AccountId: 011433970860
ContactId: 96bc7434-b0df-4cee-94ad-35d13b401d65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426369 ms
Total Talk Time (AGENT): 237047 ms
Total Talk Time (CUSTOMER): 118912 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/96bc7434-b0df-4cee-94ad-35d13b401d65_20250311T16:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, good afternoon, um,
[CUSTOMER][NEUTRAL] I need to know um all the what you pay for my, my medical insurance for the gap.
[CUSTOMER][NEUTRAL] How do I do that?
[AGENT][NEUTRAL] OK, go ahead and give me your name and your policy number.
[CUSTOMER][NEUTRAL] OK, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My policy number is 01823316, which we don't have that policy no more, but my question is about what you pay for me on [PII].
[AGENT][NEUTRAL] All right, [PII]. Well, let me get your policy pulled up. Now, while I'm pulling this up, go ahead and give me a good return telephone call number, please, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, [PII]. Thank you for all that information. I'll verify your date of birth and your address for me, please, ma'am.
[CUSTOMER][NEUTRAL] [PII], and my address is [PII].
[AGENT][NEUTRAL] All right, [PII], thank you so much for all that information. OK, now I do see that you had a medical supplemental plan here at APL. I do see it is terminated on [PII], but you want to know what your benefits were while you were covered under the plan. Is that correct?
[CUSTOMER][NEUTRAL] Yes, I have a surgery, eye surgery in August.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh they, they just send, send me a note that I owe $900.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] I don't think I should pay because uh we have 6000 in your in my policy and I didn't use that 6000.
[AGENT][NEUTRAL] OK, well, let me see. I do see that you have maxed out your benefit for 2024. Let me go see how much that was your benefit. Let's see.
[CUSTOMER][NEUTRAL] And what do I say? How did I use that money?
[AGENT][NEUTRAL] Let's see, first off, let me check to make sure on the benefit. Let's see.
[AGENT][NEUTRAL] Hm, OK, looks like you had $6000 payable per calendar year. So now let me go back to your plan. Let's see where we paid $6000. Uh, looks like you had some type of hospital bill in [PII].
[AGENT][NEUTRAL] We paid 3300 on the hospital bill.
[AGENT][NEUTRAL] Then the doctor looks like they got about 1200, the anesthesia was paid. Let's see what else you had um.
[AGENT][NEUTRAL] Uh, doctor [PII] for [PII], we paid $634.89.
[AGENT][NEUTRAL] And let's see, you had a couple of bills in [PII].
[CUSTOMER][NEUTRAL] For what?
[AGENT][NEUTRAL] Uh, let's see, go back to that.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Get back to that date. Let's see.
[AGENT][NEUTRAL] Yeah, looks like you.
[AGENT][NEUTRAL] Let me see who this bill is from, I can tell you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Memorial division of cardiac Services looks like we had several claims from them back in April.
[AGENT][NEUTRAL] Yeah, but you have maxed out your $6000 benefits, so you don't have anything left for 2024 at all.
[CUSTOMER][NEUTRAL] That the 1200, which, which was that? Who do you pay for that?
[AGENT][NEUTRAL] Where do we pay the 1000 bill to?
[CUSTOMER][NEUTRAL] 1,2009 was what was that?
[AGENT][NEUTRAL] Let's see, let me go back. Mm.
[CUSTOMER][POSITIVE] Thank you man.
[AGENT][NEUTRAL] Uh, now 821-2024, we paid $1,075.62.
[AGENT][NEUTRAL] To your doctor, your doctor for your surgery. Uh, let's see what the doctor's name is.
[CUSTOMER][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] Which doctor?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] You Miami Ophthalmology Clinic, is your doctor where you had your surgery? Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, when was that paid?
[AGENT][NEUTRAL] You want to know when the check was printed?
[CUSTOMER][NEUTRAL] When did you pay that?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I can tell you the exact date.
[AGENT][NEUTRAL] Write this check number down 399.
[AGENT][NEUTRAL] That check is dated [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. [PII]. Mhm.
[CUSTOMER][NEUTRAL] And the, and the surgery was done when?
[AGENT][NEUTRAL] [PII], you was at the um doctor hospital. Let's see where you went.
[CUSTOMER][NEUTRAL] Yeah, and how much, how much did you pay for that? I'm sorry, 1000?
[AGENT][NEUTRAL] No, to the hospital now, we paid $3,307.94 which is where you maxed your $6000 benefit out.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] On that claim that maxed you out for the year here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I, I still think that's not right. I still think something is not right, but
[AGENT][NEUTRAL] Well, uh, according to my system and the claims that I'm looking at, you, you have maxed out that $6000 benefit for your outpatient.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yes ma'am. Now, is that all I can help you with?
[CUSTOMER][NEUTRAL] How can I get my bill? How can I get to see, can you send me that information by email?
[AGENT][NEUTRAL] I cannot do anything by email any longer, but I can have that department print out a history of all your claims paid and mail it to your home address.
[CUSTOMER][NEUTRAL] Can you do that for me, please?
[AGENT][NEUTRAL] I sure can. Give it about 10 working days, [PII], but I'll get that order today.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Well, yes, ma'am, is that all I can help you with?
[CUSTOMER][POSITIVE] Yes, I appreciate your help, thank you.
[AGENT][POSITIVE] Oh, yes, ma'am, and thanks for calling APO and you have a great rest of your day, [PII].
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.