AccountId: 011433970860
ContactId: 87c7a40e-0176-4d03-9b2d-8fdd600f244b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373140 ms
Total Talk Time (AGENT): 175987 ms
Total Talk Time (CUSTOMER): 132656 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/87c7a40e-0176-4d03-9b2d-8fdd600f244b_20250312T17:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help?
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] Hi. Hi. Um, my name is [PII]. I work for a company, um,
[CUSTOMER][NEUTRAL] And they said that if you have an outpatient surgery that APL will cover up to $1500 of the procedure, you just have to file a claim.
[AGENT][NEUTRAL] OK. Um, mhm.
[CUSTOMER][NEUTRAL] I had
[CUSTOMER][NEUTRAL] Go go ahead. No, I, you go ahead.
[AGENT][NEUTRAL] No, I was gonna tell you I can help you with your benefits. Um, can I please get your policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] With the group number or?
[CUSTOMER][NEUTRAL] The payer ID.
[AGENT][NEUTRAL] Remember I
[AGENT][NEUTRAL] The member ID or it might say inpatient cert number or outpatient cert number.
[CUSTOMER][NEUTRAL] OK, yeah, it's the outpatient number.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And it's 023.
[CUSTOMER][NEUTRAL] 19205
[CUSTOMER][NEUTRAL] NL 8
[AGENT][NEUTRAL] OK, let me pull up your policy real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then also for security reasons, can you please verify your address, phone number and email address that we have on file for you?
[CUSTOMER][NEUTRAL] Um, my address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, my phone number is [PII].
[CUSTOMER][NEUTRAL] And I'm not sure which email maybe [PII].
[AGENT][NEUTRAL] It looks like I could have a um work email address.
[CUSTOMER][NEUTRAL] OK, um, [PII].
[AGENT][POSITIVE] Yes, ma'am. That's correct. Thank you so much. I appreciate you verifying your policy for me.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And this is just to verify your benefits. It's not a guarantee of payment. You do have a supplemental insurance. Um, it's a gap insurance that helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] And you do have an inpatient calendar year benefit amount of $1500 and then you also have an outpatient calendar year benefit amount of $1500 that goes towards your deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have any further questions?
[CUSTOMER][NEUTRAL] No, um, no, I wanna, I had an outpatient surgery, um, in November.
[CUSTOMER][NEUTRAL] And I wasn't aware of this insurance until a few weeks ago, so, and I was trying to make sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That all of my that the Cigna insurance was correct before I reached out to you guys so I just need to know the outpatient um copay was $2500 so I'm just hoping that maybe you guys can help me with some of that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, so when you went and had your surgery, did you give them your, uh, primary insurance card and this insurance card also?
[CUSTOMER][NEUTRAL] OK, so I should want, so I need to call, so I should call the surgery center back and give them this insurance number?
[AGENT][NEUTRAL] Both of them?
[AGENT][POSITIVE] Yes, that way they can um they can help you by filing the claim for you.
[AGENT][NEUTRAL] Because in order for this one to pay, we have to have the explanation of benefits from the primary insurance too, so um that would be if they're willing to help you, that would be awesome if they could help you do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I should try that first and then give you if they don't.
[CUSTOMER][NEUTRAL] Then call you guys back or?
[AGENT][NEUTRAL] Yeah, if they don't let me give you.
[AGENT][NEUTRAL] Yes, if they don't let me give you our um online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a direct portal to your policy. If you sign up for it, you can file your claim online.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Are you ready for it? Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's [PII]
[CUSTOMER][NEUTRAL] Yes, what is it?
[CUSTOMER][NEUTRAL] [PII] sorry.
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] It's secured
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much. I will give them a call.
[AGENT][POSITIVE] You're welcome. Yes, Miss [PII], and if you find you need any more help from us, just pick up the phone if you find out you have to file it yourself and if you need help, just pick up the phone and we'll help you, OK?
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is that all I can help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I think that's all for today.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, well you have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks bye.
[AGENT][NEUTRAL] Mm bye-bye.