AccountId: 011433970860
ContactId: 36aed144-3efb-4f3a-b396-8959fd6a30cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 910380 ms
Total Talk Time (AGENT): 457534 ms
Total Talk Time (CUSTOMER): 277391 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/36aed144-3efb-4f3a-b396-8959fd6a30cf_20250204T15:57_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, um, I just got this insurance and I was just I had a couple of questions on it.
[AGENT][NEUTRAL] OK, so you're the insured and you have some questions on your policy, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] I don't have that.
[AGENT][NEUTRAL] OK, and what, what is your social so I can try and locate your information.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, so thank you. Give me one moment please.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, so Mr. [PII], I will need to verify several things with you first for security and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct? Alright, and lastly your email address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So yes, sir, um, which policy are you calling in regards to?
[CUSTOMER][NEUTRAL] I'm not really sure. It's all kind of confusing to me. It's like I have two different things going on here. Um, basically what I wanna know is, um, like what's the total out of pocket cost, like the deductibles.
[AGENT][NEUTRAL] So this is for your medical or the limited, you don't, the coverage you have with us is not major medical insurance. This is a limited benefit plan that you have. I see this policy was actually just issued for you on yesterday.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah and it's brand new, yeah.
[AGENT][NEUTRAL] OK, so give me just a moment to be able to pull up your policy.
[AGENT][NEUTRAL] Information
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's still loading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so again, this policy provides specific benefits.
[AGENT][NEUTRAL] Specific benefit amounts for certain covered services.
[AGENT][NEUTRAL] Per you know, per cover person so what type of information specifically are you interested in?
[AGENT][NEUTRAL] There's not a deductible. There's nothing like that.
[CUSTOMER][NEUTRAL] Like, um,
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] Huh, OK.
[CUSTOMER][NEUTRAL] And so it this be the policy I, let's say I go into the hospital for I, I, I, I get cancer, go to the hospital, you know, big time money, you know, is this the cover policy that covers that?
[AGENT][NEUTRAL] This policy, if you
[AGENT][NEUTRAL] Uh, if you were admitted to the hospital, you have what's called a hospital admission benefit, which is $1000 per day, and it's a maximum of 1 day per calendar year per covered person.
[AGENT][NEUTRAL] In addition to that, there is a hospital confinement benefit.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] The benefit amount is $100 per day, maximum of 30 days per calendar year per covered person.
[AGENT][NEUTRAL] Now, this plan, if you had, you know, if there were critical illnesses involved, um, if you had, you know, a heart attack, stroke, things of that nature, then this would, you know, it has benefits on there for that. Doctor's office visits are not covered under this plan.
[CUSTOMER][NEUTRAL] Right, uh, alright, I already talked to that, that lady there. She sent me to you. I've already, yeah, that one. I'm just looking for the, the hospital one.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And normally, all right, what I have right now, uh I just started back to work. So what I have right now is government marketplace and Blue Cross Blue Shield, and they have like an $18,000 out of pocket, and then they have an unlimited, there's no cap on, you know, you go to the hospital and you're in there for a couple of years or something, there's no cap. I was wondering, is that what this is?
[AGENT][NEUTRAL] That is just
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] It is not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, if you were to be admitted to a hospital.
[CUSTOMER][NEUTRAL] So I don't have anything like that then you're saying?
[AGENT][NEUTRAL] Not, this plan does not cover anything like that. No, sir. It has, it's a limited benefit plan.
[AGENT][NEUTRAL] That will only pay specific amounts for a specific number of days per calendar year for covered person.
[CUSTOMER][NEGATIVE] This is very confusing, hm.
[CUSTOMER][NEUTRAL] So it's like I have two different places here. I've already talked to one place about my doctor's stuff and I, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she probably shouldn't have sent me to you is what you're saying?
[AGENT][POSITIVE] Well, if you need a benefit information rela related to this hospital indemnity plan that you have with us, then yes, sir, you're in the right place.
[AGENT][POSITIVE] You're in the right place for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] This is very confusing. Um, I have a heart attack today. What happened?
[CUSTOMER][NEUTRAL] They only pay $1000 a day? Is that it? You're saying?
[AGENT][NEUTRAL] Well, it's only, it's not even a day. It's one day. So if you were admitted to the hospital, your benefit for that would be $1000.
[AGENT][NEUTRAL] For it's called a hospital admission benefit, then it would pay the plan has a $100 per day confinement benefit, but $100 would be the maximum that this plan would pay, and that is for a maximum number of 30 days per calendar year.
[AGENT][NEUTRAL] You have the critical.
[CUSTOMER][NEUTRAL] So, basically what you're saying, yeah, and, and how much is this costing me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, I don't have access to that information. You enrolled for any insurance coverage that you have, Mr. [PII], through Benefits and a card or VIC.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is who handles all of your deductions, enrollments, changes to coverage, anything like that is.
[AGENT][NEUTRAL] Um, it's handled by them.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So I don't have access to that information.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well, who was I talking to before I got to you? Do you even know that, or?
[AGENT][NEUTRAL] Oh, I don't know. Mm, no, sir. I wouldn't know what company you have been speaking with before.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, I guess they're just.
[CUSTOMER][NEUTRAL] This is with MAU.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The company
[AGENT][NEUTRAL] Correct, and again you enroll through benefits in a card that's the enrollment company that handles your employers.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Enrollment for any type of insurance that you have.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh [PII], um.
[CUSTOMER][NEGATIVE] Well it just sounds like terrible insurance right here to me. I mean it's not really covering anything.
[AGENT][NEUTRAL] Again, it's not major medical, it's not major medical insurance.
[AGENT][NEUTRAL] This is essentially like in addition to what you already have, but it's not major medical coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then, you know, mhm, go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Just trying to figure all this out is very, very confusing and.
[CUSTOMER][NEUTRAL] Um, any insurance I've ever had in my whole life, it's always just one thing, that was it, and they, everybody knew everything, um, dealing with two different places here now, it's just kind of confusing. I don't understand it, but uh.
[AGENT][NEUTRAL] Sure, no, I unders I understand that.
[CUSTOMER][NEGATIVE] I guess I gotta call back to the main people then so this, I really have no good hospital insurance then basically you're, you're the only one, right? You're it.
[AGENT][NEUTRAL] Well, I can't say that because I don't know anything, you know, about your other coverage that you have with anybody else. I mean, I don't have access to another company's benefits, you know, just like they don't have.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Access to ours.
[CUSTOMER][NEUTRAL] Well she was just telling me that that I needed to go to the hospital one and she sent me to you, you know, so that's.
[AGENT][POSITIVE] And right, and that's the benefit information that I have given you a lot of, OK.
[CUSTOMER][NEUTRAL] She was just like the doctors, you know, the.
[AGENT][NEUTRAL] And I did give you your hospital admission, you know, your benefit information for that. Now, your policy, all of the policies, because your policies were just um issued with us, they're still in the process as far as you being able to view all of your policy information in our portal, Mr. [PII], but I am going to go ahead and email you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The instructions I have a user guide for our online service center portal.
[AGENT][NEUTRAL] That you can set up your profile and once your policy information is viewable there you will have access to all of your policies that you have with this company.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so I'll just tell you like I said, what I, I have now, I still have the government marketplace and basically it was, it's $18,000 for me and my wife each. That was the deductible, you know, out of pocket and then it was like you go to the hospital major stuff and it was unlimited, so this, I do not have that right now with you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, sir. You do not. That is not the type of plan you have with us. Again, that's through a major, what you're describing is through a major medical insurance carrier, we are not a major medical insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I'm just thinking about just not even just.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's not co-pays and deductibles and.
[CUSTOMER][NEUTRAL] Alright, I guess I need to go back to where I was and it's.
[CUSTOMER][NEUTRAL] See if I have that. I don't even know.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEGATIVE] I'm not really sure why I have you guys. It doesn't seem like y'all are really paying anything, so I don't understand that but.
[AGENT][NEUTRAL] Now, this policy, you know, it has a, a critical illness benefit of $5000 for you and $2500 for your wife, you know, if there was um diagnosed with a critical illness.
[CUSTOMER][NEGATIVE] Uh, this is very confusing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then, you know,
[AGENT][NEUTRAL] As far as your portion, or it would pay the percentage of a critical illness benefit such as in for invasive cancer, heart attack, permanent damage due to a stroke, major organ failure, or end-stage renal disease. Those are paid, you know, that's 100% of that benefit amount that I gave you.
[AGENT][NEUTRAL] Um, but again, this is not major medical insurance.
[CUSTOMER][NEUTRAL] Hm, this is just uh like a secondary little extra insurance thing that I signed up for I guess.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, essentially.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well, I wonder, so
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] It's just so confusing. I don't understand why the, the first lady I talked to, my, my, my regular thing, she said they had nothing to do with the hospitals. So this is all I have in the hospital, just.
[CUSTOMER][NEGATIVE] This is terrible from what I'm hearing. This is.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] I don't know, it's just kind of weird.
[CUSTOMER][NEGATIVE] Um, I guess I need to just go back and talk to the other lady and ask her like the questions I asked you. I tried to, but she just kind of just flat blew me off to you.
[CUSTOMER][NEUTRAL] Uh, I don't know.
[AGENT][NEUTRAL] Yes, so I mean, I, I can provide you, like I've been doing the benefits that are covered under this policy, but if there's any other questions related to, you know, the different coverage and, you know, other options available to you, yes, I, unfortunately, I'm not able to assist with that.
[CUSTOMER][NEUTRAL] Yeah, I know, yeah, you did, then yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Well, thank you so much.
[AGENT][NEUTRAL] Well, you're very welcome and again I'm gonna go ahead and email you that user guide that I was speaking to you about for our portal and um the email that you're gonna receive from me will come from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I will put APL in your subject line for you so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK good thank you.
[AGENT][POSITIVE] OK. Well, you are so very welcome. So is there anything else at the moment that I could help you with, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, that's it. That's it. Thank you very much.
[AGENT][POSITIVE] OK, well, you're certainly welcome and thank you again for calling APL. I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye-bye.