AccountId: 011433970860
ContactId: 45bbbc36-c923-459b-8b51-8730ac2dc8e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425149 ms
Total Talk Time (AGENT): 178424 ms
Total Talk Time (CUSTOMER): 195611 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/45bbbc36-c923-459b-8b51-8730ac2dc8e3_20250211T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. Yeah, my name is [PII]. I have a coverage with you guys and I just want to know what coverage I have because um my hospital just called me and said my uh policy doesn't cover, um, annual physical visits.
[CUSTOMER][NEUTRAL] Which is different from what my providers told me, so yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] My name is [PII] for the first name and the last name is [PII]
[AGENT][NEUTRAL] OK, if you can respell the first name a little slower, that's all I need is your first.
[CUSTOMER][NEUTRAL] All right. um [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it's pronounced [PII]?
[CUSTOMER][NEUTRAL] Yes, she will.
[AGENT][NEUTRAL] OK, and do you have your policy number?
[CUSTOMER][NEUTRAL] Um, yes, I do.
[AGENT][NEUTRAL] OK, let me have that number.
[CUSTOMER][NEUTRAL] Um, the policy number is 02587041.
[AGENT][POSITIVE] Thank you. Let me have a good phone number in case we're disconnected, you.
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you, let me pull up your policy and then we can help you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you can verify your date of birth and your complete mailing address for me?
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII] and my my mailing address is [PII].
[AGENT][NEUTRAL] And what's your email address?
[CUSTOMER][NEUTRAL] My email address is [PII] [PII].
[AGENT][POSITIVE] OK, thank you for that one moment.
[CUSTOMER][NEUTRAL] Yeah, and just to confirm, the address is correct on file, right? Because on the letter that came, he had the one, he had a word like a misspelled address. I just want to confirm what I call that is what you have on file.
[AGENT][NEUTRAL] Yeah, the, the address you verified is what we currently show on file, so it looks like we, we, it was updated.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, you need 611. OK, yup.
[AGENT][NEUTRAL] All right, and so you had a question regarding your benefits?
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, is it the office visit benefit?
[CUSTOMER][NEGATIVE] Yes, my annual, yeah, I wanna do have an annual physical and my husband called me and said it's not covered.
[CUSTOMER][NEUTRAL] But I know I have 4 visits a year.
[AGENT][NEUTRAL] OK, for, OK, what is the office visit for?
[CUSTOMER][NEUTRAL] It's for an annual fiscal.
[AGENT][NEUTRAL] OK, so routine physical is not covered under the policy.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, but that's not what the provider sent me because they sent me, um, I have, um, you know, where I could go do my blood work to check my cholesterol and everything.
[AGENT][NEUTRAL] When you say provider, are you meaning your healthcare provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what did they tell you?
[CUSTOMER][POSITIVE] Yeah, I have the form they said all of it is covered because the one I signed up for was for the enhanced and the enhanced has all the benefits for 4 times a year.
[CUSTOMER][NEUTRAL] Including like the hospital visits cause I have the, I have the paperwork with me.
[AGENT][NEUTRAL] Yeah, I see the hospital admission benefit under your policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There is a diagnostic testing benefit.
[AGENT][NEUTRAL] But that's not for wellness, that's for diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what is in the diagnostic test and I may ask?
[AGENT][NEUTRAL] What is a CT scan?
[AGENT][NEUTRAL] And MRI.
[AGENT][NEUTRAL] A CAT scan?
[AGENT][NEUTRAL] A PET scan?
[AGENT][NEUTRAL] Or the imaging tests that are covered. And then there's also an advanced study follow-up tests, which are an angiogram, uh, barium enema, a nuclear stress test.
[AGENT][NEUTRAL] A sleep study
[AGENT][NEUTRAL] Uh, TEE, which is a trans transesophageal.
[AGENT][NEUTRAL] Echocardiogram?
[AGENT][NEUTRAL] And uh an upper GI.
[CUSTOMER][NEUTRAL] OK, so what I'm looking at this and I can see if I I'm meant to have the blood pressure, the cholesterol, the cancer, the diabetes, hepatitis C, the syphilis, lung cancer, tuberculosis.
[CUSTOMER][NEUTRAL] Covered. So I'm kind of just surprised like cause I'm looking at the, the, the documents I have.
[AGENT][NEUTRAL] Where did you get that document from?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, from, um, the providers, um, the, um, the guys, the people that sold it to because it's a staff stuff and I can also see I have physician visits.
[AGENT][NEUTRAL] OK, let's, let's stop for a second. Let's stop for a second. So the, the, the document that you're looking at now, did you get that from your employer or are you saying you got it from your doctor's office?
[CUSTOMER][NEUTRAL] I have 4 physician visits.
[CUSTOMER][NEUTRAL] Yeah, I got it from my employer.
[AGENT][NEUTRAL] OK, so if you feel that there is a discrepancy as to what you're enrolled in, then you would need to contact your employer. We're showing a different policy when I say different, the benefits are not the same as what you're looking at on that document.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So we're just providing the information based on the information that we received from your employer if it's different than what you have, then you would need to clarify with your employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what you're saying, what you I have currently? So I don't need to clarify this.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And what coverage do I have?
[AGENT][NEUTRAL] OK, what I just went over the diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have an in hospitals, if you were confined to a hospital, and then you have a surgical benefit. So if you had a surgery in a hospital or a surgery in a physician's office, those items are covered as well. But wellness is not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wellness is not.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, OK. So I just have the um the, you said the diagnostics are just, they, they don't have anything to do with the wellness, right?
[AGENT][NEUTRAL] One
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, um, thank you. I'll call my providers right now.
[AGENT][NEUTRAL] Yeah, actually when you say provider, do you mean your employer?
[CUSTOMER][NEUTRAL] Yeah, uh-huh.
[AGENT][NEUTRAL] Or your doctor.
[CUSTOMER][NEUTRAL] I don't know what is my no, um, I'll call the, I'll call my employers.
[AGENT][POSITIVE] Yeah, exactly, and get that clarified as far as what your benefits are, what you have versus what we show.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][NEUTRAL] OK. Anything else I can help out with today?
[CUSTOMER][NEUTRAL] Alright, mhm.
[CUSTOMER][NEUTRAL] Um, no, that'll be all.
[AGENT][NEUTRAL] All right. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Alright
[AGENT][POSITIVE] Have a good day, Chew.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Alright.