AccountId: 011433970860
ContactId: d28d61a1-e3ac-4675-a5c9-63a4725d67c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298459 ms
Total Talk Time (AGENT): 116712 ms
Total Talk Time (CUSTOMER): 65976 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/d28d61a1-e3ac-4675-a5c9-63a4725d67c4_20250401T15:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm just checking if.
[CUSTOMER][NEUTRAL] Ambulance services covered.
[CUSTOMER][NEUTRAL] Under our policy.
[AGENT][NEUTRAL] OK, I'm happy to check on the policy. Do you have the policy number?
[CUSTOMER][NEUTRAL] 17816
[AGENT][NEUTRAL] OK, let me pull that up. 17816.
[AGENT][NEUTRAL] And let's see, are you the insured?
[CUSTOMER][NEUTRAL] No, I, I'm HR administrator. I don't know what you call it for the account.
[AGENT][NEUTRAL] Oh, OK, so this is, let me see.
[AGENT][NEUTRAL] OK, so are you calling for the group to see if the products offered if any of them actually cover ambulance care? is that what we're checking on?
[CUSTOMER][NEUTRAL] Yes, I have an employee who has a claim going and he just got a bill for ambulance service, so he's wondering if it's covered. He should, he should, um.
[AGENT][NEUTRAL] OK, do you have the insured's policy number because it looks like there's a couple different gap plans we offer to the group.
[CUSTOMER][NEUTRAL] Mail it to you.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 2,138,760
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So it would be covered, it looks like under outpatient and this plan on this member's benefit amount is up to $2000. So it looks like that's the max it's gonna pay out whatever their primary doesn't will cover up to $2000.
[AGENT][NEGATIVE] And it doesn't look like they've used anything.
[CUSTOMER][NEUTRAL] I know he's had
[CUSTOMER][NEUTRAL] Oh yes, they have a claim in there. It's been paid.
[CUSTOMER][NEUTRAL] For the daughter [PII].
[CUSTOMER][NEGATIVE] [PII].
[AGENT][NEUTRAL] The one I see is for that's been paid is showing for 10:36.
[AGENT][NEUTRAL] Um, $10.36 it looks like.
[CUSTOMER][NEUTRAL] They had helicopters, and they had EMS.
[CUSTOMER][NEUTRAL] That's the ambulance then they had um what do you call that? Hospital treatment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So yeah, I would
[CUSTOMER][NEUTRAL] So far they only paid $10.
[AGENT][NEUTRAL] Well, this is a different claim for and what is the insured that went to the ER? What's their first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] [PII].
[AGENT][NEUTRAL] Um, yeah, so it looks like they've submitted a claim for it looks like the ER visit itself.
[AGENT][NEUTRAL] And that was processed.
[AGENT][NEUTRAL] There's another facility charge that was sent in, but that was a duplicate, so that was probably the ER visit. They just sent it multiple times. I don't see anything yet for an ambulance, so if it was sent, it must be still on its way. I don't know how they sent it to us, but.
[CUSTOMER][NEUTRAL] No, we, we didn't send it yet. He's asking before he sends it in.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] If it would be covered.
[AGENT][NEUTRAL] Yeah, definitely so.
[CUSTOMER][NEUTRAL] A coverable, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Most definitely.
[CUSTOMER][POSITIVE] OK. Very good. We'll send it in to you.
[AGENT][POSITIVE] OK, sounds good. Anything else?
[CUSTOMER][POSITIVE] No, that's it. Thank you very much.
[AGENT][POSITIVE] You're welcome. Have a nice day.