AccountId: 011433970860
ContactId: 948de7b2-cedc-4919-b0f5-16a9dde73357
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243300 ms
Total Talk Time (AGENT): 102356 ms
Total Talk Time (CUSTOMER): 93303 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/948de7b2-cedc-4919-b0f5-16a9dde73357_20250110T18:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, so my name is [PII], and, um, a coworker of mine, I do his APL claims for him.
[CUSTOMER][NEUTRAL] Uh, he's standing right here. Let me get him.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So hold on.
[CUSTOMER][NEGATIVE] Hope I don't hang up on me.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, you there?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] We just had a couple questions. We had a couple questions on his claim I just did for him.
[AGENT][NEUTRAL] OK. Um, may I have the policy number?
[CUSTOMER][NEUTRAL] 1653597
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and may I have the name and date of birth, the insured?
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Thank you. And I need um the mailing address and email address and your permission to release information to Miss [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, OK, so it looks like the email address is your email address, Miss [PII]. Can you verify that for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Maybe your work?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Yes, your work email?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. All right, let's see let me pull the most recent claim.
[AGENT][NEUTRAL] OK, so it looks like it was processed yesterday and we send a direct deposit. How may I assist you with this claim?
[CUSTOMER][NEUTRAL] So his claim was like 3000 and something and I see y'all just paid 1000 as an outpatient expense, is that all it will pay?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, the calendar year maximum is 1000.
[CUSTOMER][NEUTRAL] For outpatient?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So if he, he has other claims.
[CUSTOMER][NEUTRAL] Uh, like for $705 related that that won't pay either.
[AGENT][NEUTRAL] No, he already assessed his benefit with this 1000, that is the benefit amount of the outpatient service for the year.
[CUSTOMER][NEUTRAL] So if he went into the hospital, or you'd pay the other two or whatever.
[AGENT][NEUTRAL] Mhm. Yes, if he was hospitalized and he's in the hospital 18 hours or more, then is considered under the inpatient, which is the 3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I know they did surgery on him, so I, I don't know why.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It wouldn't have said that he was there for a while, so, OK, well, let's figure that part out. I appreciate your help. Any questions, [PII]? All right, thank you so much.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] You're welcome. You're welcome. And if um if he was there more than 18 hours, I will say to send in the um discharge summary. The discharge summary will let us know how many hours he was there and then if we need to change it for inpatient instead of outpatient, if he was there more than 18 hours, that's what we're gonna need, OK?
[CUSTOMER][POSITIVE] OK, yes, all right, that'll work. Thank you so much bye.
[AGENT][POSITIVE] Mhm. All right. You're welcome and thank you for calling ATL. Have a good day, Miss [PII] and Mr. [PII].
[CUSTOMER][NEUTRAL] You too bye.