AccountId: 011433970860
ContactId: c9918de3-7757-4a5a-a66a-e009b5757185
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 167119 ms
Total Talk Time (AGENT): 71289 ms
Total Talk Time (CUSTOMER): 73299 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/c9918de3-7757-4a5a-a66a-e009b5757185_20250321T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, good morning, um, I received a paper here saying that uh was.
[CUSTOMER][NEUTRAL] Uh, explanation of benefits and I do not understand if you guys, uh, gonna pay the gap or not on the claim was a big surgery.
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] And I don't.
[CUSTOMER][NEUTRAL] 025727772
[AGENT][NEUTRAL] 02572772
[CUSTOMER][POSITIVE] That'll be correct.
[AGENT][NEUTRAL] May I have your first and last name and a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have a callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII] to [PII] and the email on file should be the email from my work at [PII].
[AGENT][POSITIVE] Thank you for verifying that info.
[CUSTOMER][POSITIVE] Hopefully it's that one.
[AGENT][NEUTRAL] Yes, sir. Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And may I have the claim number on that EOB?
[CUSTOMER][NEUTRAL] I understand that.
[CUSTOMER][NEUTRAL] 357-460-7
[AGENT][NEUTRAL] Thank you. That was processed for data service 34-2025 and under this plan, office visits are not covered, so that claim was not payable.
[CUSTOMER][NEUTRAL] OK, surgeries is the surgery covered?
[AGENT][NEUTRAL] No, this was an office visit, 992134.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] OK, so it's not the main claim because there, there's the gap over surgery.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK. And what's my maximum benefit with the gap?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For your inpatient, the max allows 2500.
[AGENT][NEUTRAL] And for outpatient, it will allow $1250.
[CUSTOMER][POSITIVE] OK, so I just wait that claim to to clock a few guys and then that should be covered. OK, perfect. Thank you. So that was not the main thing. OK, not a problem. Thank you very much. I appreciate it.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Thank you you too bye bye.