AccountId: 011433970860
ContactId: e536da5f-3d57-4fab-a2a0-64f7d9c2df91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1479160 ms
Total Talk Time (AGENT): 542848 ms
Total Talk Time (CUSTOMER): 323180 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/2025/04/04/e536da5f-3d57-4fab-a2a0-64f7d9c2df91_20250404T17:47_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm following up with the policy. I retired from my school district and I added, um, or continued the policy, so I was just calling to find out when my next payment is due and to get more information because I don't really, I haven't received anything in the mail lately from you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, OK I'll get you pulled up.
[AGENT][NEUTRAL] OK, [PII], what's your policy number?
[CUSTOMER][NEUTRAL] Um, I, I have one from before that I've received because I had breast cancer. Let's see. The one that I had before was um 02420406.
[CUSTOMER][NEUTRAL] Is that always stay with you the same policy number?
[AGENT][NEUTRAL] Uh yes, it should, it shouldn't change. Um, OK.
[AGENT][NEUTRAL] Let me, uh, verify a few pieces of information if you don't mind. Can I get a good callback number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] We have a little feedback. Do you hear that or are you OK?
[AGENT][NEUTRAL] Uh, yeah, I don't
[CUSTOMER][NEGATIVE] I keep hearing repeats.
[AGENT][NEUTRAL] I'm not sure why, um.
[AGENT][NEUTRAL] Let me see uh
[AGENT][NEUTRAL] Is that any better?
[CUSTOMER][NEUTRAL] Um, when I talk, I hear it.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, when you talk
[CUSTOMER][NEUTRAL] Yeah, I still hear it, yeah.
[AGENT][NEUTRAL] OK, huh, I don't, I don't hear a repeat on my end.
[CUSTOMER][POSITIVE] OK, well, we'll keep it going and as long as you can understand me if it becomes a or if I understand you we're good.
[AGENT][NEUTRAL] OK. What's your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then lastly, what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] Um, it looks like this policy term 912024, but let me, let me see if we've got something more recent.
[CUSTOMER][NEUTRAL] Right, because that was probably when I worked in the district, you know, I had my surgery and I retired and then I started over September.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found your active policy. OK, it looks like this one.
[AGENT][NEUTRAL] We've got it paid to 91-2025.
[CUSTOMER][NEUTRAL] Oh, that's good. Can you give me that policy number?
[AGENT][NEUTRAL] Yeah, it's 2558046.
[CUSTOMER][NEUTRAL] OK, and is it just for me or is it my husband and myself?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, it looks like.
[AGENT][POSITIVE] Looks like it's for yourself and your spouse, yes.
[CUSTOMER][NEUTRAL] OK, and let's see, I'm just trying to, I don't think you have it where it's automatically drafted. I'm trying to find out what my I can't, I didn't write all this down for some reason I can't find it like what I owe each time it's due and I guess I paid 6 months out, um.
[CUSTOMER][NEUTRAL] With so I own the next time in September. Can you tell me what our premium is?
[AGENT][NEUTRAL] Yes, let me look that up.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] It it's gonna bill you quarterly.
[AGENT][NEUTRAL] Um, and quarterly, that premium is 12942.
[CUSTOMER][NEUTRAL] Now is that including my spouse the premium because.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][MIXED] That seems kind of low to me, but I could be wrong.
[AGENT][NEUTRAL] Um, I believe so. Let me see.
[CUSTOMER][POSITIVE] I mean, that'd be great. I just wanna verify.
[AGENT][NEUTRAL] Um, let's see, so.
[AGENT][NEGATIVE] Sorry, my system is running just a bit slow.
[CUSTOMER][NEGATIVE] That's all wrong.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The premiums, let's see where is the invoice.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, you there?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I'm here. I'm here.
[AGENT][NEUTRAL] OK, sorry about that um do you mind if I transfer you over to our billing department? I I can't locate the invoice, so they should be able to access that and see if everything's right on that premium. Is that OK?
[CUSTOMER][NEUTRAL] Well, before you do that, I need to ask you a question. So I'm having surgery in April for my, I had breast cancer and um that was back in August and then I'm having reconstruction surgery done in April. So, did, does my policy cover the claims for a surgery for that type of procedure?
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's pull that up and look.
[CUSTOMER][NEUTRAL] But due to the breast cancer, I'm getting my, I have expanders in and they're gonna take those out and put implants in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's not a guarantee of payment, a basic outline of the policy. It looks like, yes, reconstruction is covered, um, and if you had just a single mastectomy, it would also cover on the non-ceased breast as well. Of course, double mastectomy would cover both.
[CUSTOMER][NEUTRAL] Right, I had a double mastectomy, um, so I just, I, I just submit the medical, I guess, you know, the surgical, when all that's complete, I submit the medical bill and then the surgical center bill, is that correct? And then you pay a percentage of that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's correct. So be sure when you submit that we can like there's codes on there that says exactly what um surgery it was and then the diagnosis, let me look at what the percentage is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so let's see surgery.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] It pays 25% for anesthesia.
[AGENT][NEUTRAL] Surgical.
[AGENT][NEUTRAL] It says $45 unit dollar amount and then a max of $4500 per operation. Let me see what that unit dollar amount means.
[CUSTOMER][NEUTRAL] OK, yeah, that's confusing. $45 to $4500 that's a big difference.
[AGENT][NEUTRAL] Yeah I know yeah.
[AGENT][NEUTRAL] OK, the surgical unit value assigned to the procedure multiplied by the unit dollar amount. OK, surgical unit value assigned. Let me see what that is.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Let me see, I'm trying to understand what this policy is saying.
[CUSTOMER][NEGATIVE] Oh, I know that I'm asking you because I'm like, well it's so confusing.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh surgical.
[AGENT][NEUTRAL] OK, let me, I'm so sorry, let me place you on another brief hold if you don't mind.
[CUSTOMER][POSITIVE] Of course, of course. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The surgical unit value.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey hey um can you look at.
[AGENT][NEUTRAL] Policy 02558046.
[AGENT][NEUTRAL] Please, uh, [PII], yeah, so she is doing, she's getting a uh reconstruction after a double mastectomy, um, so I'm having trouble understanding what is this.
[AGENT][NEUTRAL] It's a surgical unit value on the policy certificate.
[AGENT][NEUTRAL] And that really weird. I don't.
[AGENT][NEUTRAL] the amount shown schedule X surgery benefit amount up to the max per operation. This is strange. So unit dollar amount for surgical is $45 and then max per operation is $45.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And then those are, those are percents of usual customary.
[AGENT][NEUTRAL] Oh, that's a dollar by it.
[AGENT][NEUTRAL] And it says yeah I'm on page 22 of the policy certificate that's why I'm confused because I've never.
[AGENT][NEUTRAL] I don't even know what it, oh, the sooner it right, OK.
[AGENT][NEUTRAL] The surgical unit value assigned to the procedure multiplied.
[AGENT][NEUTRAL] What's the surgical unit value?
[AGENT][NEUTRAL] Surgical unit, probably should have just searched.
[AGENT][NEUTRAL] Uh I schedule benefits. I don't know what.
[AGENT][NEUTRAL] Uh, we will use the most current physicians relative value table and current.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Determine
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, this is strange. I've never seen something like this. It's like based on.
[AGENT][NEUTRAL] The cost, so you know like on the.
[AGENT][NEUTRAL] Uh for like that
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK, I guess I'm just confused. What is, what is a unit?
[AGENT][NEUTRAL] I don't know what
[AGENT][NEUTRAL] A unit dollar amount of $45. I understand like the CPT code has a 80% of UCR.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess I'm just, do I just tell her.
[AGENT][NEUTRAL] Well, just depending on what they submit for the claim, it will pay up to 4500.
[AGENT][NEUTRAL] I would tell
[AGENT][NEUTRAL] OK, so is the anesthesia under the 4500 or is that just we pay 25% of the anesthesia?
[AGENT][MIXED] OK, but 4500 is the maximum per operation.
[AGENT][NEUTRAL] OK, it is OK, it's separate from that OK.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] I've seen
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you just do the math
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that's perfect thank you so much. Yeah.
[AGENT][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] OK, I'm so sorry about that. Sorry for the long wait. I'm just trying to understand what so basically we can't determine the exact we don't know what they're going to charge yet. So basically the max that we will pay per operation is 4500. The anesthesia benefit is separate from that, so we pay up to 25% of the anesthesia. So again, that max benefit would be 45 up to 4500.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, without the CPT codes, charges, etc. um, that's what we'll determine up to that dollar amount, so.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] And that includes the doctor and the facility, the 4500 max, is that right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][MIXED] OK, because that's lumped together, but the anesthesiologist is separate, OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So I guess that answers that question. All I need to know now is you were gonna transfer me to find out about payment schedules and things.
[AGENT][POSITIVE] OK, let me get you over there and it was great talking to you and I hope you have a good weekend.
[CUSTOMER][POSITIVE] Thank you and thanks for your help. I appreciate it.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] and um on the care team and I've got a member who has questions about their invoice and um when it, when it, what the dollar amount is and making sure that it includes for her spouse.
[CUSTOMER][NEUTRAL] Is this for their individual policy?
[AGENT][NEUTRAL] Um, they, they're covered, but her and her spouse are covered, but she had a question on, I can't, I don't know where to look for the invoice, so, um, I see the dollar amount in pie that and lion, um, but, uh, she wants to make sure, does that include her spouse and then um.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Do you need that?
[AGENT][NEUTRAL] Policy number is 255.
[AGENT][NEUTRAL] 8046.
[AGENT][NEUTRAL] I'm talking to [PII].
[CUSTOMER][NEUTRAL] Yes, policy is couple coverage.
[AGENT][NEUTRAL] OK, so the 129 42 does include for her and her spouse. Is that frequency, is that quarterly?
[CUSTOMER][POSITIVE] Uh, pay for yes.
[AGENT][NEUTRAL] OK, so it's 129 42 every quarter and then does she receive a premium notice in the mail?
[CUSTOMER][NEUTRAL] Um, yeah, but it won't, she won't receive that until sometime in August.
[AGENT][NEUTRAL] OK, OK, it'll be in August. OK, and we'll, we'll send them quarterly month before they're due.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. OK. Perfect. I think those are all her questions, so I'm just gonna go ahead and let her know that information, OK?
[CUSTOMER][NEUTRAL] OK, and if she's got any like as far as like coverage questions or um really anything on this particular policy it'll go to customer service because this is considered a um individual pay.
[AGENT][POSITIVE] OK, OK, well thank you so much.
[CUSTOMER][POSITIVE] This one didn't on a group, no problem.
[AGENT][POSITIVE] OK perfect thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, bye.
[AGENT][NEUTRAL] OK, so sorry about that. I actually got the information, so the 129 42 does include you and your spouse, so that's the couple rate, um, that is billed quarterly, so you'll receive your next invoice in August, um, since you're paid through 9-1-2025.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, and if I decide to have that um deducted, do you guys, can you set up a credit card for that? How does that work if I wanna do that?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, we can only set up a bank draft.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ara, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And um how often do you do the bank drafts?
[AGENT][NEUTRAL] Uh, we can set it up at this frequency of payment if that's what you want.
[CUSTOMER][NEUTRAL] OK, and if I chose to do it, I guess just double it if it's every 6 months it would be 260.
[AGENT][NEUTRAL] Um, yeah, it would be the, yeah, 25884.
[CUSTOMER][NEUTRAL] I'm not too sick.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] OK, and is there a way for you to send me some do I need to fill out a form if I decide to do the bank draft?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah let me um let me look that up.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, there's a few different options I can of course mail you one or I can fax you a form or you can download it from our website. um, what's what's easiest for you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you, can you email it to me?
[AGENT][POSITIVE] Yeah, I can email it to you sure yeah absolutely.
[CUSTOMER][NEUTRAL] If not, I can
[CUSTOMER][POSITIVE] OK. That'd be great.
[AGENT][NEUTRAL] OK, let me let me get back and make sure I got the right email address.
[AGENT][NEUTRAL] That's the [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, I'll get this emailed to you in just a few minutes so look out for that, um, get that filled out and then you can send it back to us and then um we can get that set up for you, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Well, thank you. I appreciate that. Thank you so much.
[AGENT][NEUTRAL] OK, anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] That covers it all. Thank you.
[AGENT][POSITIVE] OK, perfect. OK well I hope you have a great weekend.
[CUSTOMER][POSITIVE] Well, you too. Thanks so much. Bye-bye.
[AGENT][POSITIVE] Thank you, thanks for calling APL.