AccountId: 011433970860
ContactId: 70c6c312-5200-454a-8920-b931965c18c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638960 ms
Total Talk Time (AGENT): 272350 ms
Total Talk Time (CUSTOMER): 292022 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/70c6c312-5200-454a-8920-b931965c18c3_20250528T20:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII].
[AGENT][POSITIVE] Yes ma'am, good afternoon to you too.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, um, I'm, uh, may I give you the group number?
[AGENT][POSITIVE] Yes ma'am, you can give me the group number.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, it's um 20.
[CUSTOMER][NEUTRAL] 698.
[AGENT][NEUTRAL] OK, and Ms. [PII], are you the um the information you're calling about, is it for the group or is it for yourself?
[CUSTOMER][NEUTRAL] For myself.
[AGENT][NEUTRAL] OK, Ms. [PII], what is your um callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK, thank you. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you very much. And then, Ms. [PII], do you see your policy number?
[AGENT][NEUTRAL] Or it might say inpatient or outpatient certificate number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, I would, I would.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I see outpatient and hospital benefit set number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let me um.
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] 420538 ML 7.
[AGENT][POSITIVE] OK, thank you so much. Let me pull up that policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] I'm going to need for you to please verify your policy for me. Can you give me your date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Verify
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[AGENT][NEUTRAL] Thank you ma'am. And then what is your address, phone number and email address that we have on the policy for you, ma'am?
[CUSTOMER][NEUTRAL] OK. Address is [PII].
[AGENT][NEUTRAL] Thank you and then may I have your email address?
[CUSTOMER][NEUTRAL] My email address is uh [PII].
[AGENT][NEUTRAL] OK, thank you and then what is um your phone number that you gave me to call you back on? Is that your cell phone number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes, but OK.
[AGENT][POSITIVE] All right, and how can I help you today?
[CUSTOMER][NEUTRAL] Um, OK, I have my daughter with me who just come from the, my, um, OBGYN doctor because I have, um, a surgery to do to have like to remove my, um, thigh bones and everything.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then uh she have um me to, to call the secondary insurance to get the authorization.
[AGENT][NEUTRAL] Oh, OK. Well, see, um, yes, I understand. On this policy, you do not have to have, um, authorization.
[CUSTOMER][NEUTRAL] So what the payment.
[AGENT][NEUTRAL] This is a secondary supplemental policy that helps with and this is just to verify your benefits. It's not a guarantee of payment, but it helps with deductible, co-pay and co-insurance only. So it, you don't need an authorization for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what about uh reference number?
[AGENT][NEUTRAL] What about the, which one, please?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Hold on for a second. I have my daughter, uh, because, um, yes, hello.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi. Um,
[AGENT][NEUTRAL] This is, this is [PII]. I'm with APL. Your mama was asking some questions about her policy as far as needing authorization. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cause, um, the, um, her OBGYN office, um, they're asking, well, my mom wants to use like um the insurance, the insurance to help cover like the cost of this, of a surgery she's having.
[CUSTOMER][NEUTRAL] And they, um, her OBGYN office is telling her that she needs an authorization, like she needs her primary care doctor to get an authorization from you guys in order to get um like the cost, the rest, the remaining cost of the um surgery covered.
[CUSTOMER][NEUTRAL] Um, and
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] They were saying
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEUTRAL] Oh, and they were saying how um
[CUSTOMER][NEUTRAL] How in order to get, in order to get like um it covered, they need an authorization.
[AGENT][NEUTRAL] OK, so on this policy, she does not, she doesn't have to contact her primary care physician. She doesn't have to do any of that stuff. There's no pre-authorization needed for this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. Even for my primary too? I don't need it for my primary too.
[AGENT][NEUTRAL] No, you just give them this card along with your major medical insurance that you have, give them both cards.
[AGENT][NEUTRAL] And then they, then they can file the claim with us and we'll pay based on how your policy is and um as your policy certificate is written. Now, if you go into the hospital and you stay in the hospital for more than 18 hours, you have benefits for that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] She could get this.
[CUSTOMER][NEUTRAL] in the
[AGENT][NEUTRAL] Um, you, you also have, um, let me see if you have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Surgery benefits, um.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so you have outpatient benefits for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what they can do.
[AGENT][NEUTRAL] If they can call the same number that you called?
[AGENT][NEUTRAL] If they want to verify your benefits, that's all they have to do if they feel better doing that they can just go ahead and call us and we can give them your benefits over the telephone.
[AGENT][NEUTRAL] But it does not have to have any pre-authorization.
[CUSTOMER][NEUTRAL] What happened?
[CUSTOMER][NEUTRAL] What happened is that they said that they um
[CUSTOMER][NEUTRAL] The manager at her at the OBGYN office called and they, they called and they said that and they claimed that you guys said that they need um an authorization from from the primary care in order to get um the cost covered. So that's why this whole like that situation is going on because they
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So we don't have to have.
[CUSTOMER][NEUTRAL] Because the manager called in, that's what they.
[AGENT][NEUTRAL] Right, I understand. The manager probably called and we and it now your primary insurance or major medical insurance might need authorization.
[AGENT][NEUTRAL] The one that she has the major medical.
[CUSTOMER][NEUTRAL] Her primary care doctor?
[AGENT][NEUTRAL] Yes, the primary insurance may need authorization, but ours does not.
[CUSTOMER][NEUTRAL] OK, like, like they said, yeah, um, um, yeah, tell them, she said that the primary care office, the like the first insurance might need authorization, and they probably, yeah.
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] The major medical insurance.
[CUSTOMER][NEUTRAL] So, um, the, the office was saying how, um, we should call you guys again to verify this information because we called before and they said that if um that they would like a reference number that they could call.
[CUSTOMER][NEUTRAL] You or like call someone that like.
[AGENT][POSITIVE] Yes, they can.
[AGENT][NEUTRAL] They can just they can just call we don't give reference numbers unless we act actually talk to a person so if they wanna just call the same number you called.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we can help them and we can verify the benefits for them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But we're feeling now. That's not for now. So, it's that they don't give reference numbers, OK.
[CUSTOMER][NEUTRAL] I don't know. OK, we'll give them a call and let them know.
[AGENT][NEUTRAL] OK. All right. Is that everything I can help you with?
[CUSTOMER][POSITIVE] Thank you so much Miss Miss sorry.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] I appreciate your help.
[AGENT][POSITIVE] You're very welcome and I hope you.
[CUSTOMER][POSITIVE] If anything, I'll call again. Yes.
[AGENT][POSITIVE] Yes, please. Always, always feel free to pick up the phone and we will help you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, Ms. [PII], I hope you have a good visit guys take care, have a blessed day.
[CUSTOMER][POSITIVE] Thank you, thank you so much.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks for calling APL. Yes, thank you, bye bye.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Bye bye.