AccountId: 011433970860
ContactId: 5e535901-b95b-4706-82b1-732d10cd4cf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691119 ms
Total Talk Time (AGENT): 229523 ms
Total Talk Time (CUSTOMER): 247893 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/5e535901-b95b-4706-82b1-732d10cd4cf8_20250206T15:59_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I have some questions. I have, um, um, questions about an accident policy and what the payouts are for different items on that policy.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you have that policy number available?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, I'm not quite sure where to find that. Hold on one second.
[AGENT][NEUTRAL] I'll tell you if it's easier I can look it up by your social.
[CUSTOMER][NEUTRAL] Sure. Um [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Thank you, Miss [PII]. And what is your date of birth, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And current mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just checking um what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I do have a Gmail address on file. Can we verify that while I've got you on the line?
[CUSTOMER][NEUTRAL] Uh um [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And Miss [PII], I've got your policy pulled up. Uh, now you are aware that the policy is no longer active, correct?
[CUSTOMER][POSITIVE] Correct, yup.
[AGENT][NEUTRAL] OK, just wanted to make sure. So you are wanting to know benefits for cer certain um.
[AGENT][NEUTRAL] What the benefit coverage is?
[CUSTOMER][NEUTRAL] Yes, yes, like, um, surgery, um, and accidents, um, physical therapies, things like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, I'm getting that up, so bear with me just one second.
[AGENT][NEUTRAL] I've got your policy certificate pulled up.
[AGENT][NEUTRAL] Did you ever create an account online on our portal?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. I was just gonna say you can also view it there, but I can, I can look that up for you.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] So what type of surgery was performed or
[CUSTOMER][NEUTRAL] Um, it was, um,
[CUSTOMER][NEUTRAL] I forgot what they call it, but it's for tendonitis when they sniff out the bad part.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Of the tendon
[AGENT][NEUTRAL] So you do have, I'm looking for that type of surgery. And of course, it's going to depend on the surgical code.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Give me just a second, I'm looking further for that.
[AGENT][NEUTRAL] I apologize. It's just taking me a minute.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] I do have the physical therapy benefit is $25.
[AGENT][NEUTRAL] So we pay to physical therapy.
[CUSTOMER][NEUTRAL] 25 per visit or just 25?
[AGENT][NEUTRAL] Looks like 25 and I'm also.
[AGENT][NEUTRAL] Verifying that as well.
[AGENT][NEUTRAL] I'll tell you what, do you mind holding just one moment?
[CUSTOMER][POSITIVE] Sure. Thank you.
[AGENT][POSITIVE] And let me get someone in that department that can look at these benefits more in depth for you, especially on that surgical benefit, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good Morning, thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Hey [PII], I'm good. How are you?
[AGENT][NEUTRAL] I'm doing good, thank you. I have an accident policy. It was an insured with accident policy and she's wanting specific surgical benefits and, you know, physical therapy benefits. Can, and I, I'm not sure if this is a per calendar day for her physical therapy or on the benefits. Can you help her further?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, what's the policy number?
[AGENT][NEUTRAL] It's 240-4835.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] I've got it pulled up in PIBFT and I've got the policy cert opened.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] She's wanting to know the surgical benefits she had.
[AGENT][NEUTRAL] Tendonitis and they did us, she didn't have the code or anything.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Come on on base.
[AGENT][NEUTRAL] I see the surgical benefit of 500, but I'm not sure on this type of accident, do you have to have specifics or?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Mm, so I pull up this. I don't know either. Let's see.
[AGENT][NEUTRAL] I see the physical therapy of $25 is that for one therapy?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Oh come on.
[AGENT][NEUTRAL] Is it per day?
[AGENT][NEGATIVE] And I'm looking at the new PIBFT and I just don't wanna give incorrect benefits.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK, so you say she had surgery?
[AGENT][NEUTRAL] She wants to know the surgical benefit and physical therapy.
[AGENT][NEUTRAL] Those were 2 that we started on.
[CUSTOMER][NEUTRAL] And does she have a CPT code or does she know what type of surgery it is?
[AGENT][NEUTRAL] She couldn't give me the name of the surgery. She said it was to repair a tendon where they go in and just snip out the part of the tendon that's damaged.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I reckon you just get paid for one physical therapy. I, I don't, I can't figure it out.
[AGENT][NEUTRAL] Oh wait, let me look at the definition.
[AGENT][NEUTRAL] It's that.
[CUSTOMER][NEUTRAL] Physical therapy.
[CUSTOMER][NEUTRAL] For each day like it's uh for each day they receive physical therapist.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Initial treatment.
[CUSTOMER][NEUTRAL] Benefits payable up to 20 days per plan year for each person.
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] And that's PT.
[AGENT][NEUTRAL] If it begins within 30 days.
[CUSTOMER][NEUTRAL] Yeah, per day.
[AGENT][NEUTRAL] And the surgery.
[AGENT][NEUTRAL] I'm thinking it's 500.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The surgery.
[AGENT][NEGATIVE] But I can't, I'm just not confident enough to in that.
[CUSTOMER][NEUTRAL] Look, that's gonna be the case for both of us. Give me one second. Uh, a patient outpatient benefits showing the schedule for each day a person undergoes surgery and an outpatient dial out based on the type of surgery shown in the.
[AGENT][NEUTRAL] She did say it was outpatient.
[CUSTOMER][NEUTRAL] She did not say
[AGENT][NEUTRAL] She said it was outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It to be before within the covered the 30 days, OK.
[CUSTOMER][NEUTRAL] Alright you can send her on over.
[AGENT][NEUTRAL] All right, and I did verify her information. She is aware that her policy is no longer active.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] All right. Thank you, [PII], [PII], let me get on the line. Good to talk to you. One moment.
[CUSTOMER][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] Alright, same here.
[AGENT][POSITIVE] Ms. [PII], thank you for your patience. I have [PII] and she is on the line. She's going to assist you further with those benefits, but thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Good morning how are you?
[CUSTOMER][POSITIVE] Good how are you? I'm doing well thanks for asking. OK, so she said you need some additional um.
[CUSTOMER][NEUTRAL] Uh, information on your benefits.
[CUSTOMER][NEUTRAL] Um, so I I'm trying to figure out.
[CUSTOMER][NEUTRAL] You would have to have to know what type of surgery do you know the exact.
[CUSTOMER][NEUTRAL] Um, type of surgery that you're going to have.
[CUSTOMER][NEUTRAL] I already had it and I already sent in all the information. Um, I was just shocked that the payout was only $50 total. Um, I had several doctor appointments, surgery, several physical therapy appointments.
[CUSTOMER][NEGATIVE] So I don't know why the payout was only $50.
[CUSTOMER][NEUTRAL] I sent in like
[CUSTOMER][NEUTRAL] Uh an $8 packet of mail to APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So it looks like uh the treatment has to be performed within a certain number of days after the uh accident occurs. And so it looks like depending uh looking at the date of the treatment, it was not performed within a timely, um.
[CUSTOMER][NEUTRAL] Within the time frame.
[CUSTOMER][NEGATIVE] Why would they have, why that makes no sense. I mean, why would you go straight to surgery and why would, why would a company penalize someone for avoiding surgery?
[CUSTOMER][NEUTRAL] Right, uh, but that's just what the policy states. The policy states that the surgery must be performed within 30 days after the covered accident.
[CUSTOMER][NEUTRAL] So, is anything covered? Physical therapy, um, doctor visits, anything?
[CUSTOMER][NEUTRAL] Uh, so it looked like she did pay you for the office visit, uh, the physical therapy.