AccountId: 011433970860
ContactId: 26dc27c7-f4b6-441c-8f20-46f6b6b8345a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671609 ms
Total Talk Time (AGENT): 379568 ms
Total Talk Time (CUSTOMER): 276528 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/26dc27c7-f4b6-441c-8f20-46f6b6b8345a_20250127T23:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I am just, um, I'm calling to verify if
[CUSTOMER][NEUTRAL] The um
[CUSTOMER][NEUTRAL] Medical cards that I have, ID cards. If every if everything, if everything is active, if that makes sense. Um
[AGENT][NEUTRAL] Yeah, I can take a look at that.
[AGENT][NEUTRAL] Do you have your policy number off of that card?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number 02571782.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Ms. [PII], would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And I do just need to verify some other information with you and then we can talk about your policies. If you could verify for me please, your mailing address on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and.
[AGENT][NEUTRAL] Let me see just the email on file if you can.
[CUSTOMER][NEUTRAL] Oh, I'm trying to think what email did I provide.
[AGENT][NEUTRAL] It looks like your [PII] like a personal one.
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] I have 3 of them as well. But OK, it's either, it's either gonna be [PII] or [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes ma'am, that was it.
[AGENT][NEUTRAL] And then do you have a call back number I could take for you just because I don't have a number on file in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, thank you. All right, and so I am seeing with us you have a handful of policies, um, your hospital indemnity, your group accident, short term disability group term life and your dental, and it looks like I'm showing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] They are
[AGENT][NEUTRAL] Well, I don't know what that code is. Hold on, let me see. Two of them definitely stay active and the other ones I'm not exactly.
[AGENT][NEUTRAL] Sure they have a status I haven't seen before, so let me pull that up real fast.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. When I go into them they say active so I don't know what that little code on the side is, but I'm gonna go into the other 31 by one and just verify that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The second one shows up as active and then this is the last one. Hang tight while I go into it.
[AGENT][POSITIVE] And that one shows active as well so I'm showing active on everything on my side.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I don't know if I
[CUSTOMER][NEUTRAL] Can ask this question with you if I have to be transferred to a different department, but I'm, this is, this will be my first time actually using the um the policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I do see on the card itself, it does say virtual urgent care um.
[CUSTOMER][NEUTRAL] It's like a click away, call or click away. But if I, does, does it.
[CUSTOMER][NEUTRAL] Are you able to tell me if I go to an urgent care in person, what I possibly may be looking at paying or what if I have a deductible or well not a a co-pay or anything of that sort?
[AGENT][NEUTRAL] Yeah, so I can take a look.
[CUSTOMER][NEGATIVE] Cause my baby is really sick. I'm trying to figure this out.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] You said your baby is sick?
[CUSTOMER][NEUTRAL] Yeah, [PII], he's the um the child that's on there. Yeah, he's been sick for like almost 3.5 days now and it's like it's he's not getting better, his fever is going up. So I'm like, OK, I gotta get him to the doctor, but I don't, I wanna make sure before I even go, kind of what I'm looking at.
[AGENT][NEGATIVE] Oh sorry.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Do you know what you're looking at? OK, yeah, so I can pull up that benefit information on my side. Um, I do wanna let you know though any benefit information I give you over the phone is always just a verification of coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and not a guarantee of payment, so you have a couple benefits with this hospital indemnity policy that I think could be beneficial for you. Um, so the first one is you do have an outpatient accident and sickness treatment, um, and that can provide you up to $100 per visit 4 times a year, um, and that's 4 times for yourself and 4 times for your child, and I can check and see if you have a family limit on that.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, sometimes it's, it'll say like 4 times for each of you, but 6 per family, you know what I mean?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um, but so that can provide you up to $100 so there's no benefit or co-pay as much as this is a limited supplemental policy. So when something happens you can get like a just a payout up to say you were only charged $75 the payout might be $75 but if the bill was $150 you could be eligible for a $100 benefit and I always say it could be because I don't process the claim, so I'd hate to tell you something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEGATIVE] Absolute and I'm not the one that does that sort of work um.
[CUSTOMER][POSITIVE] Understandable.
[AGENT][NEUTRAL] And then you also have a diagnostic testing benefit and I'm not sure if it's just for imaging or if it's um diagnostic testing like a strep test or something, but you do have that benefit you can use up to once a year and it covers for um $200. So if you need any big diagnostic testing done, that benefit could benefit you. Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other one that you have with us um that you I again think could benefit you um so you'll see on that card that you have it'll say like Pharmavale is listed as like your preferred pharmacy provider or whatever like that card should say Pharmavale on it.
[CUSTOMER][NEUTRAL] Pharma, yes, uh-huh.
[AGENT][NEUTRAL] Yes, so they coordinate your pharmacy benefits, so like we don't do that, but you do have a benefit for prescription drugs. So what that means is when you go to the pharmacy, Pharmavale will take care of everything at the pharmacy, but if you pay any money out of pocket, you can submit a reimbursement for an outpatient prescription drug that will benefit you up to $20 a prescription up to 15 times per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that can help close some of the gap and for that one you would just want to submit your the the receipt from the pharmacy.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know what I mean?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, and then so.
[CUSTOMER][NEUTRAL] OK, that, that makes sense.
[AGENT][NEUTRAL] So then from how much it would cost, it's really gonna depend on like the out out of pocket cost of your urgent care so you know if you go and it costs over $100 you are, you do have an up to $100 benefit for urgent care treatment um and treatment might not cover a consultation fee though.
[CUSTOMER][NEUTRAL] So I'll just pay the the balance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] It might just cover like treatment done and so you'll just want to, I, I would just like to point that out um because again I don't process it but I do see it says treatment on here so I wanna make sure that's.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mentioned
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, OK, let me ask you this is um.
[CUSTOMER][NEUTRAL] I don't know if you're able to or not, but it's just a question, are you able to tell me if.
[CUSTOMER][NEUTRAL] Cause like it's the, the the the plan that I have or policy that I have, doesn't matter if it's in network, out, out of network or anything of that sort or if it, or is it just wherever.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] We don't have a network we're gonna honor benefits wherever you go because we're supplemental.
[CUSTOMER][NEUTRAL] I I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK. OK. Cause I, I'm trying to, I, I'm gonna take him actually to
[CUSTOMER][NEUTRAL] I don't know if I should take him to the actual Cooks ER here in, in um [PII], or if I should take him to the actual urgent care center.
[CUSTOMER][NEUTRAL] Um, here, and so I'm trying to just figure it out, cause this, this benefit is different than what I've had before. So I, I can't really
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Yes, I, I don't know if that makes sense.
[AGENT][NEUTRAL] No worries. You do have an ER benefit, but it's that same benefit of up to $100 and it's only available twice per year, um, and so I mean I can't make, I mean you I don't.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You do have a benefit. So whichever you decide, you do have a benefit there, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The ER benefit is a little more limited. It's the same dollar amount as the urgent care, but you only have that one twice in a calendar year.
[CUSTOMER][NEUTRAL] I got you. OK. Yeah, and I think that the ER probably will be more or a little more expensive than the urgent care, so I might just go with the urgent care, but I just wanted to kind of just, you know, find out.
[AGENT][NEUTRAL] Oh, absolutely. And then I did wanna follow up that that diagnostic testing benefit is for imaging. So it does, it is in imaging. So I don't know if they would, I don't, I, I don't know how your baby's feeling, but if they needed like a CT or an MRI, but it, I'm not sure, but those would be the sort of things that would fall under that imaging test for you.
[CUSTOMER][NEUTRAL] Um, just.
[CUSTOMER][NEUTRAL] It's quite.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yeah, I think they're probably gonna end up testing them for like, you know, like COVID and the flu, stuff like that, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, OK, that kinda gives me an idea of what I'm looking at cause I know they're gonna end up having to verify the benefits anyway before they even um register us, and that's normally how the urgent care does. So I'll give them a call real quick and just see, and the number that I called, that's the number that they could call to verify the benefits as well, right? Cause they're gonna ask me, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, absolutely. You'll have them talk to us and we'll, we'll take care of everything as far as their verification.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right well I appreciate it thank you so much.
[AGENT][POSITIVE] Yes, it's my pleasure and if you have any other questions along the way um or further down the line you're not sure you quite remember something, just give us a call and we'll do our best to take care of you. I wish you and your baby.
[CUSTOMER][NEUTRAL] How late are y'all open?
[AGENT][NEUTRAL] Oh, we're open until [PII] tonight, but we open at [PII].
[CUSTOMER][POSITIVE] OK, OK, alright, I appreciate it, thank you.
[AGENT][POSITIVE] Oh, it's my pleasure. I wish you and your son the best of luck.
[CUSTOMER][POSITIVE] Thank you I appreciate that you have a good day.
[AGENT][POSITIVE] Thank you. You too.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.