AccountId: 011433970860
ContactId: 035007f8-7645-4fe6-a977-64671ac9193e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479829 ms
Total Talk Time (AGENT): 208755 ms
Total Talk Time (CUSTOMER): 247701 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/035007f8-7645-4fe6-a977-64671ac9193e_20250319T17:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling to see um what benefits is covered um.
[CUSTOMER][NEUTRAL] What services is covered under the package that I have, um, as far as like medical doctors, um, can you assist me with that?
[AGENT][NEUTRAL] Yeah, let's take a look. Do you by chance have your policy, [PII], your policy number?
[CUSTOMER][NEUTRAL] I don't have the policy number on me. Um, let me see, I don't know if you guys might have said I'm, I'm, I'm kind of new to this one, so.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, let's take a look. Is your last name spelled [PII]?
[CUSTOMER][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Right, and then.
[AGENT][NEUTRAL] First name, is it [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] OK, let me see if you guys might have sent me something. Let me see American public.
[AGENT][NEUTRAL] What state do you live in?
[CUSTOMER][NEUTRAL] Um, I'm in [PII] right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I think I located you here, [PII]. Can you give me your date of birth, please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you so much and then what would be the physical address and email address we would have on file?
[CUSTOMER][NEUTRAL] Sure, the physical address will be [PII], and the email should be [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] OK. So it looks like you have a medical plan with us, and it looks like
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, you also have dental. It looks like there is some life insurance, a short-term disability, couple different policies. Are you wanting to check on the medical?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that's the one, yeah, the medical so what am I covered because yesterday I found out that it did not cover urgent care, so I had to end up paying out the pocket. So yes, I wanna know so I have to go back um for wound care and so um I'm trying not to pay out the pocket so much so I'm trying to see what does the um insurance actually cover and what it covers that.
[AGENT][NEUTRAL] OK, so what you have is what we call a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This plan is not like a major medical where it's going to pay a percentage and you just have a co-pay if that's something that you're used to. It is different than that.
[AGENT][NEUTRAL] Um, it does cover.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] An office visit um with a physician and it pays $75 per visit. You're only allowed a total of 5 visits in a year with a physician.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The plan will pay 75 towards the visit. We're, you know, whatever that physician charges for the visit, if you know the difference then would be your responsibility, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It does have a benefit for hospital confinement if you were in intensive care.
[AGENT][POSITIVE] And then it has benefits for wellness exams and diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Aside from that, the other benefit listed is for surgical and anesthesia.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm, OK, and that is the best plan. Well, you guys, I mean that's the best plan that Oxford is offering their employees. Am I correct? Is that the best of the best that's not the best of the best that you guys actually offer, but that's the best that they're actually offering correct?
[AGENT][NEUTRAL] So I don't know let me see if I can check the group and see if they offer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything different. I'm not certain.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, I mean, it looks like under the products in the group, your employer, it looks like
[AGENT][NEUTRAL] You selected the ones that were being offered. Um, we wouldn't know, unfortunately, if there's any other medical that they're offering with a different company, that would be a question for them, but it looks like with us, this is the only medical plan they offer to that group.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] To the group, OK, that's the only one. OK, so you said that it's 5 doctor visits and $75 is, um, actually contributed to the visit and anything so and it's only $5 a year, correct? You said?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Correct, yeah. So if the, like if a primary care office visit, let's say he charges $225 for the visit, we would pay $75 of the $225 yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Right, it's
[CUSTOMER][NEUTRAL] You guys would take 75% of that visit. OK, so there's no urgent care. OK, so it looks like I'm gonna have to probably get some other type of insurance now. Does this insurance work? Well, I don't know. I probably get rid of it probably, um, OK, so it looks like, OK, because I have to go in for wound care, so it looks like I might have to use that, um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That 75 probably to go towards that because otherwise I have to pay out of pocket.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, well, I'm gonna have to pay out regardless unfortunate mhm go ahead.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Did you ever, I'm sorry, I was just gonna say, did you ever get a card for the policy?
[CUSTOMER][NEUTRAL] I don't see it. I'm, I remember seeing something AP that came like the other day. I had yet to open it, so it might be that in there. That might be what it is. So yeah, I'll take a look at it, but now that you're telling me, like I said, every little day like from yesterday to today, it's like it's kind of confirming everything, so it's not really much that I'm getting out of this plan, to be perfectly honest, because.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, because I'm used to the traditional plan, so I'm gonna have to most likely find a traditional plan.
[AGENT][NEUTRAL] Yeah, no, I understand for sure. If you've got medical costs and things of that nature, things that go on where you need routine visits, um, sometimes these don't always, uh, cover the best, you know, for somebody in those situations, so I get it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, yeah, yeah, yeah, because I have to have because I had a, I had to go to urgent care like I said, I had to end up paying out the pocket and then I have to go in for wound care because I have like an abscess and so you know those have to be, you know, so and unfortunately this is not gonna cover it and if I have to go continuously for wound care, then it's not gonna really help assist me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK, I was just kind of wondering, so, OK, well, thank you. Now I know exactly what I need to do, OK.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome. Have a good rest of your day, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It's the same, thank you for your time.
[AGENT][NEUTRAL] Uh-huh. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.