AccountId: 011433970860
ContactId: 3ddb0627-298d-416a-9ec2-f21104d5ae8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249190 ms
Total Talk Time (AGENT): 124186 ms
Total Talk Time (CUSTOMER): 79810 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/3ddb0627-298d-416a-9ec2-f21104d5ae8c_20250203T21:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I will come because my employer, um, I guess APL is who they go through for medical uh medical dentist, um, things of that nature. I have some questions because I did call their number and they gave me this number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you have an active policy with us right now?
[CUSTOMER][NEUTRAL] Not yet. I just need, I just have some questions.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. May I have your name and a contact number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII], [PII].
[AGENT][POSITIVE] OK. Thank you, Ms. [PII], um.
[AGENT][NEUTRAL] And what is the name of the group?
[CUSTOMER][NEUTRAL] It's TRC hold on I think staffing company.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, PRC staffing.
[AGENT][NEUTRAL] OK, let me pull that one on.
[AGENT][NEUTRAL] OK. And what is your question?
[CUSTOMER][NEUTRAL] OK, so she did send me over like the brochure for the different groups. Uh, so I guess my question is, do any of the um plans cover the bariatric portion like surgery?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] OK, I can check and see if in that standard um.
[AGENT][NEUTRAL] Policy, um, there is a benefit and let's see, so.
[AGENT][NEUTRAL] And this is for um.
[AGENT][NEUTRAL] It's a sickness, correct?
[CUSTOMER][NEUTRAL] Is it what, say it again now?
[AGENT][NEUTRAL] Um, you're needing the bariatric uh surgery due to sickness?
[CUSTOMER][NEUTRAL] Yes, yes, yeah, for the reasons.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. If there is a surgery benefit under that plan, which it should be listed on that brochure.
[AGENT][NEUTRAL] That will be the flat amount that it's gonna cover. Um, usually, those surgeries are done in a facility like a surgery center or hospital. Um, so it's gonna be that benefit that is applied under the surgery benefit.
[CUSTOMER][NEUTRAL] OK, yeah, I did see like hospital stays, hospital visits, but I didn't know specifically did they cover, do they cover that portion so.
[AGENT][NEUTRAL] OK. So you don't see a surgery benefit under that plan?
[CUSTOMER][NEUTRAL] Yeah, I see, I see. I see surgery benefit, but does that included? I guess I, cause I've had different plans, I mean different jobs and you know, even though you have surgery benefits, some of them don't cover the the uh specifically the um bariatric portion of surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got you. Yeah, it really depends. If it's uh cosmetic, we do not cover anything cosmetic, but if it's due to health, then, yes, um, any health surgeries will be considered under that benefit. We cannot guarantee any payments over the phone, but if it's listed on the, uh, if it's a surgery and it's a health due to sickness, because we do cover sickness, then uh we'll go ahead and consider the charges under the surgery benefits.
[CUSTOMER][NEUTRAL] No, it's not cosmetic, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the amount that you see listed there is the amount that we cover. So just an example, if the amount listed under the surgery benefit is 1000, that is what we're gonna cover and you'll be responsible for the rest, OK?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate it.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh-huh.