AccountId: 011433970860
ContactId: 638640b2-696d-4fc2-9af4-9e855e45f3de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317429 ms
Total Talk Time (AGENT): 103012 ms
Total Talk Time (CUSTOMER): 168736 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/638640b2-696d-4fc2-9af4-9e855e45f3de_20250319T14:41_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I have an insured on the line, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, unfortunately I was not able to pull up a policy number, not even using her social security number, but she said she called in yesterday and um one of our representatives was able to find her policy through a claim number.
[AGENT][NEUTRAL] Did she give you a claim number?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is she wanting?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, she wants to verify, uh, the benefit explanation because she's gonna have a one-day procedure. Um, and she was advised that she will not be covered for it. And she just wanted to verify if that information was correct or not.
[AGENT][NEUTRAL] OK, um, you can send her through.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hello, is this Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, um, and do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's 683-264-362. It says member ID. I'm guessing that's my policy.
[AGENT][NEUTRAL] Uh, no, ma'am, it's not our policy number. Um.
[AGENT][NEUTRAL] What is your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII].
[CUSTOMER][NEUTRAL] No, wait [PII] is my date of birth.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, my address is [PII], and my email is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much. And you say you're calling to see if a procedure is covered?
[CUSTOMER][NEUTRAL] Well, the thing is I have.
[CUSTOMER][NEGATIVE] I, I went to the doctor because I have this like lump under my jawline and she did a CAT scan and she said that I would, there are two salivary stones in there and because of the size of them, they won't pass and they're giving me some problems.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And she said the only way to get them out of there is to like cut that open. So it's like a one day surgery and uh I did talk to someone the other day and they said if I would be admitted.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It would be covered like if I spend a night or two in the hospital, but one day surgery wasn't covered. So that's kind of confusing because why would you want to pay for like a night or two in the hospital as opposed to just there for a few hours in the morning.
[AGENT][NEUTRAL] I understand. Yes, ma'am. Give me one moment pulling up your benefits.
[CUSTOMER][NEUTRAL] Because that, I don't know, it just didn't quite make sense to me, so that's why I'm calling again.
[AGENT][NEUTRAL] OK, because under your policy, uh, it's a limited medical indemnity plan, and you have benefits for inpatient admission confinement.
[AGENT][NEUTRAL] Um, and you have benefits for like an office visit, but not any surgical benefits. So they were probably saying that if you were confined in the hospital, then you have a benefit as far as the con uh confinement, but as far as any outpatient facility besides ER or urgent care.
[AGENT][NEGATIVE] Uh, it's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Who could I talk to to find out what I would have to do to get coverage so I could have that done?
[CUSTOMER][NEUTRAL] I don't turn [PII] till October.
[CUSTOMER][NEGATIVE] And I, I really hate to wait 7 more months.
[AGENT][NEUTRAL] OK, you may have to contact your group admin, uh, administrator, and they can verify what other policies that are offered through APL, but, uh, through your policy you have with us, it doesn't cover surgery nor outpatient facility.
[CUSTOMER][NEUTRAL] OK, I will get in touch with them, or can you transfer me or should I just call?
[AGENT][NEUTRAL] Uh, you will have to contact them. I'm not sure their phone number, who your group administrator is.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Alright, well thank you so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Uh, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.