AccountId: 011433970860
ContactId: 2279838b-c089-4fe6-8530-361333dc1ab0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908159 ms
Total Talk Time (AGENT): 383297 ms
Total Talk Time (CUSTOMER): 272979 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/2279838b-c089-4fe6-8530-361333dc1ab0_20250408T18:02_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] About the action policy.
[CUSTOMER][NEUTRAL] [PII] [PII] Benefits. How are you today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Oh, you know, it's a wonderful day. The weather is getting warm again and, um, you know, just enjoying life.
[AGENT][POSITIVE] Yes, yes, yes.
[CUSTOMER][NEUTRAL] I have a question for you.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] We have a group, um, South Beach Biloxi Hotel and Suites, one of my, my own running groups, and I have a late, um, one of the employees that was hired and critical illness.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Does that cover anything with Crohn's disease?
[AGENT][NEUTRAL] Hm, let me look under that policy. Um, do you have a group number for that group?
[CUSTOMER][NEUTRAL] I, yes, I do. Give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Right in front of me.
[CUSTOMER][NEUTRAL] It's going to be 259-006.
[AGENT][NEUTRAL] Alright, let me pull that up real quick. So the Beach Biloxi, let's see.
[CUSTOMER][NEUTRAL] Do you want to wait that long?
[CUSTOMER][NEUTRAL] But you have to kick in, you want to get in.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I got approval with [PII], but I'm sure she'll let me.
[AGENT][NEUTRAL] I'm pulling it up. Give me just a second here.
[CUSTOMER][NEUTRAL] On your phone.
[AGENT][NEUTRAL] You wanna know if it covers Crohn's disease? Let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I got one other question after that.
[AGENT][NEUTRAL] OK, I'm looking for crimes real quick.
[AGENT][NEUTRAL] I do not see Crohn's listed on as one of the conditions for the critical illness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I wasn't sure. I thought I saw it, but I like I said, that's why I was calling y'all.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But on the hospital indemnity, because they do have hospital indemnity in here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, what's the look back, 3 months?
[AGENT][NEUTRAL] Um, let me look.
[CUSTOMER][NEUTRAL] Oh, I thought I did not uh there's no exclusions. I don't remember.
[AGENT][NEUTRAL] Let, let me pull up the policy on that real quick and see what it says.
[CUSTOMER][NEGATIVE] I'm just worried about the clones, that's, that's what I'm worried about.
[AGENT][POSITIVE] Oh, totally understandable, yeah.
[CUSTOMER][NEGATIVE] And I'm not gonna sell them buy something if they can't, if God forbid something happens again.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know what I'm saying?
[AGENT][POSITIVE] Mhm, absolutely.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I hate reading small plan. I just need to let AI do it for me.
[AGENT][NEUTRAL] I'm looking for the table and I can go.
[AGENT][NEUTRAL] Pre-existing the sickness. OK, physical condition it has a preexisting. I'm looking for the look back.
[CUSTOMER][NEGATIVE] She doesn't look like, she, she doesn't want to get hospitalized, but God forbid something happens, you know.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Exactly, yeah, you definitely wanna know, so looking for the time frame because it does have a pre.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Right. that period usually it's right here.
[CUSTOMER][NEUTRAL] I'm trying to think. I don't, I don't think we have a pre X for this now that I'm thinking about it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] me probably on the schedule.
[CUSTOMER][NEGATIVE] Just don't go to war. You can't go to war.
[AGENT][NEUTRAL] policy effective poorly any restorer, OK.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's read this preexisting thing again just to make sure because maybe it's trying to tell me that it doesn't have a preex.
[AGENT][NEUTRAL] An injury, sickness or physical condition for which medical advice or treatment, including prescribed medication, was recommended or received by a member of the medical profession within the pre-existing period immediately proceeding the covered person's effective date. The preexisting period is shown in the certificate schedule. The term preexisting condition also, OK, so on the schedule, hold on, make sure I'm not overlooking the schedule. Sometimes we're in the middle of the policy here it is.
[AGENT][NEUTRAL] that doesn't say anything on here about preexisting.
[CUSTOMER][NEUTRAL] I think when [PII] leave.
[CUSTOMER][NEUTRAL] That with everyone thought these I think I'm, I'm well I'm thinking there's no pre-ex on this.
[AGENT][NEUTRAL] Yeah, I think you might be right because the schedule it says to look at it on the schedule of benefits and it doesn't have it listed. I'm not seeing. I'm just double checking going down a little bit further, make sure I'm not missing anything, but there's no preexisting listed on the schedule, so that would lead me to believe that there is not preexisting on this, um.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I don't see a look back period anywhere on the policy. I don't see a time frame on the policy. It just listed, so it's listed on the schedule, but the schedule doesn't have anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Listed for preexisting lit back or anything that just definitely don't want to give the wrong information so I'm just double checking.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] Making sure I'm not missing anything on the policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't see any preexisting one here.
[AGENT][NEUTRAL] Mm, I don't, it doesn't say anything on the schedule about the preexisting period and it says it would be listed on the schedule of benefits and it's not listed on there. Um, if we wanna make, let me just make sure that I wanna ask claims real quick. Is that OK?
[CUSTOMER][POSITIVE] Yeah, no, by all means, yes, please.
[AGENT][NEUTRAL] OK. OK. OK, just like that.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], this is [PII]. Um, I have a question. I have a group, let's see, I've got [PII] on the line, so it's one of their groups, it's group 25906. Um, he's asking on their HI policy which I pulled up a policy number for one of their people. It's 2,330,590, and he's asking if there is a pre-existing provision on.
[AGENT][NEUTRAL] For HI policy. I see the policy has it listed in there but it doesn't have a look back period or anything like that. It says to refer to the schedule and it doesn't have anything on the schedule of benefits.
[CUSTOMER][NEUTRAL] OK, um, let's see.
[AGENT][NEUTRAL] So I just wanted someone from claims to double check me.
[CUSTOMER][NEUTRAL] And you're looking at um [PII]?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] or something like that, OK.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Thank you. I just wanna make sure we're on the same page. All right. And um so you're looking for pre-existing, mm let's see. I believe there is, but uh let me just double check, OK.
[AGENT][NEUTRAL] Yeah. Yes, yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, the provision, it says it on the definitions, but it didn't give a look back period, so I was like.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I would think there would be, but he was thinking that there wasn't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, it's not showing, but I know there is one. Why is it not showing?
[AGENT][NEUTRAL] I don't know. That's why he's thinking that there wasn't one on there, so, um, I don't know, it's weird.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm gonna put you on hold for just one second. I'll be right back. I'm gonna ask him a question real quick.
[CUSTOMER][NEUTRAL] Yeah, sure, yeah, go ahead.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] That name.
[AGENT][NEUTRAL] What's her name? What's the lady's name that's on the phone or that you're asking for? I just wanna look at, look at her policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, she, she's, she's just hired. We're, we're actually doing her new hire stuff.
[AGENT][POSITIVE] OK, OK, new hire. OK, perfect, that's all I needed. Hold on just one second.
[CUSTOMER][NEUTRAL] Yeah, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] I'm here, yes, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thought it was a new person, yes.
[CUSTOMER][NEUTRAL] But she's gonna be a new hire. Um, yeah, I know I know there's a pre-existing condition on this type of policy. I don't see it, uh, I don't see where it's marking that it is, but I know there is one. usually when
[AGENT][NEUTRAL] Yeah, a new hire.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. I know they always have, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh, go ahead. I'm sorry, no, go ahead.
[AGENT][NEUTRAL] No, it's, no, I just know it's [PII] or roller group, so sometimes I know they have some special provisions, so I wasn't sure. Um, I can do some more checking on our side too just to see how it was set up maybe because I just wasn't, he's he's, he was going, I think they don't have it and then when you're reading in there, there's a preexisting clause in there.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then it says to refer to the schedule of benefits for the lookback period and there wasn't anything on the schedule of benefits, so I was like, well, I don't know, now I'm confused.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It says um if there's any exclusion, there's none. So basically, if there's no, no exclusions and it, it will be based on what the certificate is saying. So if there is a um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's, yeah.
[AGENT][NEUTRAL] Let's see, I can do the exclusions and see what it says.
[AGENT][NEGATIVE] Mitations and exclusions. No benefits are payable. Maybe if they're payable. OK, that's hernia or dental, so she's got Crohn's disease. That's what they're worrying about.
[CUSTOMER][NEUTRAL] Let me go one more place.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK yeah.
[CUSTOMER][NEUTRAL] Let me look at the other uh this is an HI 17 uh uh HP OK, one moment, one moment let me
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let me see if I can find more information.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] I didn't see.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] What did I say HP.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][POSITIVE] for group relaxing oh.
[CUSTOMER][NEUTRAL] Not even a special group let's see.
[CUSTOMER][NEUTRAL] Uh, I approve and blah blah blah, yeah, that doesn't tell me anything. No, OK, uh, let me do one more search, um.
[CUSTOMER][NEUTRAL] Let's see what I got here.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, I'm just gonna try to explain.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Really strange that it's not showing up.
[AGENT][NEUTRAL] That's OK. I can do some more research on our site too. I just think there's, I have a feeling there's something weird about this one because normally it would list it right on the schedule of benefits. It would say the pre X time frame.
[CUSTOMER][POSITIVE] Uh correct.
[AGENT][NEUTRAL] OK, so I'm thinking there probably is that I'm just.
[CUSTOMER][NEUTRAL] Mhm. Yes. Yeah.
[AGENT][NEUTRAL] OK, I'm gonna double check on our end too just to make sure on how it was set up and I'll just tell him at the moment it doesn't look like it, but I just wanna double check before I say yeah or nay because I don't wanna mislead this lady and give her the wrong answer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Okey dokey.
[CUSTOMER][POSITIVE] Yeah, and I'm gonna go ahead and check it and if I find anything I'll go ahead and let you know, OK? Alright, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK perfect thank you so much bye.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, sorry, thank you so much for holding I apologize um claims is not seeing it on there. I'm not seeing it on there but I just wanna do one double check. Can I call you back at the moment I don't see that there's a preexisting there's, it defines what preexisting is, but it doesn't give it an exclusion or anything but I just wanna double check on our end. Can I call you back in just a few minutes just to make sure we're not overlooking anything? I don't think there is based on what you're saying, but I just wanna double check.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, yeah, no, no worries.
[AGENT][NEUTRAL] OK, can I reach you at [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I'm checking with my team and I'll give you a call back here in just a little bit, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Thank you so much talk to you soon.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye.