AccountId: 011433970860
ContactId: 5bc33857-ac6d-417a-a5be-b7e723d6aed1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427540 ms
Total Talk Time (AGENT): 214036 ms
Total Talk Time (CUSTOMER): 129946 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/5bc33857-ac6d-417a-a5be-b7e723d6aed1_20250204T22:54_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, I have a I have a question about my um plan because I can't, I haven't been able to find it online.
[AGENT][POSITIVE] OK, can I please get your your name and your callback number so I can help you with your benefits.
[CUSTOMER][NEUTRAL] OK, [PII] and my callback number is [PII].
[AGENT][NEUTRAL] OK. And [PII], what is your um policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02565492.
[AGENT][NEUTRAL] OK, let me look that up, Miss [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, I've got your policy pulled up. Can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, my address is [PII], and I, I have updated my phone number but I updated your system. I'm not sure it updated with you yet, but it's [PII].
[CUSTOMER][NEUTRAL] And what is the other one?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Your email address, please.
[CUSTOMER][NEUTRAL] Oh my email is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. I appreciate you verifying your policy for me. So you said you were, you were in the online service center and there was something that you couldn't see?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well, I mean, I'm just not understanding it. Maybe I don't know, so I just figured I would call, but I went to the emergency room with and I have gallstones and so I need to see a specialist and basically get it removed, but I didn't know how much it would cost me to go to a specialist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Like I didn't know if there was like, if I have like a deduct like it didn't show me none of that.
[AGENT][NEUTRAL] OK, so let me pull in your policy real quick, um.
[AGENT][NEUTRAL] OK, so your policy, and this is just to verify your coverage, it's not a guarantee of payment. You have uh accident and sickness surgical benefit for a facility, one per calendar year that helps pay $1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that like, but, so I guess I'm, I don't know. I guess I'm confused because I just haven't had, I guess insurance like that. So really just me going to the like going to a specialist and having a surgery, they're only gonna cover $1000.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is a this is a hospital indemnity plan and it does have limited benefits.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So if you have to go into the hospital for more than 18 hours, your hospital admission benefit one day per calendar year is also $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your daily confinement is 30 days per calendar year and that pays $100 daily confinement.
[CUSTOMER][NEUTRAL] And so what if I was, um, what if, what about just seeing the specialist to even get it started? Do I, what do I, what would I, you're I guess basically what would the policy say on that?
[AGENT][NEUTRAL] Let me see if you have office visits to see a specialist on this policy. Let me, I'm gonna actually pull up the policy and read it.
[AGENT][NEUTRAL] So it might be just a moment so I can, the computer can download it.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Let's see what it says. And you're gonna probably have the, are you thinking outpatient for your surgery?
[CUSTOMER][NEGATIVE] Well, I mean, well, yeah, it'll just be outpatient, but I mean I have to go in and have like I guess like the consultation first but I didn't wanna make the appointment and not have a way to pay like I don't know what it's gonna cost me like just even have appointment.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK, so you do have um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm trying to look to see. I'm reading really, OK, so you do have physician office visits.
[AGENT][NEUTRAL] Physician's office does not include a free-standing outpatient surgery center.
[AGENT][NEUTRAL] Hospital emergency room, hospital outpatient facility, physical therapy facility, or urgent care facility.
[AGENT][NEUTRAL] So let me look and see if it says any more about outpatient for you.
[AGENT][NEUTRAL] OK. So this is what it says about outpatient accident or sickness treatment benefit, which you do have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It says we will pay applicable outpatient accident and sickness treatment benefit per day when treatment due to an injury or a covered sickness is received by a covered person in an emergency room, urgent care facility, physician's office.
[AGENT][NEUTRAL] Physical speech or occupational therapy facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you do have the office visits.
[CUSTOMER][NEUTRAL] OK, and so I would just call them set up the appointment, give them my insurance information, and they should be able to tell me like what that'll cost me out of pocket, right?
[AGENT][NEUTRAL] Right, and then they'll also probably call us and verify your benefits with us too, and we can tell them the same thing, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're so very welcome. I hope you um have good luck with your surgery, Ms. [PII], and you get to feeling [PII]er.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. You take care.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks for calling APO bye bye.