AccountId: 011433970860
ContactId: 1b3fb98a-13f7-4c98-9eb2-93273e273b01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469019 ms
Total Talk Time (AGENT): 246916 ms
Total Talk Time (CUSTOMER): 162459 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/1b3fb98a-13f7-4c98-9eb2-93273e273b01_20241231T18:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello. Hi, my name is [PII]. Um, I'm calling, uh, regarding, um, my wife is pregnant, so I'm calling to, um, see if you guys, um.
[CUSTOMER][NEUTRAL] Cause we're here at the hospital and they say they don't take like more um like cause we and my wife are together on the under the insurance, but they say, yeah, they say they don't take that.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, so you're have, you have a question about the network that you're in, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes. So well, I can direct you. I'll be able to help you as far as to who you would need to speak to regarding network questions. But what I'll have to do first just to pull up your policy information and verify some things with you for security. So what was your last name again, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] I called [PII], but I'm calling because of my wife.
[AGENT][NEUTRAL] OK, but are, whose name is this insurance in, yours or hers? Is this for your employer?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Hers.
[AGENT][NEUTRAL] OK, but I need to know your name because you're who I'm speaking with.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK. And Mr. [PII], what is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] Um, it's 02.
[CUSTOMER][NEUTRAL] 55.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 25
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 84.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. And so if you could please verify your wife's name and date of birth, and then your date of birth.
[CUSTOMER][NEUTRAL] Excuse me, sir, again, please?
[AGENT][NEUTRAL] I need for you to verify your wife's name and date of birth, and then also your date of birth.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Her name is [PII]. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we would have on file for your wife?
[CUSTOMER][NEUTRAL] It's um yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then her email address, please.
[CUSTOMER][NEUTRAL] Um, her first name [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much. So for this particular policy, the network questions, any questions you have related to the network that is handled by multiplan. Multiplan is the network provider company. Now, I'll be happy to give you their phone number, Mr. [PII]. I can also connect you with them.
[AGENT][NEUTRAL] But just in case for some reason we were to be disconnected, you could call this number directly.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I just wanna know because because I just have a question about because she called yesterday and they said so she's pregnant right? and they say they just cover for for basic.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think if she's pregnant, I think that's not enough. So I just wanna know.
[AGENT][NEUTRAL] OK, so do you have a question regarding network or you, do you have a question regarding her benefits on the policy?
[CUSTOMER][NEUTRAL] If it's a regular.
[CUSTOMER][POSITIVE] Yeah, yeah, her, yeah, her benefits.
[AGENT][NEUTRAL] Which
[AGENT][NEUTRAL] OK, so this is not major medical coverage that you all have and any information that I provide regarding benefits would be a verification of benefits and not a guarantee of payment, Mr. [PII]. This is a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] That only pays certain dollar amounts for certain services.
[AGENT][NEUTRAL] It is not major medical insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So, so if she, because my question is because right now she has an appointment, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The bill, do you guys pay like an amount of the bill or something?
[AGENT][NEUTRAL] Is this for a doctor's office appointment?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so under this policy.
[AGENT][NEUTRAL] For an office visit, the benefit amount that this plan would pay.
[AGENT][NEUTRAL] If for covered services would be $50 per day and a maximum of 4 days per calendar year.
[AGENT][NEUTRAL] That's for any, any type of office visit that's related to sickness.
[CUSTOMER][NEUTRAL] So, so.
[AGENT][NEUTRAL] Or accident or sickness.
[AGENT][NEUTRAL] Um, pregnancy would be is considered a sickness, but again, the benefit that we would pay would be $50 per day.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] That's the maximum and then the maximum amount of days per calendar year is 4.
[CUSTOMER][NEUTRAL] So it doesn't matter if if she's like pregnant.
[AGENT][NEUTRAL] No, sir, not with this policy. That is correct.
[CUSTOMER][NEUTRAL] Just 4
[CUSTOMER][NEUTRAL] So what about if I wanna upgrade the policy?
[AGENT][NEUTRAL] OK, now you would have to speak and this is through her employer, so you would have to speak to someone with benefits and a card regarding any.
[AGENT][NEUTRAL] And I don't know if they would provide you that information since this is through her employer, but I can give you the phone number for benefits and a card. I don't believe that they are working this afternoon. Um, someone else on my team had tried to.
[AGENT][NEUTRAL] Connect someone to them earlier and received that there was no agents available, but I'll be happy to try and connect you but there is a possibility that they are closed for the holiday.
[CUSTOMER][NEUTRAL] OK, and I have a question so.
[CUSTOMER][NEUTRAL] It don't matter if if if they don't take.
[CUSTOMER][NEUTRAL] Multiple like the insurance that we have. You guys still cover like like the portion?
[AGENT][NEUTRAL] For the for an office visit, the amount that I gave you would be, that, that is all that would be covered.
[CUSTOMER][NEUTRAL] Yeah, but my question is if they say they don't take that that insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause that's my question. They say they don't take that insurance.
[CUSTOMER][NEUTRAL] Or if, if they, if.
[CUSTOMER][NEUTRAL] They say you you got the bill. Do you guys still pay the 50 or something?
[AGENT][NEUTRAL] We would review it again, I can't guarantee payment of benefits. We have to, we can't pay claims over the phone. We have to receive all the documentation to review.