AccountId: 011433970860
ContactId: bea2ead6-4377-48f7-905d-083627caf0ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465100 ms
Total Talk Time (AGENT): 245287 ms
Total Talk Time (CUSTOMER): 199987 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/bea2ead6-4377-48f7-905d-083627caf0ae_20250127T18:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm a member of ACL and I need to verify my benefits.
[AGENT][NEUTRAL] OK, Miss [PII], you have a question regarding your benefits. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Um, I guess is, do I, OK, here we go. 02505772 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] OK, thank you. One moment while I get your information pulled up. Once I do, Miss [PII], I will need to verify several things with you first for security, so just one moment please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], also any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. And first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Your phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you. And lastly your email address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying your information. So, what type of benefit information do you have a question regarding Ms. [PII]?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK, I, I'm gonna run through the, OK, I want everything. I want to know what is the maximum in hospital benefit.
[AGENT][NEUTRAL] Inpatient, outpatient or office.
[AGENT][NEUTRAL] The maximum inhospital for an in-patient admission is $7900 per covered person per calendar year with no in-hospital deductible. Yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK. How about the in-hospital ambulance benefits?
[AGENT][NEUTRAL] Mhm. That falls under the same category.
[CUSTOMER][POSITIVE] Perfect. OK, I'm just here, OK.
[AGENT][NEUTRAL] That falls up now, sure, and, and I do wanna ask you one question is going instead of you trying to write all of this down. Have you ever set up your profile in our portal called the online service center?
[CUSTOMER][NEUTRAL] Yes, I have, but the reason I'm calling to verify is because I called once before and they gave me some information that I don't think that was correct and before I wanna write this down so I could take it to my employer's risk management which they're the ones who purchased this for me.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they could fix it because they gave me some wrong information, but that's I, I wanna verify with you again if the information that they gave me was wrong or maybe you know it's correct what you're giving me but it was wrong what they signed me up for so I also need to know which is this is the important one, what is the maximum outpatient benefit.
[AGENT][NEUTRAL] On the policy
[AGENT][NEUTRAL] That you currently have for covered outpatient services, your calendar year benefit maximum is $2500.
[AGENT][NEUTRAL] With no outpatient deductible.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK, and the outpatient ambulance, the same?
[AGENT][NEUTRAL] It falls under that 2500.
[CUSTOMER][NEUTRAL] OK, perfect. And the physicians for specialty outpatient treatment, it should, should it be physicians [PII] and specialty [PII], is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. On the, on the physician's office visit, see that's up to $25 per visit with a maximum of 4 visits per covered person per calendar year, and for a specialist office visit, that is up to $50 per visit, also a maximum of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] OK perfect and can you verify what coverage I had last year for calendar year [PII]? Is it the same? What I'm looking at is the maximum outpatient.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, this policy number that you provided for me went into effect [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So since [PII] I've been with this $2500 coverage, correct?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEGATIVE] OK, which mistake because I pay for the advanced gap which should be 7900. That's what I'm going to go to my insurance department to argue the point because I pay for advanced gap.
[AGENT][NEUTRAL] Yes, ma'am, your
[AGENT][NEUTRAL] OK, so yes, ma'am, your inpatient benefit max is 7900 and your outpatient benefit max for covered outpatient services is 2500 on the policy. Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and it should be 2 and it yeah it should be 79 because I don't pay for basic gap. I pay for advanced gap. So and that's why a lot of my bills are not getting paid, but I wanted to verify with you so that I could go now to my risk management department and say since [PII] I've been paying for the advanced gap, including 2025. So, OK, that's all I needed to know, thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. And if you, and Miss [PII] too, if you need to print out, you know, if you were to need to print a page to take with you, and your policy certificate is in the portal. So you could go to your schedule of benefits pages. They're separate for the in-hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Versus the outpatient, but um again you can search under that schedule for schedule of benefits and you could print those pages that shows the uh the amounts.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On them.
[CUSTOMER][NEUTRAL] OK, OK, so do I go online to APL because I don't have access to it. I've never done it. Or do is there an app or how does it work?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I'm sorry. I thought you said, oh, I'm so sorry. I misunderstood when I asked you if you had ever set up your portal. I, I thought that you said you had.
[CUSTOMER][NEUTRAL] No. No.
[AGENT][NEUTRAL] So what I'll do is I'll email you this user guide that explains Miss [PII] how to set it up and then the different ways it also gives you, um, you know, steps for different things whether it's printing ID cards or looking up your policy information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or seeing claims that have been processed, all of that's in here and I'll send that to you in just a moment. The email that I'm gonna send to you will come from [PII] and I will put APL in your subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Thank you. I appreciate it.
[AGENT][POSITIVE] Absolutely. You're very welcome. And you, you will have that email in just a couple of minutes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Absolutely. Can I help you with anything else today?
[CUSTOMER][POSITIVE] No, that's it. Thank you very much.
[AGENT][POSITIVE] Uh, you're very welcome and thank you again for calling APL. Have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.