AccountId: 011433970860
ContactId: da3c8a56-86d4-41cf-bef8-952103327175
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592969 ms
Total Talk Time (AGENT): 176845 ms
Total Talk Time (CUSTOMER): 240688 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/da3c8a56-86d4-41cf-bef8-952103327175_20250206T16:04_UTC.wav
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[AGENT][POSITIVE] Good Morning, thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you doing?
[AGENT][POSITIVE] Hey [PII], I'm good how are you?
[CUSTOMER][NEUTRAL] I'm doing good, thank you. I have an accident policy. It was an insured with the accident policy and she's wanting specific surgical benefits and, you know, physical therapy benefits. Can, and I, I'm not sure if this is a per calendar day for her physical therapy or on the benefits. Can you help her further?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, what's the policy number?
[CUSTOMER][NEUTRAL] It's 240-4835.
[CUSTOMER][NEUTRAL] I've got it pulled up in PIBFT and I've got the policy shirt opened.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] She's wanting to know the surgical benefits she had.
[CUSTOMER][NEUTRAL] Tendonitis and they did us, she didn't have the code or anything.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Come on on base.
[CUSTOMER][NEUTRAL] I see the surgical benefit of 500, but I'm not sure on this type of accident, do you have to have specifics or?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] So I pull up this. I don't know either. Let's see.
[CUSTOMER][NEUTRAL] I see the physical therapy of $25 is that for one therapy?
[AGENT][NEGATIVE] Oh come on
[CUSTOMER][NEUTRAL] Is it per day?
[CUSTOMER][NEGATIVE] And I'm looking at the new PIBFT and I just don't wanna give incorrect benefits.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] That's weird.
[AGENT][NEUTRAL] OK, so you say she had surgery?
[CUSTOMER][NEUTRAL] She wants to know the surgical benefit and physical therapy.
[CUSTOMER][NEUTRAL] Those were 2 that we started on.
[AGENT][NEUTRAL] And does she have a CPT code or does she know what type of surgery it is?
[CUSTOMER][NEUTRAL] She couldn't give me the name of the surgery. She said it was to repair a tendon where they go in and just snip out the part of the tendon that's damaged.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can you just get paid for one physical therapy. I, I don't, I can't figure it out.
[CUSTOMER][NEUTRAL] Oh wait, let me look at the definition.
[CUSTOMER][NEUTRAL] So it's that
[AGENT][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] For each day like it's uh for each day they receive physical therapy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Initial treatment.
[AGENT][NEUTRAL] Benefits payable up to 20 days per plan year for each person.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] And that's PT.
[CUSTOMER][NEUTRAL] If it begins within 30 days.
[AGENT][NEUTRAL] Yeah, per day.
[CUSTOMER][NEUTRAL] The surgery.
[CUSTOMER][NEUTRAL] I'm thinking it's 500.
[AGENT][NEUTRAL] The surgery.
[CUSTOMER][NEGATIVE] But I can't, I'm just not confident enough to in that.
[AGENT][NEUTRAL] Look, that's gonna be the case for both of us. Give me one second. Uh, a patient, outpatient benefit showing the schedule for each day a person undergoes surgery and an outpatient dial out based on the type of surgery shown in.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] She did say it was outpatient.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] She did not say?
[CUSTOMER][NEUTRAL] She said it was outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Has to be performed within the covered the 30 days, OK.
[AGENT][NEUTRAL] Alright, you can send her on over.
[CUSTOMER][NEUTRAL] Alright, and I did verify her information. She is aware that her policy is no longer active.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right. Thank you, [PII], [PII], let me get on the line. Good to talk to you. One moment.
[AGENT][POSITIVE] Alright, no problem.
[AGENT][NEUTRAL] All right, same here.
[CUSTOMER][POSITIVE] Miss [PII], thank you for your patience. I have [PII] and she is on the line. She's going to assist you further with those benefits, but thank you for calling ATL, and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thanks you too. Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Good morning. How are you?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][POSITIVE] I'm doing well thanks for asking. OK, so she said you need some additional um.
[AGENT][NEUTRAL] Uh, information on your benefits.
[AGENT][NEUTRAL] Uh, so on the type of surgery.
[CUSTOMER][NEUTRAL] Yes, please. I'm trying to figure out.
[AGENT][NEUTRAL] We would have to, have to know what type of surgery. Do you know the exact
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, type of surgery that you're going to have.
[CUSTOMER][NEUTRAL] I already had it and I already sent in all the information. Um, I was just shocked that the payout was only $50 total. Um, I had several doctor appointments, surgery, several physical therapy appointments.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I don't know why the payout was only $50.
[CUSTOMER][NEUTRAL] I sent in like
[CUSTOMER][NEUTRAL] Uh an $8 packet of mail to APL.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like uh the treatment has to be performed within a certain number of days after the uh accident occurs. And so it looks like depending uh looking at the date of the treatment, it was not performed within a timely, um.
[AGENT][NEUTRAL] Within the time frame.
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] Why would they have, why, that makes no sense. I mean, why would you go straight to surgery and why would, why would a company penalize someone for avoiding surgery?
[AGENT][NEUTRAL] Right. Uh, but that's just what the policy states. The policy states that the surgery must be performed within 30 days after the covered accident.
[CUSTOMER][NEUTRAL] So, is anything covered? Physical therapy, um, doctor visits, anything?
[AGENT][NEUTRAL] Uh, so it looks like she did pay you for the office visit. Uh, the physical therapy also must be, uh, must begin within 30 days.
[AGENT][NEUTRAL] After the uh after the accident.
[CUSTOMER][NEGATIVE] Wow, that's a really, really bad policy.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] See.
[CUSTOMER][NEGATIVE] Uh, I'm, I'm in shock that it, you get penalized for avoiding surgery.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know that's what most doctors, they try to.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Treat it with other methods prior to.
[AGENT][NEUTRAL] But with this one it must must begin within that specified number of days.
[CUSTOMER][NEGATIVE] Wow. So my $50 check, which barely covers the premium, I, I definitely will not be renewing this, um.
[CUSTOMER][NEUTRAL] The $50 was for an office visit.
[AGENT][NEUTRAL] Uh, yes ma'am.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] I'm just, I'm, I'm, I know it's not your fault that I am blown away, but it's so typical of the insurance agency in general, I probably should not be shocked.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's why there was no payment.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][POSITIVE] Wow, OK.
[CUSTOMER][NEUTRAL] So technically, what was the $50 for?
[AGENT][NEUTRAL] Uh, the $50 was for the.
[AGENT][NEUTRAL] Looks like it was the office treatment one.
[AGENT][NEUTRAL] Let me open your client, give me one second.
[AGENT][NEUTRAL] It was for the uh office treatment on [PII].
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] So you guys don't have follow up? I mean, literally after 30 days, the the like.
[CUSTOMER][NEUTRAL] Everything stops.
[AGENT][NEUTRAL] Mm let me see if you have any follow up office physician treatment.
[AGENT][NEUTRAL] So that screening, no, ma'am, it doesn't look like there's any benefits for a follow up.
[CUSTOMER][NEGATIVE] OK, what an awful policy. I'm, I'm just, I'm blown away. I'm blown away that there's even a timeline.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] It's just, it's, wow, it's really bad.
[CUSTOMER][POSITIVE] OK. All right. Thank you for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome and you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] All right. Bye-bye.