AccountId: 011433970860
ContactId: ec7c0c6b-8375-4045-ab80-a39dfad4e978
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254690 ms
Total Talk Time (AGENT): 87392 ms
Total Talk Time (CUSTOMER): 110152 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/ec7c0c6b-8375-4045-ab80-a39dfad4e978_20250214T13:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and um I submitted a claim and it said that I've met my, you've met your obligations for the year, but the only problem is my year starts [PII].
[CUSTOMER][NEUTRAL] And the claim was made [PII], so I need to find out about that.
[AGENT][NEUTRAL] OK, what's your policy number?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] 01841149 M as in match L 8
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Also, can I have a new card sent to me?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, I can do, would you like for me to email you one?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][MIXED] Well, I, I, I like the plastic, so if they can or the harder one, if you can mail it to me, I'd appreciate I just it's getting hard to read the phone number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] [PII] and my mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address on file?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, and which claim are you referring to?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And which, which claim I'm showing 3 for this date, is it the facility charge, the office visit?
[CUSTOMER][NEUTRAL] Well, it's it's at the end of the day there's $155 that's being applied to the deductible.
[AGENT][NEUTRAL] OK, but who is it from?
[CUSTOMER][NEUTRAL] Oh, Cleveland Clinic.
[AGENT][NEUTRAL] Cleveland Clinic, OK.
[CUSTOMER][NEUTRAL] That should be the only charge for [PII].
[AGENT][NEUTRAL] You have a facility charge for that day, an office visit charge for that day and look like you may have an X-ray or some type of imaging on that day.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So there's a claim for each of those.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and so does it state that your outpatient um benefit was maxed for the calendar year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So your outpatient benefit is 1000 per calendar year.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Right, my calendar year starts [PII].
[AGENT][NEUTRAL] Calendar year is January December.
[CUSTOMER][NEUTRAL] OK, well that's not how our benefits work here in the office. Everything starts over the.
[AGENT][NEUTRAL] Maybe your open enrollment, you know, maybe your open enrollment is in December, but your policy benefits are calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK, so you're saying you may not be in sync with our medical insurance?
[AGENT][NEUTRAL] It sounds like that may be when you enroll, so your open enrollment period.
[CUSTOMER][NEUTRAL] No, no, no, no, my medical insurance starts on um [PII]. It's like I'm looking at my card, it says effective date [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that's all of our insurance. All of our effective rates go from 121 to 121.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Yeah, so your policy
[AGENT][NEUTRAL] Your policy with American Public life, your benefits are calendar year.
[CUSTOMER][NEUTRAL] OK. All right. Very good. So you're not in sync with any of our other insurance. I'll have to let them know that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, well, it's a yeah it's a policy that your employer chooses, so they choose it they choose the they choose that so it's not something that APL has done.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. Very good.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks. OK.
[AGENT][POSITIVE] You're, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye.