AccountId: 011433970860
ContactId: 34a6fcf1-b86f-4db8-869c-fd88a497922f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410489 ms
Total Talk Time (AGENT): 181117 ms
Total Talk Time (CUSTOMER): 176196 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/34a6fcf1-b86f-4db8-869c-fd88a497922f_20250207T15:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] You answering the phone for a hospital indemnity.
[AGENT][NEUTRAL] Well, hospital indemnity calls are coming to the care team now.
[CUSTOMER][NEUTRAL] Oh, really?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So get someone, um, do you have a.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yeah, they were needing benefits and I'm not sure about this policy because I haven't even seen this policy. It's a HI 172.
[AGENT][NEUTRAL] I think that's a newer policy. What's that policy number?
[CUSTOMER][NEUTRAL] It is, it is 02574790.
[AGENT][NEUTRAL] Lord, let me.
[AGENT][NEUTRAL] 7825.
[CUSTOMER][NEUTRAL] And I, I'm trying to pull up the policy but I can't see anything.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, it's
[CUSTOMER][NEUTRAL] And all I wanna know if the office visits covered, but I'm not sure on this one.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The older ones I know, but this, this one I don't know.
[AGENT][NEUTRAL] I don't see anything, but let me get, one second. I'm trying to see if I can pull up something.
[AGENT][NEUTRAL] Yeah, this is
[CUSTOMER][NEUTRAL] Is there
[AGENT][NEUTRAL] I know our policy.
[AGENT][NEUTRAL] Please be in here, not the car policy certificate.
[CUSTOMER][NEUTRAL] That's what I was looking to see. I didn't, I've seen a car.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Give me half a second. I've been looking in the group and see if I can find someone else that has a policy to where I can do TRPIQ.
[AGENT][NEUTRAL] 717
[CUSTOMER][NEUTRAL] I hated to transfer, but I don't know. I'm not gonna tell them wrong. I didn't.
[AGENT][NEUTRAL] Oh no, I understand.
[CUSTOMER][NEUTRAL] I didn't um
[CUSTOMER][NEGATIVE] I tried to pull up the policy, but all I see is cards.
[AGENT][POSITIVE] Yeah, I just saw the card and it looks like this one's just a card too. Well, uh, you can send it to me. I can try to help as much as I can.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Hold on just a second. Call from Insure Part two for offices benefits. Somebody had to call them back, so they didn't put it in the notes. I was trying to see if they put it in notes.
[CUSTOMER][NEUTRAL] But they didn't put it in there. Yeah, I was trying to see if they put the benefit in the note, but they didn't give put the benefit in and they just said they called them back.
[AGENT][NEUTRAL] But what oh.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Well, um, his name is [PII]. He's with the hospital.
[AGENT][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] Uh-huh. It's a him.
[AGENT][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] His phone number is [PII].
[AGENT][POSITIVE] Alrighty then.
[CUSTOMER][NEUTRAL] And all he wants to know if the office visits covered.
[AGENT][NEUTRAL] Just office visit. OK.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Good morning. Thanks for calling APL. Is this Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. This is [PII]. How can I, uh, can you help me out with, uh, verifying benefits on a mutual patient medical.
[AGENT][NEUTRAL] Uh, yes, sir. I can help you with that. Let's see, and this is for Mr. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, this is for the spouse, uh, Ms. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're needing from the late transfer you say you're needing office visit benefits, is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah, they're coming in to visit with their family care doctor and I just want to see if they have any co-pays, any deductibles are out of pocket. And of course, if there's any accumulations to reward those, and lastly to see if they have like an annual physical available for them this year.
[AGENT][NEUTRAL] OK. Well, the type of policy they have with us is a limited medical indemnity plan. There's there's not a deductible, co-pay or co-insurance. There's just a max benefit payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and give me half a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Treatment benefit.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] what they call
[AGENT][NEUTRAL] And I don't show, oh, I'm about to give you the wrong information and you're needing digits let's see.
[CUSTOMER][NEUTRAL] Uh yes ma'am mhm.
[AGENT][NEUTRAL] And this is for a sickness or an injury?
[CUSTOMER][NEUTRAL] Oh yeah, sickness or injury. Mhm.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage for an office visit, the max payable is up to $75 per visit and they have a total of
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6 digits per calendar year.
[CUSTOMER][NEUTRAL] OK, and do they have all remaining? Mhm.
[AGENT][NEUTRAL] Uh, let me double check. I don't think they've used any. one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, no, uh, visits have been used, so they are available.
[CUSTOMER][NEUTRAL] OK, and if they were to get like an annual physical, like a general checkup once a year, do they have that available on this type of policy?
[AGENT][NEUTRAL] Uh, let me double check. I don't believe so. Most of these policies don't have a wellness benefit, but let me just double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I could be wrong, let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, there is health screening, so they do have a health screening benefit on the plan.
[CUSTOMER][NEUTRAL] OK, alright, and then is that covered at 100% or they still subject to the $75 worth.
[AGENT][NEUTRAL] Uh, for a screening, the maxi pages is up to $150 and it looks like it's once per calendar year.
[CUSTOMER][NEUTRAL] OK, for annual alright.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And just to double check, is Houston Methodist is in network with uh with this policy?
[AGENT][NEUTRAL] Well, we don't have a network, so it's open to where we'll take any claims from any provider or the insured can go to any medical provider.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, alright, pretty much answers the question. uh, what was your name again, ma'am?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you. Alright, and then is there any reference number for today's call?
[AGENT][NEUTRAL] Uh, no, sir, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And they say, OK, perfect, thank you so much, [PII], for all your help.
[AGENT][POSITIVE] You are welcome and thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You too mhm bye bye.
[AGENT][NEUTRAL] Bye.