AccountId: 011433970860
ContactId: 253b2c6b-43e0-4fc0-9f8d-93dde6fc1b06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534859 ms
Total Talk Time (AGENT): 285115 ms
Total Talk Time (CUSTOMER): 160745 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/253b2c6b-43e0-4fc0-9f8d-93dde6fc1b06_20250213T13:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, yes, [PII], my name is [PII], and we just got this insurance and um it's a lot different from other our other our other insurance, and I was just wondering, um, we have a couple of questions. One, is it a co-pay? I can't get a clear answer. And two, is our provider, current provider in the network? They don't know and they ask us to call you.
[AGENT][NEUTRAL] OK, so you're wanting to find out if there's a co-pay involved on this policy and also about a network provider, is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, if we need to change doctors, yeah.
[AGENT][NEUTRAL] OK, you say like
[AGENT][POSITIVE] OK, so I can partially help you um with your questions today. First off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And what is your policy number?
[CUSTOMER][NEUTRAL] Um, my husband's looking it up.
[CUSTOMER][NEUTRAL] Just one sec. I'm sorry.
[AGENT][NEUTRAL] OK. OK. No, you're fine.
[CUSTOMER][NEUTRAL] There is something that says policy. I think I've got to give it to me. Yeah, there's a policy.
[AGENT][NEUTRAL] Policy certificate. Mhm.
[AGENT][NEUTRAL] Depending on the type of plan you have, Ms. [PII]. OK.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 0025
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 94567
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get your policy information pulled up, Miss [PII], and I will have to verify several things with you first for security. So just one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], so first off, any information that I do provide will be a verification of benefits and not a guarantee of payment. If you could first please verify the subscriber's name and date of birth and then your date of birth, please.
[CUSTOMER][NEUTRAL] Uh, which means my husband, right? [PII], the, OK. [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] Mhm thank you and then your date of birth please.
[CUSTOMER][NEUTRAL] That's [PII]. My date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Your home mailing address?
[CUSTOMER][NEUTRAL] [PII], that's in [PII].
[AGENT][NEUTRAL] Thank you. And the phone number that we would have on file for Mr. [PII], please?
[CUSTOMER][NEUTRAL] Is what is your phone number [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Alright, so I appreciate you for verifying all of your information. OK, so I see that this is through his employment with management analysis and utilization or MAU, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so on this policy.
[AGENT][NEUTRAL] That you all have with AP. This, this is not major medical insurance.
[AGENT][NEUTRAL] So there are no co-pays for doctors, offices, or any type of co-pay. This is a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] So it pays specific amounts.
[AGENT][NEUTRAL] For specific things, X number of days or times per year per calendar year.
[CUSTOMER][NEUTRAL] I'm diabetic.
[AGENT][NEUTRAL] OK, um, yes, ma'am. And you're questioning
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] OK, so he got the highest one they, they offered, so you're telling me that I have to pay full price for any time I go to the doctor?
[AGENT][NEUTRAL] Let me see if there are any benefits even on this policy for office visits.
[AGENT][NEUTRAL] So this policy does not have any benefits for that type of thing. I can see that he also set up his profile in this way in our portal to have access to the policy information so that you all can look at that online, but this policy only has benefits for hospital admissions and confinement.
[AGENT][NEUTRAL] Or surgical, like outpatient surgical benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it does not have prescription.
[AGENT][POSITIVE] It has a diagnostic testing benefit.
[AGENT][NEUTRAL] A hospital admission benefit, a confinement benefit, and then surgery done within a hospital or an outpatient facility, surgery center or in a physician's office.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] That is the benefit on this plan.
[CUSTOMER][NEUTRAL] OK, so you're saying no pharmacy benefits and no doctor's office benefits. So we have to pay any medicine full price?
[AGENT][NEUTRAL] Not, no, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. On this policy, if this is the only policy you have, it does not.
[CUSTOMER][NEUTRAL] Wait a minute, honey. You can ask your questions in just a second. Be in line. OK, so you're telling me that I have to pay full price for the doctor's office visit and full price for any medicines.
[AGENT][NEUTRAL] That is correct, based on the coverage of this policy that he is enrolled with.
[CUSTOMER][POSITIVE] Can I ask the question. Thank you.
[CUSTOMER][NEUTRAL] OK. And my husband has some questions.
[AGENT][NEUTRAL] And then, OK, yes.
[CUSTOMER][NEUTRAL] Is it possible for me to, is it possible for me to upgrade the insurance to what we actually need?
[AGENT][POSITIVE] Now, Mr. [PII], I will be happy to give you all the phone number for benefits and a card. That is the enrollment company that handles any type of benefit enrollment for your employer.
[AGENT][NEUTRAL] And then they provide the different companies your information based on what you have enrolled for. So I can give you their phone number and I can also connect you with them.
[CUSTOMER][POSITIVE] OK, that'd be great. Thank you. You can just connect me.
[AGENT][POSITIVE] OK, you're welcome.
[AGENT][NEUTRAL] OK, would you like their number in case our call were to get disconnected, you could call them directly.
[CUSTOMER][NEUTRAL] I already have their number. I just don't have it in front of me.
[AGENT][NEUTRAL] Oh, OK. All right, well, I'll be happy to connect you all as far as this plan. I know that uh Ms. [PII] had also inquired about network providers. Now the network company for this particular plan that you're currently enrolled in is through multiplan.
[AGENT][POSITIVE] And I can give you that phone number if you all want that. If not, you know, then I can just connect you over to benefits and a card.
[CUSTOMER][NEUTRAL] I thought you said they don't cover any of that stuff anyway, even if.
[AGENT][NEUTRAL] Well, you still have a hospital benefit, so there's no work associated with any provider that's, you know, for this particular plan that you're enrolled for now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, could you, could you just connect me? that'd be great thank you.
[AGENT][POSITIVE] I would, and I'll be happy to do that. Is there anything else that I can help you all with before I, I do?
[CUSTOMER][POSITIVE] That's all, thank you.
[AGENT][POSITIVE] You're welcome and thank you both for calling APL. I hope you both have a very nice day.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][NEUTRAL] You're welcome. One moment, please.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Pa espanol pres.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling Benefits in the card. My name is [PII]. Who do I have the pleasure of speaking with?
[AGENT][NEUTRAL] Hey [PII], it's [PII] with APL. How are you today?
[CUSTOMER][POSITIVE] I'm great and yourself?
[AGENT][NEUTRAL] I'm doing fine, thank you. So I have a uh an insured on the line. He's got questions regarding a different plan option for him that could be available.
[AGENT][NEUTRAL] His name is [PII], and he is with MAU.
[CUSTOMER][POSITIVE] Alrighty, I'll go ahead and get get him situated. You can go ahead and put him through.
[AGENT][POSITIVE] OK, [PII]. Well, thank you so much and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You as well. Have a good one.
[AGENT][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Bye-bye