AccountId: 011433970860
ContactId: cfa0017e-a5c2-443a-bd39-9249f0329f8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389140 ms
Total Talk Time (AGENT): 128185 ms
Total Talk Time (CUSTOMER): 172928 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/cfa0017e-a5c2-443a-bd39-9249f0329f8f_20250507T18:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling because I have a question about a claim that I submitted.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, um, 1066842.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, could you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have a good callback number in case we are disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then just need two more pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] OK, email is [PII] and my address is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And what was that date of service you're checking on for that claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like we just processed that. Um, that was.
[AGENT][NEUTRAL] We made a payment of $25.
[AGENT][NEUTRAL] That went out on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I have a question about that, cause I, it's like I, I really don't know um.
[CUSTOMER][NEGATIVE] Really never understood how the payment, like how much you guys pay like for what or why. Um, I'm just curious why it's only $25.
[AGENT][NEUTRAL] Um, let me pull up your policy and see what kind of benefits you have.
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] O
[AGENT][NEUTRAL] Uh, it looks like so if you receive treatment in the physician's office.
[AGENT][NEUTRAL] It pays $25 maximum on your policy.
[CUSTOMER][NEUTRAL] Um, OK. Hold on, let me write that down because I, I, I never freaking remember. OK, so if it's just a doctor's visit, no matter if it's a specialist or not, it's just $25.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, and then looks like you have a few other benefits, um, which aren't a guarantee of payment, just a basic outline of your policy. So if you received services outpatient hospital, like outpatient hospital services, that pays $500 per occurrence and by occurrence would mean for a specific medical problem.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so that would pay a maximum of 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so regular doctor visit max is 25 outpatient.
[CUSTOMER][NEUTRAL] 500 max per current.
[AGENT][NEUTRAL] And then your inpatient, if you're ever confined to a hospital, um, it pays 5000 per confinement, up to 5000.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Give me just a second because I was looking at something.
[CUSTOMER][NEUTRAL] What I have you on the phone. I'm sorry.
[AGENT][NEUTRAL] No, you're fine. I, have you created an online account with us?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm logged in right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that I, like I said.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so this specialist that I went to, that's just considered a regular doctor visit?
[AGENT][NEUTRAL] Yeah, so it would be whether it's a specialist or primary care, it, it pays a $25 maximum for physician services, so office visit and treatment in a physician's office.
[CUSTOMER][NEUTRAL] OK, so that's different than an outpatient. I'm sorry, I'm asking so many questions. I just wanna understand like, OK, what is considered an outpatient visit or whatever, what's, what is that considered? Like if I went to urgent care or something?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] That's when you go to an actual hospital or an urgent care facility. So it's not gonna cover if, yeah.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, I got you. I got you. That's why I was confused because I'm, because I'm looking at the um, you know, the bill that I got from the this.
[CUSTOMER][NEUTRAL] Ortho or whatever and it says there office slash outpatient visit new. OK, so that's doesn't matter it's just because, you know, it's a regular doctor's office or whatever it's not like a hospital thing, OK.
[AGENT][NEUTRAL] Yeah, it's based on
[AGENT][NEUTRAL] Right, yeah, where the services are rendered kind of dictate what, how that process is. So if it's at that doctor's office, that's at $25 and then if you go to an actual hospital or facility, that's the $500 benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ah, OK. OK. So those are, that's what I have, the doctor's visits and that, how many do I have covered for the year? Like 4, I think it is or something like that?
[AGENT][POSITIVE] Yes, that's, that's correct, 4, yes.
[CUSTOMER][NEUTRAL] 4, OK, and then I have the outpatient thingy and then the inpatient and that's it, right?
[AGENT][NEUTRAL] Uh-huh, that's it. Uh-huh.
[CUSTOMER][POSITIVE] OK, now I know I'm a little bit more informed so I won't be so confused. Thank you so much.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye, bye