AccountId: 011433970860
ContactId: 101c5c07-d279-433f-83a3-059158d6710c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 732340 ms
Total Talk Time (AGENT): 240106 ms
Total Talk Time (CUSTOMER): 239524 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/101c5c07-d279-433f-83a3-059158d6710c_20250324T22:21_UTC.wav
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[CUSTOMER][NEUTRAL] matter?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Hi, I needed to talk to someone that knows like my benefits on my insurance basically.
[AGENT][NEUTRAL] OK, I can help you with your benefits. Can I please get your name and your policy number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] And give me 1 2nd.
[CUSTOMER][NEUTRAL] My policy number, can you hear me?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am. It's 246-709-8.
[AGENT][NEUTRAL] OK, Ms. [PII], can I also get your callback number just in case the call gets disconnected I can call you back?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Absolutely [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, ma'am. Let me pull up your policy real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], I'll need for you to verify your policy for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Address is [PII]. Um what was the next thing you wanted? Email? [PII].
[AGENT][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK and the phone number that you gave me to call you back on is that a good um cell phone number for you, Miss [PII]? OK, thank you.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, absolutely. Sorry, I'm like, what did you ask me to answer? I forgot.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a lot. I know I try to break it down.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I have service. Can you hear me?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I can hear you, yes ma'am.
[CUSTOMER][NEUTRAL] OK, sorry, my must have broke up. I apologize.
[AGENT][NEUTRAL] OK. All right, and this is just to verify your coverage. It's not a guarantee of payment. You have a limited benefit hospital indemnity plan.
[AGENT][NEUTRAL] So if you go
[CUSTOMER][NEUTRAL] So I know what I have. The my question, I, I don't have a question about that. I'm just trying to go to the OBGYN and I see on the policy thing it says like 2 to 3 years or it says 3 to 5. I just wasn't sure if that's for like uh routine like visits basically is my main question.
[AGENT][NEUTRAL] Right, let me pull up your policy certificate and read it.
[CUSTOMER][NEUTRAL] Cause like it's kind of finicky, it just says for like one thing, so I just wanna make sure the doctor was like, oh, I'm sure it's covered, but I don't wanna like go and then it not be, and then, you know what I mean?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So let me pull it up. It's gonna be just a second while I pull that in for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, it's pulled up so now I just need to review it.
[AGENT][NEUTRAL] And you're gonna be going as an outpatient for
[AGENT][NEUTRAL] Um, just for.
[CUSTOMER][NEUTRAL] Just like a yearly checkup. Yeah. But I think on it says 3 to 5 or it says 3 or every 3 that it, I don't know. So that's where I just need clarification. Just like a routine, like women's exam, you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, alright, let me check and see.
[AGENT][NEUTRAL] Well, it's a big policy. I'm trying to find it.
[AGENT][NEUTRAL] OK, so I do see that.
[AGENT][NEUTRAL] Medical imaging tests?
[AGENT][NEUTRAL] So if they have to do any kind of medical imaging for you is $100 per day and you get a maximum of 2 days per calendar year. Um, let me keep looking.
[CUSTOMER][NEUTRAL] That's not, not, that's not what I, not for that. It's like just uh exam. I don't know what it's called just to get like, not for like a, a baby or anything, like, just like a yearly, like, I think it's like a pap smear like on there, like it was worded different. So I was just unsure of like what the year limit was. If it was like the doctor was trying to tell me that some insurances do it yearly, some do it every 3, some do it every 2, you know what I mean?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Guess that would be under wellness. Let me look under wellness.
[CUSTOMER][NEUTRAL] I'm so sorry. I saw it the other day. I wish I could tell you what page it was on.
[AGENT][NEUTRAL] I know, and, and the wording and it can make it really hard sometimes to look it up because it has insurance jargon.
[AGENT][NEUTRAL] Doesn't talk like, it doesn't talk like we talk.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, for sure. I just wanted to clarify with this because then you know what I mean, I'm not gonna go for a full whatever. I could just go for like a visit then at that point if I need to wait another year, you know what I'm saying.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no imaging needing to be done hopefully ever.
[AGENT][NEUTRAL] Yeah, that, I, I hope you don't ever have to have imaging either.
[AGENT][NEUTRAL] Well, it didn't pull up under wellness. Let me keep searching. I'm sorry you're having to wait so long.
[AGENT][NEUTRAL] OK, I'm showing I'm looking at your schedule of benefits which has everything.
[AGENT][NEUTRAL] That this policy covers and it has a hospital admission hospital confinement.
[AGENT][NEUTRAL] Accident and sickness for surgery.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It has a diagnostic testing benefit for medical imaging tests and advanced study. I'm not finding wellness on here or PAPAP uh scan or um
[AGENT][NEUTRAL] Mammogram on this policy.
[CUSTOMER][NEUTRAL] So I see a mammogram. I'm like on an older one that I've had, and there's like mammogram screening on there.
[AGENT][NEUTRAL] So I'm looking at the one from.
[CUSTOMER][NEUTRAL] Um, and then it says like.
[CUSTOMER][NEUTRAL] Cause I'm in the stay healthy enhanced because I have like the double coverage. I have this one and another one. So would it be considered then just like a primary or a specialist like visit? Like I don't care if it's that. I just wanna know, you know what I'm saying?
[AGENT][NEUTRAL] I'm looking at
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me see if there's another one.
[AGENT][NEUTRAL] Right. So I'm showing on your policy that was taken out.
[AGENT][NEUTRAL] That was issued [PII].
[AGENT][NEUTRAL] And then um
[AGENT][NEUTRAL] This is the new policy contract, does not have mammogram or Pap smear on it. It just has um the benefits I gave you for the
[AGENT][NEUTRAL] Hospital confinement or hospital stay.
[CUSTOMER][NEGATIVE] So I don't even have any doctor's visits you're telling me? Cause that's an issue.
[AGENT][NEUTRAL] Right, I'm showing that it has hospital admissions.
[CUSTOMER][NEGATIVE] So I'm paying $100 a week. Yeah, well, I don't know who I should talk to. Do I need to call benefits and a card then? Because I have double insurance. I have preventative and regular, so I don't know why it would. I just went to the doctor two weeks ago and it was covered. So who do I need to contact to like get the correct information is my guess, I think.
[AGENT][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I can um transfer you over to benefits in a card if you'd like I can do that for you so you can talk to them.
[CUSTOMER][NEGATIVE] Well, they said they weren't able to like answer this stuff for me, so you're saying I just have hospital visits and that's it?
[AGENT][NEUTRAL] Right, according to your policy contract that I have pulled up for you, you have hospital admission benefit, hospital confinement benefit, accident and sickness surgery benefit, and diagnostic testing.
[CUSTOMER][NEUTRAL] But,
[CUSTOMER][NEUTRAL] It's all I have on my insurance is what you're trying to say.
[CUSTOMER][NEGATIVE] Because that doesn't even make sense.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you. I will call benefits in a car tomorrow because I'm that doesn't even make sense of anything, you know what I mean? I'm not trying to, I know you're just reading off what you have, but I am like got into the more expensive one on purpose.
[AGENT][NEUTRAL] Right, I know.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right. Yes, ma'am. I understand. Um, yeah, that is.
[CUSTOMER][NEUTRAL] Do you mind sending me a a contract or policy of like what this what you're stating are you able to send that to me so I can take a look at it?
[AGENT][NEUTRAL] Yes, yes, let me put you on a quick hold and I'll email that uh policy to you, OK? Hold on real quick and I'll get it emailed to you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.