AccountId: 011433970860
ContactId: eb4f8f11-9f1b-486d-bbdb-819b3c49d7e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417230 ms
Total Talk Time (AGENT): 150333 ms
Total Talk Time (CUSTOMER): 67954 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/eb4f8f11-9f1b-486d-bbdb-819b3c49d7e4_20250520T15:34_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], this is [PII]. I need a benefits.
[AGENT][POSITIVE] Sure, I can help you with benefits. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 06626372 ML
[CUSTOMER][NEUTRAL] Um, I think I need 4 inpatients, I'm 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment while I look that up.
[CUSTOMER][NEUTRAL] Inpatient.
[CUSTOMER][NEUTRAL] Right, inpatient at 7.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Give me just a moment while I look at that policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not finding it. Um, let me read it back to you. I have 06626372.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] It's 01. The rest of the numbers are correct.
[AGENT][POSITIVE] OK, I'm so sorry.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] It looks like I'm showing this policy has an effective date of [PII]. The policy lapsed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So are you needing benefits for something coming up?
[CUSTOMER][POSITIVE] Yes, for her delivery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][POSITIVE] So I do show that she has a new active policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I can give you that policy number whenever you're ready.
[CUSTOMER][POSITIVE] Yes please thank you.
[AGENT][NEUTRAL] 02
[AGENT][NEUTRAL] 59.
[AGENT][NEUTRAL] 72
[AGENT][NEUTRAL] 79.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That her her new policy was an effective date of [PII].
[AGENT][NEUTRAL] Let me pull up her inpatient benefits.
[AGENT][NEUTRAL] It looks like she has an inhospital benefit maximum of up to $3000 per covered person per confinement.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And she is also, uh, her inpatient benefit is subject to a maximum of 30 days per treatment per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Um, this would cover her, uh, deliveries up to $3000?
[AGENT][NEUTRAL] Uh, let me see, and this is a verification of benefits and not necessarily a guarantee of payment, um, and I don't know if you've used this policy before, but this is a secondary gap policy, so her major medical will need to pay first, and we will need that, uh, major medicals EOB um before this claim can be paid as well.
[AGENT][NEUTRAL] So let me see.
[CUSTOMER][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, case of maternity expense coverage continuation of policy benefits.
[AGENT][NEUTRAL] It looks like this may cover delivery as well. So this policy, um, I'm not showing it as an exclusion. Again, major medical will need to pay first, and this one does pick up uh for co-insurance, co-pay, um, and co-deductible.
[CUSTOMER][NEUTRAL] As
[CUSTOMER][NEUTRAL] Pick up
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like
[CUSTOMER][NEUTRAL] So up to $3000 and she has not uh used any, anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] I only see her as having used outpatient benefits so far for this calendar year.
[CUSTOMER][NEUTRAL] Only OK.
[CUSTOMER][NEUTRAL] OK, perfect, thank you. um OK, uh can I have a call reference number please?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial, so [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a good day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye.