all the benefits payable.
[AGENT][NEUTRAL] By going um in your policy there's a page called the schedule of benefits page.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right, so I mean if I have to go to the doctor in the next 3 months, you all will take care of that bill, right?
[AGENT][NEUTRAL] And now for your doctor's visit, we can pay $75 towards your visit.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Each visit, right?
[AGENT][NEUTRAL] Uh yes ma'am, up to 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um,
[CUSTOMER][NEGATIVE] Alright, I don't think this would be the best insurance for me.
[AGENT][NEUTRAL] Yes, ma'am. If you want to view those benefits and then review it and see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] If it's beneficial for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I think I'm gonna need something else.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEGATIVE] You know, I'm [PII] old. Anything could happen. I need to go to the doctor. I'm not trying to cover no pay, no doctor payment each time I go when I'm paying for insurance.
[AGENT][POSITIVE] I understand. I'm right there with you.
[CUSTOMER][NEUTRAL] I mean, you know, I know I know but.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm all right now.
[AGENT][NEUTRAL] I am I do. So if you are
[CUSTOMER][NEUTRAL] So I have, I have 3 more visits.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I have 3 more visits.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] Now, actually you have 4 because the screening was not included in your office visit benefit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you should, did you receive that $150 check?
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Let's see if that went to the doctor for you.
[AGENT][NEUTRAL] So that did actually go to the doctor's office at SGMC Physicians Network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, do you, do you all have like a.
[CUSTOMER][NEUTRAL] Uh, network that the doctors you deal with?
[AGENT][NEUTRAL] Not on this policy.
[CUSTOMER][NEUTRAL] Or is my doctor with you?
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You can go to any provider on this, on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then thank you very much.
[AGENT][POSITIVE] It's been my pleasure to assist you this morning, Ms. [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a wonderful day as well. Take care and call us if we can assist you further, OK?
[CUSTOMER][POSITIVE] Thank you have a good day.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.