AccountId: 011433970860
ContactId: 6be19c4d-3ad5-44ce-b9af-0a3120f883ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484140 ms
Total Talk Time (AGENT): 220964 ms
Total Talk Time (CUSTOMER): 156524 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/6be19c4d-3ad5-44ce-b9af-0a3120f883ee_20250212T16:48_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, yes, my name is [PII]. I'm just trying to see if uh my insurance plan covers uh orthopedic surgery.
[AGENT][NEUTRAL] OK, I can check for you. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, yes, hold on, just real quick. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] What you mean like the PO box number or what, what number?
[AGENT][NEUTRAL] No, the, the policy number, the, your policy number so I can look at the benefits.
[CUSTOMER][NEUTRAL] 0202588.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 144.
[AGENT][NEUTRAL] OK, bear with me, let me put this information.
[AGENT][NEUTRAL] Mm, OK, it looks like I got too many numbers. Let me check, um, bear with me. 144.
[AGENT][NEUTRAL] May I have your date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and I need the mailing address and email address for verification.
[CUSTOMER][NEUTRAL] Billing address is [PII].
[CUSTOMER][NEUTRAL] And you said what was the other one?
[AGENT][NEUTRAL] The email address on file.
[CUSTOMER][NEUTRAL] That would be [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And um the surgery is gonna take place in the office or is it gonna be outpatient surgery center or hospital?
[CUSTOMER][NEUTRAL] Uh, it's gonna be the center, um, because I know I, I know I had a, well, they just called me and they said they couldn't find a plan, so I had to call y'all to make sure that it was covered.
[AGENT][NEUTRAL] Surgery.
[CUSTOMER][NEGATIVE] Or whatever the case is, cause I just had a, a car wreck this Wednesday that just passed and broke my wrist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So let me go ahead and give you your benefits, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. We cannot guarantee payment until we receive the claim. Um, but it looks like you have a surgery benefit. If it's an outpatient facility or hospital, we cover 250, 250. Now, if it's in an office setting, we cover 125.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said this was due to an accident. Was it a car accident? You said it was a car accident?
[CUSTOMER][NEUTRAL] Yeah, I well, it, I didn't, I didn't, didn't have a car crash. I had a car wreck. I uh was driving my wife to work, uh, and we slipped on some ice and we hit the concrete things that, that keeps on opposite, that keeps cars from coming over. We basically hit that.
[AGENT][NEUTRAL] Got you. OK, um, you also have an accident policy, um, that's why I was asking. Um,
[AGENT][NEUTRAL] Let me check and see if what's covered under that accident policy. OK, one moment, let me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If it may be a little bit different.
[AGENT][NEUTRAL] Let me pull your benefits, one moment.
[AGENT][NEUTRAL] And you said it was your wrist, correct?
[CUSTOMER][NEUTRAL] Yeah, ma'am.
[AGENT][NEUTRAL] OK let me check and see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Did you end up going to the hospital emergency room?
[CUSTOMER][NEUTRAL] I know going to [PII].
[AGENT][NEUTRAL] OK. Was it an emergency room or was it like an office or?
[CUSTOMER][NEUTRAL] Yeah, it was an emergency room.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Did you get a um X-ray or anything like that to determine?
[CUSTOMER][NEUTRAL] Yeah, they gave me 6 X-rays and uh 222 bones in my wrist but one of them is connected to the pinky and basically my job told me that I can't work until I get everything situated.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] I have the paper in my room.
[AGENT][NEUTRAL] OK. So basically, um, this is what I see under the accident policy and um you might want to just go ahead and submit a claim as well on your accident, but, uh, and again, this is not a guarantee of payment, just a verification of coverage. You have a hospital emergency room benefit of $250 if you submit the claim that will be paid to you when you have to submit your claim.
[AGENT][NEUTRAL] Um, and then you have, um, an imaging test, uh, we cover $100 for the imaging test.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] I don't see any surgical benefits under the accident, but you do have the surgery benefit under the medical.
[CUSTOMER][NEUTRAL] OK, so I have the surgery based on the medical.
[AGENT][NEUTRAL] It looks like that that will be the 2.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK, so you might want to just go ahead and send both of the claims or give both of the cards and have them to submit the claims.
[CUSTOMER][NEUTRAL] So you said send both of the cars where?
[CUSTOMER][NEUTRAL] At the place I went to.
[AGENT][NEUTRAL] Either you
[AGENT][NEUTRAL] Yeah, either you can just provide the information on the, of the cards um for the place that you visited so they can submit the claims for you, or you can submit your own claims under the accident policy. You can submit your own claim to get a reimbursement.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I'm gonna, I'm gonna just go, uh, to them because they was just basically uh they just basically just because I'm trying to set up an appointment and, uh, they basically just called me and, and asked me just to make sure if it was getting a little bit covered that way I ain't gonna pay most of it out pocket or whatever. So since I already got so I could just call them back and let them know.
[AGENT][NEUTRAL] To the mhm.
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] And do you need any other information about your policy?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. Um, well, thank you, thank you for calling APL. You have a good day and you just um give them the information. If they have any questions, they can always call us to the same number you just dialed, OK? So they can always call us to that same number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APR. Have a good day.
[AGENT][NEUTRAL] Not
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Then he has.
[CUSTOMER][NEGATIVE] Your ass to wait.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] *** ain't doing nothing