AccountId: 011433970860
ContactId: 80795269-7b60-48a5-891e-9c9ef32af737
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697530 ms
Total Talk Time (AGENT): 307963 ms
Total Talk Time (CUSTOMER): 224367 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/80795269-7b60-48a5-891e-9c9ef32af737_20250121T14:30_UTC.wav
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[AGENT][NEUTRAL] Calling ATL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. Good morning. Ma'am, um, I'm calling because um I have the American Public Life through my employer, and um I need to get more information because uh I might need a surgery. I will find out on the [PII], and this is, this is my first time.
[AGENT][POSITIVE] Good morning
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, going through this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I did, I did um create an account years back online, but I don't remember my username.
[AGENT][NEUTRAL] OK, so do you need help creating the account or do you want me to give you benefits or both?
[CUSTOMER][NEUTRAL] So I can check the benefits.
[CUSTOMER][NEUTRAL] Both, both.
[AGENT][NEUTRAL] OK. What's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] It's 01
[CUSTOMER][NEUTRAL] 868-817
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's your date of birth and mailing address?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Uh thank you for that.
[AGENT][POSITIVE] So your policy has been effective.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Since [PII].
[AGENT][NEUTRAL] And it is currently active at this time. And what type of service is it for? Is it for in a doctor's office, outpatient, uh, hospital, or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's uh on Thursday, I have a specialist appointment and it's gonna be my last appointment. I might need ankle surgery.
[CUSTOMER][NEUTRAL] But I really don't know if it's gonna be like an in office, in and outpatient. I really don't know until Thursday.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And so for the office visit, um, the, the office visit co-pay is not covered. Um, if you're having some type of treatment in the office, the surgery is a treatment which your ankle surgery, I think, will more than likely be in a hospital setting.
[AGENT][NEUTRAL] Um, which is outpatient, but like if there's treatment done, like if they need to do lab work or X-rays during that visit, the treatment is, can be considered, but the co-pay is not covered for the physician's visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, for your, if your surgery is like in an outpatient facility or an outpatient hospital, you do have an outpatient benefit that that can be considered under and that's up to $2,500,550.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per calendar year for outpatient coverage services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mhm. And of course, information provided is verification, not a guarantee of payment. And you stated that you tried to create an online account, so you do have the web, the web address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, um, cause I did, uh, I, I didn't remember about creating an account, but I try to uh create an account and it says that I'm already an existing member. But I don't remember my username.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see if I can get that for you, so I can provide you with your username, but of course your your password is private, um your your username.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is your first name, so it's a [PII] and the rest is lowercase.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So I'll just reset my password.
[AGENT][NEUTRAL] Mhm and I'll hold the line until you reset it and you're able to get in. I need to know that you're able to get in after resetting your password.
[CUSTOMER][NEUTRAL] OK. And this po uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I'm just waiting for that verification code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The phone number that you have on file, is that a cell?
[AGENT][NEUTRAL] Or are you OK, is it going to your cell or email?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Myself.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the cell number is the one that you could verify that you gave me?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, that's what we have on file.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, now, so I already reset, so let me log in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, I'm already in.
[AGENT][NEUTRAL] OK, and so you said that you wanted to know what your benefits are if you go to the.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] My coverage dashboard.
[AGENT][NEUTRAL] There should be a hyperlink uh with your policy document.
[CUSTOMER][NEUTRAL] Policy, yes.
[AGENT][NEUTRAL] And you can click that that link and it should populate your policy or open up your policy.
[CUSTOMER][NEUTRAL] Ok, it's downloading right there.
[AGENT][NEUTRAL] And the schedule of benefits, let me see what page that's on.
[AGENT][NEUTRAL] Um, it'll give you definitions, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The schedule page which is where your benefits specific benefits are housed is on page.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Then, uh, I think, I see it here in section 5.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] All right. I'll go through it. OK, I see it here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good of benefits.
[CUSTOMER][NEUTRAL] In hospital benefit, maximum is the 2, 2550 per covered person on calendar year.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And then I have an in-hospital benefit maximum, and then the outpatient benefit maximum, so I have both.
[AGENT][NEUTRAL] It's, yeah, 22 separate benefits.
[CUSTOMER][NEUTRAL] OK. Got you. OK.
[AGENT][NEUTRAL] Mhm. So if you're in the hospital, 18 hours or more, that's inpatient.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, let, let me write that down. In hospital?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Mhm. It's actually in your definitions. If you go to your definitions.
[CUSTOMER][NEUTRAL] Definitions.
[AGENT][NEUTRAL] Um, that is, that's gonna be in section.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Section 3.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] And if you go down to
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right here, OK.
[AGENT][NEUTRAL] If you go down to
[AGENT][NEUTRAL] H I.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] If you look for inpatient, the definition for inpatient.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, and they're alphabetized. It says confinement in a hospital for at least 18 continuous hours in duration. So you have to be in the hospital at least 8, 18 hours.
[AGENT][NEUTRAL] For it to be considered inpatient, so that means 17 hours or less in a hospital would be outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so your ankle surgery, um.
[AGENT][NEUTRAL] Could possibly be outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which the benefit is the same for outpatient as well.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What, OK.
[CUSTOMER][NEUTRAL] In hospital treatments for a serious mental illness? No, OK, OK.
[CUSTOMER][NEUTRAL] Hospital emergency room. OK. Well, thank you very much. I'm gonna briefly go through it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, and this one, it ends when?
[CUSTOMER][NEUTRAL] When is that the ending like?
[AGENT][NEUTRAL] You mean your
[AGENT][NEUTRAL] Your policy
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, as long as you're employed with your employer.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] it's, it'll, it'll be active unless you choose to term it or they choose to terminate the coverage. I mean, it's, it's, it's active. Unless you, unless your policy, unless your company changes and get a different policy with us, this will be your policy number.
[CUSTOMER][POSITIVE] Will be OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it'll be active, you know, until we get notification from your group so like if you leave your place of employment, it'll it will end.
[CUSTOMER][NEUTRAL] OK. All right. Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, well, I, I have my appointment on Thursday, so I'll find out that day.
[AGENT][NEUTRAL] OK, and if they should need to call us to verify your benefit information, you can just give them the toll-free number that you dialed and select option 2, and then we can verify your 2 number 2.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Options
[AGENT][NEUTRAL] And then we can verify the benefits as, as, as done with you today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. OK, thank you very, very much for your help, ma'am.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][POSITIVE] [PII], I'm good, thank you.
[AGENT][POSITIVE] You're welcome thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Likewise, you too.
[AGENT][NEUTRAL] Uh-huh, bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.