AccountId: 011433970860
ContactId: e098925a-1944-4ddd-a921-d9057f39c71d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 429609 ms
Total Talk Time (AGENT): 181261 ms
Total Talk Time (CUSTOMER): 157370 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/e098925a-1944-4ddd-a921-d9057f39c71d_20250121T15:21_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. my name is [PII]. How may I assist you today?
[CUSTOMER][POSITIVE] Good morning [PII]. um, I'm calling to get um benefits.
[AGENT][POSITIVE] I'll be happy to assist with benefits. May I have your first name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] And here, if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Policy number would be 02273102 M as in Mary L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] I do show the inpatient calendar, your maximum is $4000.
[CUSTOMER][NEUTRAL] Inpatient.
[CUSTOMER][NEUTRAL] 4 correct?
[AGENT][NEUTRAL] $4000 per calendar year.
[CUSTOMER][NEUTRAL] $4000 per calendar year.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, I had called before and they told me the same thing, but as for the patient, she's saying that she has $5000.
[CUSTOMER][NEUTRAL] Gap insurance.
[AGENT][NEUTRAL] No, she has 4000. Let me see if she's had another policy before. OK, let me look at her policy from [PII]. Let's see.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, actually her policy that she had with us beginning in [PII] that ended in [PII] was only $2000.
[CUSTOMER][NEUTRAL] So from [PII].
[CUSTOMER][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] It was $2000.
[AGENT][NEUTRAL] That's correct, and that was under policy number 212.
[AGENT][NEUTRAL] 0323
[AGENT][NEUTRAL] And then she upgraded beginning [PII].
[AGENT][NEUTRAL] To the policy number that you gave me.
[AGENT][NEUTRAL] No, excuse me, she No she upgraded [PII].
[AGENT][POSITIVE] And that's the one that she has now she, she, um increased it because it looks like her premium went up as well.
[AGENT][NEUTRAL] Um, to the policy that she has now, which is $4000 per calendar year.
[AGENT][NEGATIVE] So she has a $5000 gap policy, it's not with us.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me see, what about with a different, no, I mean.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Can I give you another um ID number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be 0227312 I mean 3102 M as in Mary, L as in Lima number 7.
[AGENT][NEUTRAL] Um, can you
[AGENT][NEUTRAL] Can you start with the numbers?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 273102 ML 7
[AGENT][NEUTRAL] That's the number that you.
[AGENT][NEUTRAL] Gave me
[AGENT][NEUTRAL] The first time.
[CUSTOMER][NEUTRAL] The first time it ends with an 8.
[AGENT][NEUTRAL] And that's the
[AGENT][NEUTRAL] That we don't, we don't put those numbers in. We don't, we're only worried about the numbers. That's why when I ask you to repeat it, I ask just for the numbers.
[CUSTOMER][NEUTRAL] Mm, cause that's what.
[CUSTOMER][NEUTRAL] Yeah, that's OK, so the one I have on file is the first one I gave you and then she sent me this one, the one I just gave you, so it's the same one basically.
[CUSTOMER][NEUTRAL] The same thing.
[AGENT][NEUTRAL] The same is the that number leads to the same screen that tells me her benefits whether it has a 7 on the end or an 8.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] It's just, I'm sorry, but I'm not trying to be complicated. It's just the patient is arguing back that she has 5000, 4000.
[AGENT][NEUTRAL] No, I, and just let her know, we don't doubt that she has a gap policy for 5000. She just does not have it with us. She never did. Her first policy was $2000 this policy is 4000, so she just needs to contact her human resource department to see if she has another gap insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it, yeah.
[AGENT][NEGATIVE] With another company.
[CUSTOMER][NEUTRAL] Says American Public Life, my inpatient coverage is 5000, not 4000.
[AGENT][NEUTRAL] Well then she should have a policy that she can send you that states that or she can log into her portal and pull up her policy with us and she can see the $4000 but if she has a $5000 policy then just ask her to produce the paperwork showing that.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] Well, she sent me a picture of her policy, but it nowhere it says here that she has 5000. It just says like inpatient benefit certificate number which is the one I gave you.
[CUSTOMER][NEUTRAL] Effective date of plan [PII], which that's what you gave me and then her name, that's it, it doesn't say anything else.
[AGENT][NEGATIVE] Then she must only gave you one page uh it cause, you know, normally the policy is like 50 something pages, but if she looks under her benefits inside of the policy, she's not gonna see $5000 anywhere. Now, I don't know if she mistakenly read it wrong because her outpatient per day is $500.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Exactly, that's what I'm thinking.
[AGENT][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] I mean, I'm just trying to figure it out too.
[CUSTOMER][POSITIVE] But no worries.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Um, thank you so much, my love. You were very helpful. Can I have a reference number for the call?
[AGENT][NEUTRAL] The reference is just gonna be my name [PII] last initial [PII]am, and the date and time of the call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 21.
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][POSITIVE] Thank you so much again have a great day.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][NEUTRAL] Bye.