AccountId: 011433970860
ContactId: dc25a4c5-ddaf-49c1-bcac-14ae4968e3f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316200 ms
Total Talk Time (AGENT): 77549 ms
Total Talk Time (CUSTOMER): 158567 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/dc25a4c5-ddaf-49c1-bcac-14ae4968e3f2_20250428T15:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII] and I was just, I had a question. Um, I see that um a claim went through and they paid $500.
[CUSTOMER][NEUTRAL] Um, I could believe they probably paid it. I don't know if they're paying it to my to my um surgeon or to me. Could you clarify that?
[AGENT][NEUTRAL] Uh, yes. Do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] 01975687 M as in Mary, L as in Laurie and then the number 8.
[AGENT][NEUTRAL] OK, thank you. And can you verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, just need 2 more pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, it looks like it's a work address.
[CUSTOMER][NEGATIVE] Oh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's see what we have. Um, was that for what date of service was that for?
[CUSTOMER][NEUTRAL] Um, let me go back a little bit.
[CUSTOMER][NEUTRAL] Um, date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, looks like, uh, yes, we sent that to the provider and that was sent on that date.
[AGENT][NEUTRAL] That was sent on [PII].
[CUSTOMER][NEUTRAL] OK. So, all right, so they'll be replacing it to me. OK, and I have a quick question. I'm fairly new to the APL um insurance. So I also paid an additional like $1100 and some change, an additional for my surgery. One was for the anesthesia, and this one was to the doctor of $500. Is there a cap, like $500 a year to date is the max for APL to, to pay out?
[AGENT][NEUTRAL] Um, let me pull up your policy and see what that dollar amount is.
[AGENT][NEUTRAL] I'm getting that
[CUSTOMER][NEUTRAL] OK, because I was, I really was hoping that that 1100 was an additional.
[CUSTOMER][NEUTRAL] Money is coming back to me.
[AGENT][NEUTRAL] Um, and this is not a guarantee of payment. It's a basic outline of your policy. Uh, so it looks like, so your benefit is $500 per calendar day for outpatient services. So it's not an annual amount.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] You'll pay 500 per day, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I could, I could potentially still get the 1100 that was um out of pocket for the anesthesiologist.
[AGENT][NEUTRAL] Um, it, it, yeah.
[CUSTOMER][NEUTRAL] OK, I'm just waiting.
[AGENT][NEUTRAL] Yeah, it's per day so if if it already was taken up, so it looks like this has been the max payout for that date of service.
[AGENT][NEUTRAL] It would have to be a different data service.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well, let's see, [PII], what date was that?
[CUSTOMER][NEUTRAL] The same day that.
[CUSTOMER][NEUTRAL] I had surgery, so that's the day that.
[CUSTOMER][NEUTRAL] I paid that 1100 out as well.
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] OK, I, I'm not sure. Let me, I guess, I guess I should open up the claim and see what date that was.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sorry, I'm downloading it see what it says.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] From day to day less.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, they took, they took that out.
[CUSTOMER][NEGATIVE] They called me a day before, a couple of days before my, I wish they would have changed that day.
[CUSTOMER][NEGATIVE] Uh, it's probably gonna get denied then.
[AGENT][NEUTRAL] Yeah, if we received anything else from [PII], it would, it would say that the max is met if it's eligible for benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, maybe I can call them and see what they did. OK, well, that's all I needed. Thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.