AccountId: 011433970860
ContactId: 8ec6d839-60cc-4530-b766-ddea9556f8d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489510 ms
Total Talk Time (AGENT): 206546 ms
Total Talk Time (CUSTOMER): 161456 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/8ec6d839-60cc-4530-b766-ddea9556f8d1_20250124T17:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi. What's your name, I'm sorry?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi, [PII], how are you? Um,
[AGENT][NEUTRAL] Hi, hi.
[CUSTOMER][NEUTRAL] Good, good. I'm calling to see if you might be able to give me an estimate or an idea of um if you, well, um, first of all, if I can use the benefits for, I'm gonna have a um outpatient surgery, and I wanna see if you might be able to see if the APL um might be able to cover something of that surgery.
[CUSTOMER][NEUTRAL] For the hospitalization.
[AGENT][POSITIVE] OK, I can help you with your benefits.
[AGENT][POSITIVE] Yes, I can help you with your benefits. What is your name?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your policy number?
[CUSTOMER][NEUTRAL] My what?
[AGENT][NEUTRAL] Your policy number?
[CUSTOMER][NEUTRAL] My, the payer ID, oh no, the payer ID is you, right? Uh, the
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, the number.
[AGENT][NEUTRAL] It may say it may say inpatient or outpatient certification number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, outpatient. It's 02501270, Mother [PII] 8.
[AGENT][POSITIVE] OK, let me pull in that policy real quick so I can get your benefits for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, Ms. [PII].
[AGENT][NEUTRAL] OK, and this is um for security reasons I'm gonna need for you to verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then I'll also need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] It's [PII]. And the phone number.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The phone number I gave it to you. No, did I? No, I don't remember, no. OK, phone number is [PII]. OK, I did, right? And the email address is uh [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing that
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, I'm showing that we have your Luminair.
[AGENT][NEUTRAL] [PII] email.
[CUSTOMER][NEUTRAL] Yeah, the employee. Oh, you need, oh, you have, that's my, my work, OK, [PII], yeah.
[AGENT][POSITIVE] OK, thank you so much. I appreciate you, Ms. [PII], verifying that information for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, and this is just to verify your coverage it's not a guarantee of payment, so you have, if you go inpatient to the hospital, you have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's, it's
[AGENT][NEUTRAL] It's outpatient? OK, so outpatient, you have a calendar year benefit amount of $2000. That $2000 helps with deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] It's outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me check to see if you have surgery benefits. I'm going to pull your policy and it's gonna take a little bit for the computer to download it so that we can read it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And see if you have surgery benefits.
[AGENT][NEUTRAL] OK. I've got your policy pulled up. I'm gonna read through it real quick and see if I see if it says anything about surgery to help you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So you do have um benefits if you have surgery in a freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So that's good.
[CUSTOMER][NEUTRAL] Yeah, mhm. But um
[CUSTOMER][NEUTRAL] Can you give me an estimate of maybe how much I
[CUSTOMER][NEGATIVE] And having a small procedure is so expensive, [PII]. Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the way that your policy works is your primary insurance that you have has to be billed first we're billed.
[AGENT][NEUTRAL] So if you pay deductible, co-pay or co-insurance and your primary insurance covered, then we come in and help pay for deductible copay or co-insurance only. So depending on how much your deductible is or your A or your co-insurance is based on how much this policy will pay up to $2000 per calendar.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, I, I hear you.
[CUSTOMER][NEUTRAL] Oh yeah. OK, I'm sure. I think I lost you. OK. OK. Oh, OK.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So do you understand?
[CUSTOMER][NEUTRAL] Uh, not really.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] Oh, OK, so if you, if you have a deductible to pay with your primary insurance, your major medical insurance, you have a.
[CUSTOMER][NEUTRAL] Yeah, I have $5000. My deductible is $5000.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for outpatients.
[AGENT][NEUTRAL] This policy will help with $2000.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for the surgery, just.
[AGENT][NEUTRAL] Uh, it, it doesn't cover the surgery. It just covers only if you have a deductible, a co-pay, or a coins. So it will help with your deductible up to $2000.
[CUSTOMER][NEUTRAL] OK. OK. Got you. OK.
[CUSTOMER][POSITIVE] OK, OK, thank you very much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a blessed weekend and I hope your surgery goes really well for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL, Miss [PII].
[CUSTOMER][POSITIVE] OK, thank you. Uh, have a great day. Bye.
[AGENT][NEUTRAL] Mm.