AccountId: 011433970860
ContactId: 9e33b5cf-28bf-493b-82bc-f6661d6d6846
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297070 ms
Total Talk Time (AGENT): 135259 ms
Total Talk Time (CUSTOMER): 169390 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/9e33b5cf-28bf-493b-82bc-f6661d6d6846_20250313T21:50_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Well, I never get you anymore, Miss [PII].
[AGENT][NEUTRAL] Oh, is this like? OK.
[CUSTOMER][NEUTRAL] This is [PII] girl.
[AGENT][NEUTRAL] Usually I was like doing emails, but I'm on the phones a little bit in training.
[CUSTOMER][NEGATIVE] Yeah, oh my goodness. All right, my dear, we're running out of days, so I've got, uh, um, a very sweet lady on the phone. Thank goodness because I got such an ugly call earlier. I just, I didn't wanna answer another call. Oh, I know y'all know as many calls as you get. You all get, OK, so this policy number is 22.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] I bet.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] 95713.
[CUSTOMER][NEUTRAL] It is the insured [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have verified her date of birth, address, phone number, email, her phone number on file is the same as what she's calling from, but I can give that to you.
[AGENT][POSITIVE] No, it's all good if it's in the system. It's all gravy, baby.
[CUSTOMER][NEUTRAL] All right [PII], OK, um, Miss, Miss, Miss [PII] has had this and didn't even realize what she had, so she's just, I think really needing some understanding of what it is. I, I did my best, but then I can only go so far.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] No, you're fine. I can give her that info. You're good.
[CUSTOMER][NEUTRAL] I, there, and I told her about the website.
[AGENT][POSITIVE] Oh, good deal.
[CUSTOMER][POSITIVE] So she's, she's gonna check that out and um yeah, OK. Anyway. All right, love. Thank you, [PII].
[AGENT][POSITIVE] All right, sweetie, it's so good to hear from you.
[CUSTOMER][POSITIVE] You too, honey. You too. Bye, dear.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm a policyholder. I'm just finding this out. Didn't know I have a policy from [PII], and I'm just basically calling for information, so I just spoke with a customer service rep who pretty much showed me what, what the, the policy is for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and so I wanted to know if you're able to tell me like what the balance is on the card. I looked at my payslip and I saw the year to date balance, which wasn't much, and I saw the prior balance. I wanted to know, does it roll and if I still have access to all these funds, if I can still claim for like [PII] and [PII] um medical expenses and that kind of thing.
[AGENT][NEUTRAL] Well, the way the policy works is not like a health savings card or anything. It's just you have benefits for outpatient or in hospitals. Uh, what this policy does, it helps with your primary insurance deductible, co-pay or co-insurance for services outpatient or in hospital, um, outpatient being ER, urgent care, ambulatory surgery center, MRI or imaging center.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so not necessarily for like your, your, your regular doctor visits and stuff like that.
[AGENT][NEUTRAL] Correct. Office visits are not covered nor procedures in office, just outpatient or in hospital.
[CUSTOMER][NEUTRAL] Oh, OK, got it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so just like hospital, like ER and that kind of thing.
[AGENT][NEUTRAL] Yes, ma'am, like when you give them your primary insurance information, you can give them our information as secondary, but it just helps with those services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh wow. OK. It would have been great if it was like with like with procedures.
[CUSTOMER][NEUTRAL] So like if I go to get a mammogram done or I can't use it for the copay.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Uh, no, not for any, uh, has to be for a sickness or an injury. So if you have to go to an ER because of, um, you fell and hurt yourself or if you have a sickness and go to an urgent care facility, um, or say you have to have outpatient surgery, this is what, that is what the policy covers.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We got you. All right. Are you able to tell me like is there like a balance on it or no, that's not how it works.
[AGENT][NEUTRAL] Um, there's a max benefit that is payable, um, not a guarantee of payment, just a verification of your coverage. If it's for outpatient, it pays up to $500 per occurrence. Uh, that means for the same or related condition has to be separated by 90 days before we pay up to that $500 again. and inpatient is if you're confined in the hospital 18 hours or more, it pays up to $500 per confinement.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] Alright, you're welcome. Uh, thank you for calling APL. You have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][NEUTRAL] Bye.