AccountId: 011433970860
ContactId: 6fae738b-aa4a-4bc9-aedd-39b56912f1f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649340 ms
Total Talk Time (AGENT): 342642 ms
Total Talk Time (CUSTOMER): 216962 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/6fae738b-aa4a-4bc9-aedd-39b56912f1f5_20250602T22:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, this is [PII]. I just got disconnected somehow. I was just trying to check on some benefits.
[AGENT][POSITIVE] OK Miss [PII], I can help you with benefits ma'am um may I please get your callback number just in case the call is dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Yeah, thank you. [PII].
[AGENT][NEUTRAL] Thank you. And are the benefits going to be for yourself or are you with the provider's office?
[CUSTOMER][NEUTRAL] Uh, it's for myself. Yes, I'm with [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, and then what is your um policy number Ms [PII]?
[CUSTOMER][NEUTRAL] Um, the group, uh, do you want the benefit certificate number or the group number?
[AGENT][NEUTRAL] You can give me the certificate number.
[CUSTOMER][NEUTRAL] OK, and hospital certificate number 02472972 M as in Mary L as in love 7.
[AGENT][POSITIVE] OK, thank you so much. Let me pull that up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right. I'll need for you, Ms. [PII], to verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] OK, uh, [PII]. Phone number is [PII] and email you probably have my [PII].
[AGENT][NEUTRAL] Uh, I don't have an email address for you. Would you like to provide one that you would like for us to put in for you?
[CUSTOMER][NEUTRAL] Sure. Uh-huh.
[AGENT][NEGATIVE] And you want it to be the one that you just gave me the [PII].
[CUSTOMER][POSITIVE] Yeah, it's right [PII]. That's my school one. So this is school related, that's probably best.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][NEUTRAL] That's it, uh-huh.
[AGENT][NEUTRAL] What was the last part?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] That's it, it's just no.
[CUSTOMER][NEUTRAL] Uh-huh. That's it.
[AGENT][NEUTRAL] OK. All right. I wanna make sure I had it correct. I've got that updated for you now, Miss [PII].
[AGENT][POSITIVE] OK, let's go ahead, you're very welcome.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, and you're just wanting um your basic benefits for this policy, is that correct?
[CUSTOMER][NEUTRAL] Um, yes, I, I'm going to be having hip surgery this summer and I'm in the hospital, um, I think it's a 2 day stay, um, and I, this is like a gap insurance, so I just want to see exactly what the benefits were and what it would cover.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright. Well, I can give that to you. And this is just to verify your benefits. It's not a guarantee of payment. So when you go in the hospital, that first day that you're in the hospital, you have a, a $3 I'm sorry, $3000 inpatient benefit amounts per confinement.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So each confinement you get $3000 to go towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, that's it, so is it so much per day or just one lump sum?
[AGENT][NEUTRAL] It's just one lump sum um of per confinement of 18 hours or more and it's specific for accident or sickness, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you do have a deductible. No, you don't. You don't have a deductible.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] No deductible, it says 0. It says 0 there, so.
[AGENT][POSITIVE] So that's a good thing. Yes, yay.
[CUSTOMER][NEUTRAL] Thank [PII] there's been a deductible thing uh.
[CUSTOMER][POSITIVE] Hallelujah.
[AGENT][NEUTRAL] Yes, so when you go to the hospital, if you give them both your, your primary insurance card and this insurance card, all the um information should be on your card for them to be able to file a claim for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, this says, um, my card is effective date [PII]. Have they given us new ones for this year or no? That this is still good?
[AGENT][POSITIVE] Let me look. Yes, it's still good.
[CUSTOMER][NEUTRAL] OK, because I know I resigned for it, but yeah, I didn't get a, a new card, so I wasn't sure.
[AGENT][NEUTRAL] Yes, and, and that is your effective date.
[AGENT][POSITIVE] Yes ma'am, yes, that card will still work for you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Very good, very good. OK. So I just give this to the hospital and then, and it, it just covers the hospital. It doesn't cover anything, doesn't cover anything towards doctors or other stuff or no?
[AGENT][NEUTRAL] No, it looks like it's just going to be your hospital confinement.
[AGENT][NEUTRAL] Um, of course when they send in the claim if they send the other stuff in, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have, uh, let's see.
[AGENT][NEUTRAL] Yeah, it's just um inpatient benefit.
[AGENT][NEUTRAL] Per confinement of $3000. And then um if you have to have any durable medical equipment, you have a rider for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That pays um.
[AGENT][NEUTRAL] For durable medical equipment. And that looks like it's a, it's about it. It just looks like it's just a hospital inpatient. Now, outpatient, if you have to go to the doctor for any reason, let me see.
[AGENT][NEUTRAL] Afterwards, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You've got a benefit amount per calendar day of $300 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, is that, uh, a doctor visit or does it have to be like at a hospital?
[AGENT][NEUTRAL] It's um going to be an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The ambulatory, is that, is that considered physical therapy?
[AGENT][NEUTRAL] Uh, let me look and see if there's gonna be physical therapy. I'm gonna pull up your policy and look and see if you have any physical therapy benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a minute while the computer loads it up for us.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Some of them do and some of them don't, so I wanna make sure.
[CUSTOMER][NEGATIVE] Yeah, it's very confusing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so these are your covered outpatient facilities.
[AGENT][NEUTRAL] Uh, a freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A hospital emergency room, hospital outpatient facility, MRI facility, and physical therapy facility.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Or urgent care.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And that would be $300 per occurrence. So in between um occurrences there needs to be, if I'm not mistaken, let me make sure I read this right, I think it has to be separated by 90 days.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For your occurrences.
[CUSTOMER][NEUTRAL] So I think it, I do like physical therapy once within 90 days or?
[AGENT][NEUTRAL] Yes, ma'am. That's, that's the way, but I wanna make sure that that's what it reads.
[AGENT][NEUTRAL] Um, let me see if I can find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is what it means by per occurrence. Per occurrence means treatment for the same or related condition unless separated by a 90-day period. Treatment for the same related conditions separated by 90 days or an unrelated condition will be considered a new occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so as long as the physical therapy is related to what it is, then they would give that much towards it.
[AGENT][NEUTRAL] Right, for the same or related conditions.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Yeah, it's gonna be, yeah. It sounds complicated, but I'm sure once I get down to the doctor, they will be able to sort of work through this and file and see exactly what's covered too, right?
[AGENT][NEUTRAL] Yes, ma'am. They should be able to, and look, if they um need to verify your benefits, um, they can call the same number that you called and we can give them the same information that we just gave you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And verify the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Very good, very good. You've been very helpful. I just have to get this all in my little book and file and going my way. I appreciate it.
[AGENT][POSITIVE] Yes, ma'am. Yes, ma'am. You're very welcome. Is there anything else, Miss [PII], I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's it. I appreciate it.
[AGENT][POSITIVE] All right. Well, I hope that everything goes well for you and that your surgery, everything is just perfect.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] I do too. Thank you for saying that. I appreciate it. Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] OK. You have a blessed night and thank you for calling APL.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][NEUTRAL] Um, bye-bye, Miss [PII].