AccountId: 011433970860
ContactId: 6cdc4fdd-4a8a-4362-ac00-de6262431e1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354299 ms
Total Talk Time (AGENT): 92995 ms
Total Talk Time (CUSTOMER): 162890 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/6cdc4fdd-4a8a-4362-ac00-de6262431e1a_20250417T20:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name's [PII], and I'm with Grant Iron and Motors, and I had a question about.
[CUSTOMER][NEUTRAL] General question about one of our um uh about our policy, can you help me with that?
[AGENT][NEUTRAL] Yes, of course. Do you have the policy, sorry.
[CUSTOMER][POSITIVE] Super, um, do you need policy number do you need that?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][NEUTRAL] 236-669.
[AGENT][NEUTRAL] Is that by chance the group number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you need the is the policy number something different?
[AGENT][NEUTRAL] Yes, it should say policy er number or member number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Um, JPO right here.
[CUSTOMER][NEUTRAL] I'm the administrator for [PII] and so I'm calling for one of our employees, but you need, you need his which is [PII] his ID number that's not gonna oh policy certain number here we go 2267.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 450.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then what's his first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and he is oh golly I don't know what his date of birth is let me find out one second.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Coming up [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about [PII]
[AGENT][NEUTRAL] OK, and then can I get the group's mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and so I have his policy pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so he needs to get a colonoscopy and I guess our deductible is whatever it is, and he needs to pay.
[CUSTOMER][NEUTRAL] $1900 before they'll give him the colonoscopy because I guess that's his portion of it that the insurance won't pay um.
[CUSTOMER][NEUTRAL] And he doesn't have $1900 la la la. So because I know you what you would normally tell me is have him turn in and then you guys will reimburse him correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, we may reimburse him, um, depending on his policy.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Has he submitted a claim for that yet?
[CUSTOMER][NEGATIVE] No, he hasn't because he, his appointment was for the [PII] of this month, [PII], and they called him today and said that he'd have to pay the $1900 before he, but now that I, as soon as I said that I thought I bet they didn't even, I bet they didn't even contact you.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you see whether or not they've tried to pre-approve that?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So I'm not seeing anything in here where they tried to contact us. um, yeah.
[CUSTOMER][NEUTRAL] Yeah that's what I thought OK.
[CUSTOMER][NEUTRAL] Um, which is to say that, um.
[CUSTOMER][NEUTRAL] If they call you, um, you guys will tell them whether or not it'll be what portion of it will be paid and.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And then that probably would change the amount of money that he has to show up with I'm assuming correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] Because people do that all the time that's the purpose of the pre-approval, correct?
[AGENT][NEUTRAL] Yes, correct, so usually providers will call us and they'll ask about if a certain benefit is covered and we'll let them know, so.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so it sounds to me like he needs to ask his doctor to call you guys and and find out how much, uh, or if any is gonna be covered by our APL policy is that correct?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] OK, super, I'll have him do that and then my other question is, can you refresh my memory? Um, what is the maximum, um, pay? I, I forget what my policy is for is it for $5000 or $6000 per employee?
[CUSTOMER][NEUTRAL] Or is it not even that I don't know.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, so it looks like for inpatient benefit max per calendar year is 6000.
[CUSTOMER][NEUTRAL] That's what I thought, OK.
[AGENT][NEUTRAL] And the outpatient benefit max per calendar year is also 6 6000, and this is not a guar guarantee payment, it's just a verification of coverage.
[CUSTOMER][POSITIVE] Yeah, right, yeah, sure, got it, OK, um, OK, because we have someone else who's pregnant and she wanted to know it, but that would be same thing. OK, alright, I appreciate your time thank you mhm.
[AGENT][NEUTRAL] So, right, yep.
[AGENT][NEUTRAL] Oh, yeah.
[AGENT][POSITIVE] Yeah, of course. Have a good day. Thanks for calling APL. Mhm, bye.
[CUSTOMER][POSITIVE] You too bye thanks bye.