AccountId: 011433970860
ContactId: 71131ab7-b0f0-4077-b6dd-351c0548bd4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609020 ms
Total Talk Time (AGENT): 192101 ms
Total Talk Time (CUSTOMER): 185872 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/71131ab7-b0f0-4077-b6dd-351c0548bd4c_20250409T15:08_UTC.wav
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[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Um, I'm calling on behalf of one of my employees.
[CUSTOMER][NEUTRAL] Um, he received a
[CUSTOMER][POSITIVE] Uh, I'm trying to find the email. I'm so sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One of her dependents is trying to use the APL or
[CUSTOMER][NEUTRAL] Thought he was using the APO coverage.
[CUSTOMER][NEUTRAL] Um, for his physical therapy, but he received the bill.
[CUSTOMER][NEUTRAL] And um basically saying that they reached the maximum out of
[CUSTOMER][NEUTRAL] The maximum amount for outpatients?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm sorry, I'm just trying to find it here for you to give you the exact same information um.
[CUSTOMER][POSITIVE] I think I got it here now.
[CUSTOMER][NEUTRAL] OK, yeah. So it says outpatient benefit for this calendar year has been met, but I'm not showing any claims under that specific employee.
[AGENT][NEUTRAL] OK, so you're the group administrator and you're calling on behalf of a an employee, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so yes ma'am I'll be able to partially help you with this um is the employee available to authorize me to speak to you regarding claims?
[CUSTOMER][NEUTRAL] Um, no, but I could loop her in.
[CUSTOMER][NEUTRAL] Is that OK?
[AGENT][NEUTRAL] OK, so yes ma'am, so let me go ahead and get some information from you first before we do that. So who am I speaking with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So my first name is [PII], last name is [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 437-49991
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] It is um
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 25912
[AGENT][NEUTRAL] That's the group number. What's the specific policy number for the employee?
[CUSTOMER][NEUTRAL] Uh, OK, hold on, let me pull that up.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] On her card, is, would it be the payer ID?
[CUSTOMER][NEUTRAL] That you
[AGENT][NEUTRAL] No, ma'am. No, ma'am. There should be some other number on the front of the card.
[AGENT][NEUTRAL] Depending on the type of.
[CUSTOMER][NEUTRAL] I'm just showing the group number.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, it says the insured, the coverage group number, effective date, and then the plan. And then it also has an in hospital benefit certification number, and outpatient benefit certification number, and then that payer ID. So that's.
[AGENT][NEUTRAL] OK, you may
[AGENT][NEUTRAL] OK. Either one of the, either the inpatient or the outpatient, either number will be fine.
[CUSTOMER][NEUTRAL] OK, so it's 023325.
[CUSTOMER][NEUTRAL] 88
[CUSTOMER][NEUTRAL] M [PII].
[AGENT][POSITIVE] OK, thank you. So give me just.
[AGENT][NEUTRAL] Just one moment please to get that information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I will need to verify a few things with you first, [PII] related to the group. So first off, if you could please verify the group's name and address.
[CUSTOMER][NEUTRAL] It is Key Service Group LLC um, address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], and I'm sorry, the [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you. And then the contact primary contact name for the group?
[CUSTOMER][NEUTRAL] Which should be our broker, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, he is the broker, but we do have someone else listed.
[AGENT][NEUTRAL] Under your specific group.
[AGENT][NEUTRAL] As a contact.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the email address that we would have on file?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then let me, give me just one moment.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] It's just taking a moment.
[AGENT][NEUTRAL] Going to load some information for me.
[CUSTOMER][NEUTRAL] OK. And then, um,
[AGENT][NEUTRAL] OK, and then your email address please, [PII]?
[CUSTOMER][NEUTRAL] My email is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you very much for verifying the information and then.
[AGENT][NEUTRAL] Lastly, what is the employee's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is for [PII].
[CUSTOMER][NEUTRAL] Costoa. Uh, date of birth is [PII].
[CUSTOMER][NEUTRAL] So [PII]. Let me get the actually, hold on.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And last thing to verify is the dependent's name and date of birth that you're calling about.
[CUSTOMER][NEUTRAL] So this is for [PII]?
[CUSTOMER][NEUTRAL] Oh, and his date of birth.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Give me one second, I'm sorry.
[AGENT][NEUTRAL] No, you're fine. No worries. I know it's a lot of information to verify, but we have to do this for security. Yes, ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, I get it. Um, let me just log into our enrollment portal just so I can pull that info for you. Give me one second.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK, there we go. Sorry about that. Um, so his date of birth is [PII].
[AGENT][POSITIVE] No, no, you, no worries.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, thank you. Um, so yes, I will, [PII], have to be able to speak to.
[AGENT][NEUTRAL] Ms. [PII] in order to get authorization.
[AGENT][NEUTRAL] And actually,
[CUSTOMER][NEUTRAL] OK. Let me um loop her in the call then.
[AGENT][NEUTRAL] OK, now, actually, let me go a little step farther. Because of his age.
[CUSTOMER][NEUTRAL] He has to call in.
[AGENT][NEUTRAL] We will have to receive all from him. Mhm. Yes. I just realized I was focused on his name and his, but his date of birth with, yes, with his age, he would be the one that would have to contact us.
[AGENT][NEUTRAL] To give authorization to speak to someone else on his behalf for that one phone call.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] OK then, let me, I don't know what his schedule is like honestly, so I will have to return the call. Um, thank you though. I'll, I'll let her know.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] OK, that's fine and I'll, you're welcome. I just, um, we are here Monday through Friday and we are on Central time, [PII]. So we are here from [PII] Monday through Friday. So we're an hour behind you all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome. Is there anything else that I can help you with at the moment?
[CUSTOMER][POSITIVE] No, that's all. Thanks.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you