AccountId: 011433970860
ContactId: 8fdf2969-ce60-4ef2-adb2-7795dd372919
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502619 ms
Total Talk Time (AGENT): 270905 ms
Total Talk Time (CUSTOMER): 244127 ms
Interruptions: 7
Overall Sentiment: AGENT=1.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/8fdf2969-ce60-4ef2-adb2-7795dd372919_20250108T20:27_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name's [PII] and I'm calling in regards to our American Public Life, the hospital indemnity plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, my husband, my husband is scheduled to have a cataract surgery. And I was just checking to see if anything is covered, but you'll need his information, and I'm on his plan as well, obviously.
[CUSTOMER][NEUTRAL] Um, his, what would, what do you need?
[AGENT][NEUTRAL] OK, yeah, what is that policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh, I don't know the policy number.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] OK. Um, I
[CUSTOMER][NEUTRAL] He said that I, if I gave you the name and the last four of his social, you should be able to look it up for us.
[AGENT][NEUTRAL] I can try searching with either his full social or just his first and last name.
[CUSTOMER][NEUTRAL] OK, that's easy cause his last name and first are pretty different.
[CUSTOMER][NEUTRAL] His name is [PII], [PII]
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] [PII], perfect.
[CUSTOMER][NEUTRAL] And his last name is, his last name is [PII], which is [PII].
[CUSTOMER][NEUTRAL] BOR.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. All right, give me just a moment to take a look. And it was, so it was.
[CUSTOMER][NEUTRAL] Lots of these, OK? Yeah.
[CUSTOMER][NEUTRAL] If not, I'll give you his social.
[AGENT][NEUTRAL] G O and then B like boy or V?
[CUSTOMER][NEUTRAL] No, V as in void.
[AGENT][NEUTRAL] Void, understood.
[CUSTOMER][NEUTRAL] OR
[CUSTOMER][NEGATIVE] KO void again.
[AGENT][NEUTRAL] Understood. And you're right, I just had to type in that last name and
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, and it came up, he's the only one.
[AGENT][NEUTRAL] And Miss [PII], I'm gonna have you, if you can verify a couple bits of information. Um, first off, if you could verify your husband's date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, [PII]. Sorry, Canadians, we do it the other way around, sorry.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] No, that's OK. And then um if you could verify your last name and your date of birth for me.
[CUSTOMER][NEUTRAL] Yeah, my last name is [PII], and my birth date is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful and then I'm gonna have you verify the mailing address on file if you can.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Perfect. And then do you, would you be able to verify the email address on file?
[CUSTOMER][NEUTRAL] Sure, it's probably uh [PII]. So [PII]
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Or it's gonna be [PII].
[AGENT][NEUTRAL] Thank you, thank you. And then, give me one second. I just want to write down this policy number. And do you want me to give you that policy number so you have it on hand?
[CUSTOMER][NEUTRAL] Hm. Sure.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, cause I mean, I should have all this. Go ahead.
[CUSTOMER][NEUTRAL] Policy number.
[AGENT][POSITIVE] Let me know if whenever you have a pen and paper ready, no worries, OK? OK, awesome.
[CUSTOMER][POSITIVE] I'm ready. I'm ready. I'm ready. Oh, I'm so good.
[AGENT][NEUTRAL] It is 1665666. So 2 6s on the first round and then 3 on the second.
[CUSTOMER][NEGATIVE] Wow. It's like the devil.
[CUSTOMER][NEUTRAL] It is nearly 6666 times 2, nearly, nearly.
[AGENT][NEUTRAL] Yeah, there's a lot of six is there.
[AGENT][NEUTRAL] All right, my friend, and so I'm pulling up that benefit information. I do wanna let you know that any benefit information I give you over the phone today is just a verification of coverage and never guarantee a payment and
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Let's see um.
[AGENT][NEUTRAL] It looks like we have a surgery and anesthesia benefit on here, um, but I do need to, I do need to pull up your whole policy document to take a closer look at that. So give me just a couple moments.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure. No worries. Yeah.
[CUSTOMER][POSITIVE] [PII], that's great news. Well, if it is.
[AGENT][NEUTRAL] Yeah, yeah, if it covers it. I mean, but even if not just knowing that you have it.
[CUSTOMER][POSITIVE] Well, everything helps, like it's OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I accidentally pulled up an outdated one. Give me.
[AGENT][NEUTRAL] Just a second. Yeah.
[CUSTOMER][NEUTRAL] Oops
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And I'm just waiting for that document to load now, but it's coming up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Oh, [PII]. You want another blueberry? Sorry, my dog, begging for blueberries. Mama's eating blueberries, blueberries.
[AGENT][NEUTRAL] Oh, mine bugs for
[AGENT][POSITIVE] Everything. She loves apples, my little girl.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, I don't eat anything.
[CUSTOMER][NEUTRAL] What kind of dog you got?
[AGENT][POSITIVE] Yeah, likewise, I've got a little lab pit mix. She's a sweetie.
[CUSTOMER][POSITIVE] Nice. I have English bull terriers, like the target dog.
[AGENT][POSITIVE] Oh, that sounds like um a lot of very focused energy.
[CUSTOMER][NEUTRAL] I got 2 of them.
[CUSTOMER][NEUTRAL] Uh-huh. Um, the, the, yeah, energy comes in spurts.
[CUSTOMER][NEUTRAL] And then they'll just sleep the rest of the time and cuddle.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, oh yeah.
[AGENT][NEUTRAL] And you said we were looking at.
[CUSTOMER][POSITIVE] Yeah, you're pretty, uh, yeah.
[CUSTOMER][NEUTRAL] Cataracts.
[AGENT][NEUTRAL] Cataracts?
[CUSTOMER][NEUTRAL] So, and so I know that there's gonna be a surgical charge from the surgery center, there's going to be an anesthesiologist charge of about 300, they said. And then, you know, and then the doctor, it's like, whatever. So like, they gave us an estimate for each eye of just over 3000.
[CUSTOMER][NEUTRAL] And I was just kinda hoping that something was covered because, yeah, anyway.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna just read to you what is listed under this policy, and I just want to be honest, I'm not sure what is involved in the cataract surgery to know if any of these things are covered. So my general recommendation is to just go ahead and submit a claim and let's hope something is covered, but it says removal of eye excision of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But that's just gonna be
[CUSTOMER][NEUTRAL] All right. Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Pediogram, which is P T E R Y G I U M.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] I'm, I'm so sorry. I'm not even sure how to say some of these words, [PII]hich is S C L E R O T O M Y.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And they have the posterior and the anterior on that ureterectomy, which is, I think for the iris, I R I D E C T O M Y. Then it says extraction of lens, including cataract extraction. So I don't know if there's an extraction happening there, but that is listed.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] That does look good.
[AGENT][NEUTRAL] Reattachment of retina.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Muscle operation, one or more muscles and excision of lacrimal L A C R I M A L gland or sac.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Interesting.
[AGENT][POSITIVE] So, my overall recommendation is to submit a claim and um and see if you have anything. Um, as far as, I don't know if this is like an outpatient procedure, but you do have some benefits if you end up being confined to the hospital or the ICU. Hopefully you won't ever even need to touch those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yeah, for sure.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] I know we don't want that.
[CUSTOMER][POSITIVE] That is super. I really appreciate that and we will, uh, we'll put that claim through and then we'll see what happens.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK perfect and then if there is anything else you need just give us a call um do you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you know if you guys have the online web portal set up to submit claims?
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, yeah. I'm pretty sure I, I think I do.
[AGENT][NEUTRAL] OK perfect and you can check your claims, all of that from there.
[CUSTOMER][NEUTRAL] Oh, maybe I don't. Oh well, whatever.
[AGENT][POSITIVE] If you need help, give us a call, no worries, OK?
[CUSTOMER][POSITIVE] Sounds good.
[CUSTOMER][POSITIVE] OK, thanks so much. Bye.
[AGENT][POSITIVE] My pleasure. Thank you so much, [PII] you have such a wonderful day.
[CUSTOMER][NEUTRAL] You do
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] OK.