AccountId: 011433970860
ContactId: 00807e5a-afe1-4014-a9ec-ed5292f40390
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678559 ms
Total Talk Time (AGENT): 329939 ms
Total Talk Time (CUSTOMER): 149848 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/00807e5a-afe1-4014-a9ec-ed5292f40390_20250213T23:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Uh, I just had a quick question. Um,
[CUSTOMER][NEUTRAL] So I use the APO VIP Classic, and I was just wondering the coverage for physical therapy.
[AGENT][NEUTRAL] OK, yeah, let's take a look. Do you have a policy number? I can pull that up and take a look?
[CUSTOMER][POSITIVE] Yeah, I have it in front of me. I'm ready whenever you are.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 59
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] 42
[AGENT][NEUTRAL] OK, let me pull this up here. Give me a second.
[CUSTOMER][NEUTRAL] Sure, no rush.
[AGENT][NEUTRAL] And then if I could get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yeah, first name is [PII], last name is [PII] and then date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and then can you verify with me the address on file as well?
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] Thank you. And then the email that we have on here is [PII]. Is that still valid also?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] So it looks like policy does cover physical therapy. Let me just see what it's gonna pay.
[AGENT][NEUTRAL] OK. So your plan does have a benefit, it looks like for physical or occupational therapy.
[AGENT][NEUTRAL] Um, looks like it'll pay $30 per day and then it's a maximum of 4 days per calendar year.
[AGENT][NEUTRAL] Per covered person on your plan, so you, that's the maximum amount of visits it looks like.
[CUSTOMER][NEUTRAL] Wait, so it only covers 4 visits?
[AGENT][NEUTRAL] Yeah, that's what it says on here. It says $30 per day maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK. I mean, if I have a referral from the doctor, you guys would be the ones to determine how many sessions would be approved, is that correct?
[AGENT][NEUTRAL] So, yeah, I mean, the plan that you have only pays for a maximum of 4. So it's not gonna pay for anything over that even if the physician says you need 12. Um, unfortunately, it's only gonna pay for up to 4.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Does that change if you're on a different?
[CUSTOMER][NEUTRAL] Plan like the Elite Pro, I guess.
[AGENT][NEUTRAL] Let me see, I'm not sure what your group offers, um.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] I don't see anything yet as far as
[AGENT][NEUTRAL] A different option, um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm, yeah, I mean, it looks like everybody in the group pretty much has the same.
[AGENT][NEUTRAL] It looks like the same as what you have. You would have to double check with your staffing group to see if they're offering a different plan. Um, I don't show that they have anybody else on anything different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I guess the biggest thing to kind of explain with this that if you're not familiar with it is that they call this a limited benefit plan. So it's not the same as like a major medical like PPO HMO. I don't know if any of that was explained to you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So, yeah, so your plan pays just a set amount depending upon what you're being seen for. Most of us, generally, if we have major medical, when we go to the doctor's office.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's a percentage that is covered and we're just paying whatever the difference is in cost. This is different than that. This is like if you go to the emergency room, this plan is gonna pay $50 a day for your emergency room visit. There is no percentage of coverage.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, so it's very different in that sense that it's just that amount and nothing more, nothing less.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this plan is more
[CUSTOMER][NEUTRAL] Oh God, I'm so confused. Sorry, but it's more related to like hospital then?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] I mean, you can use it for a doctor's office or you can use it to go, like if you're in the hospital, um, but for instance, so like a physician's office visit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Your plan's gonna pay $50 towards the visit. So if you go to your primary care doctor, generally, most people go, present their major medical, and then they have a $25 co-pay or whatever that may be, and they don't pay anything else.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This.
[AGENT][NEUTRAL] We don't have any way of knowing what your primary care doctor charges for an office visit. So if they charge $200 then your plan's paying $50 towards that office visit, you then pay the difference. Does that make more sense?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I guess I just wanted to follow up to see if like the coverage is different if I upgraded the plan.
[AGENT][NEUTRAL] I'll be honest with you, [PII] I don't know if that's an option because I don't see anything else offered through your employer with us so you would need to check with the employer to see if.
[AGENT][NEUTRAL] There's a different plan that maybe you can pick through them.
[CUSTOMER][NEUTRAL] Well, not like plan with American public life. I mean, like, cause they, they had the VIP classes and the Elite Pro, like, are those the same?
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] That's the thing I don't see anybody on the other plan, so I can't even pull that plan.
[AGENT][NEUTRAL] I don't even know if they're offering that still that's why I would check with them and.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] They should be able to give you some sort of overage. They should have some sort of pamphlet or brochure or something to give you kind of like a
[AGENT][NEUTRAL] Adjust of what you're getting, you know.
[CUSTOMER][NEUTRAL] Yeah, it's just, OK. I'm just now looking at the, the schedule of benefits from the document that I've got, but like before when they're announcing that they're changing the coverage, they have like these pamphlets, but they don't explain the difference between the two plans between VIP Classic and Elite Pro, and then I spoke to someone from the healthcare administration, I think, and
[CUSTOMER][MIXED] And that wasn't a very great explanation, to be honest, but yeah.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, it's, that's totally not your fault, but
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEGATIVE] Yeah, I'm just really baffled that it's only covering 4 visits, so that's why I'm just kind of out of it, I guess.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, no, I mean, it's not.
[AGENT][NEGATIVE] Unfortunately, it's not a whole lot. Um,
[AGENT][POSITIVE] They're really honestly these plans I feel like this is just my personal opinion, take it or leave it for what it's worth. I feel like these plans are better for people who don't really have any sort of like medical concerns they wanna just like have coverage just in case, you know what I mean?
[CUSTOMER][POSITIVE] For sure.
[CUSTOMER][POSITIVE] Yeah, no, I totally agree. It's just, I don't know, I'm surprised because I was also on another like limited benefits plan and it's been paying for all of my visits even though I have a copay, but I'm just surprised with this one that it's so blessed.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK. Um.
[CUSTOMER][NEUTRAL] It's not much I can do, so I'm just gonna have to look for something else, but I really do appreciate your help, [PII], though.
[AGENT][POSITIVE] Yeah, not a problem if you have any other questions or concerns feel free to call we're happy to help in any way we can.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a good one.
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.