AccountId: 011433970860
ContactId: 5a31bbeb-59d6-45ff-b2d1-7f22df0759cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735520 ms
Total Talk Time (AGENT): 177332 ms
Total Talk Time (CUSTOMER): 174562 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/5a31bbeb-59d6-45ff-b2d1-7f22df0759cb_20250430T15:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, so, you said?
[AGENT][NEUTRAL] Yes, so, mhm.
[CUSTOMER][NEUTRAL] Uh, how's it going? So, my name is [PII]. I just got a call from, um, the Baptist, stating that my wife's visit to the doctor was not covered due to a discrepancy with her, uh, last, uh, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He, uh, the year of the, of her birth.
[CUSTOMER][NEUTRAL] It seems that it was my mistake. I believe that I already solved this issue, but I don't understand why it's not being communicated with [PII].
[AGENT][NEUTRAL] I can check and see if it was um fixed, Mr. [PII]. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Or the hospital?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And what is the policy number?
[CUSTOMER][NEUTRAL] The policy.
[CUSTOMER][NEUTRAL] And, uh, where can I find the policy number? Is it the payer ID? No.
[AGENT][NEUTRAL] In the bottom. Now, in the bottom where it says in hospital outpatient er number.
[CUSTOMER][POSITIVE] Oh, I have outpatient benefit and inpatient benefit.
[AGENT][NEUTRAL] Mhm. Either one of those, either the inpatient or outpatient.
[CUSTOMER][NEUTRAL] Uh, number
[CUSTOMER][NEUTRAL] Either one, OK, so it's 0242.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4874
[CUSTOMER][NEUTRAL] ML 7
[AGENT][NEUTRAL] OK, thank you. For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] My email address?
[AGENT][NEUTRAL] The date of birth, mailing address and email address for security.
[CUSTOMER][NEUTRAL] OK, so [PII], email address is [PII], and address uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And what is um Miss [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. When you said you uh fixed this, did you fix this through your employer or how did you get this fixed?
[CUSTOMER][NEUTRAL] Through my employer and through the system as well. I did the changes myself and they and the payroll manager and benefit manager send the the information to AP or to you guys.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] OK, I don't see it. Uh, let me see if I can go ahead and fix it here. Um, and you said the year is [PII]. OK, let me go ahead and see if I can change that. And do you mind holding for me? Mhm. Yes.
[CUSTOMER][NEUTRAL] [PII]. [PII], yes, [PII].
[AGENT][NEUTRAL] OK, um, do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Mr. [PII]. OK, I went ahead and corrected that to [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, so should I, are they going to send a new, uh, card?
[CUSTOMER][NEUTRAL] Or the, the everything stays the same.
[AGENT][NEUTRAL] Everything stays the same, um, yeah, because then date of birth is not reflected on the card, so it's not gonna initiate a new card because it's the same information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] Yeah, so all they need to do from [PII] is call to verify and then they can send in the claims if they need to, OK? You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Perfect thank you so much have a wonderful day.
[AGENT][NEUTRAL] Mhm. You, you as well. Is there anything else I'm gonna help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Nope, that will be all. Yes, um, I have a question. I do have a question now that I, it happens. Um, I'm going to have surgery tomorrow, and, uh, for, I want you to please explain to me how is that I run out out of the, the, the coverage of the.
[AGENT][NEUTRAL] OK. mhm.
[AGENT][POSITIVE] OK. OK. Yeah, sure, no problem.
[CUSTOMER][NEUTRAL] Um, my servers with APL.
[AGENT][NEUTRAL] OK. Is this gonna be an in.
[CUSTOMER][NEGATIVE] I I don't have any more coverage.
[AGENT][NEUTRAL] OK. Is this gonna be for inpatient surgery or is it gonna be an outpatient surgery?
[CUSTOMER][NEUTRAL] Uh, the outpatient is the.
[CUSTOMER][NEUTRAL] The, the quick one, right?
[AGENT][NEUTRAL] Yeah, the outpatient is in and out. So you, you stay there more than 18 hours. Mhm.
[CUSTOMER][NEUTRAL] The quick in and out, yeah.
[CUSTOMER][NEUTRAL] Yeah, it will be uh um.
[CUSTOMER][NEUTRAL] Uh, outpatient.
[AGENT][NEUTRAL] Outpatient. OK, so let me check and see if we have, you have a 2500 calendar year maximum on that one. OK, so let me check and see if you have used all your benefits, and this is not a guarantee of payment, just a verification of coverage. One moment please.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Yeah, you already use that benefit.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] I must pay.
[AGENT][NEUTRAL] Yeah, we send the 2500 to the doctor's hospital for the date of service of [PII].
[AGENT][NEUTRAL] Of this year.
[CUSTOMER][NEUTRAL] OK, so I won't be able to use anything to cover uh no.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, for this surgery, no, you're already use all your benefits for outpatient. You only have inpatient benefits which inpatient is um if you're in the hospital 18 hours or more.
[AGENT][NEUTRAL] Like if they have to leave you an observation or anything like that. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect, understood now I understand, yeah.
[AGENT][POSITIVE] You do have that benefit is 4000. OK. All right. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, that will be all. Thank you so much.
[AGENT][POSITIVE] Yeah. You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Likewise bye bye.
[AGENT][POSITIVE] Thank you. Bye.