AccountId: 011433970860
ContactId: 462587bc-3fa7-428d-ba2e-c14217bcd83b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586179 ms
Total Talk Time (AGENT): 439136 ms
Total Talk Time (CUSTOMER): 96812 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/462587bc-3fa7-428d-ba2e-c14217bcd83b_20250122T17:49_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, hello how you doing, ma'am? Um, I'm calling because I have a couple of questions regarding this benefit package card that I just received in the mail.
[CUSTOMER][NEUTRAL] Um, OK, my first question is.
[CUSTOMER][NEUTRAL] Is this like a um
[CUSTOMER][NEUTRAL] For this insurance, where where can I get a list of providers that I can go, um, see?
[AGENT][POSITIVE] Absolutely. Would you mind if I actually like get your policy number and pull up your policy so I can help you out a little more details?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, what's the policy number, sir?
[CUSTOMER][NEUTRAL] Um 0258.
[CUSTOMER][NEUTRAL] 3333.
[AGENT][NEUTRAL] All right, perfect. And let me get that pulled up real quick and I'll just need to verify some information. If you could verify with me your first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Perfect. And would you also be able to verify for me, please, your mailing address?
[CUSTOMER][NEUTRAL] [PII], that's [PII].
[AGENT][POSITIVE] Perfect I appreciate that and the last thing is if you could verify that email address for me.
[CUSTOMER][NEUTRAL] Um, it should be my, my name, [PII].
[AGENT][POSITIVE] Thank you very much I do appreciate that and um Mr. [PII], if I could just get a callback number in case our call gets disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. All right, and I am pulling up your benefit information so I'm able to help you out the best. Um, it looks like your policy with us is a limited supplemental policy so there's actually no um network associated with this. We're gonna honor benefits um anywhere possible that you go, um.
[AGENT][NEUTRAL] And I'm trying to see.
[AGENT][POSITIVE] Real fast on your ID card.
[AGENT][NEUTRAL] So it does look like your benefits were put together through benefits in a card, so you do have a multi plan um.
[AGENT][NEUTRAL] A multi-plan policy number and on that card it's gonna be the one that says medical ID [PII] um and so you can go to [PII] and locate providers through them that will offer you additional discounts but as far as APL goes and your policy with us, we don't have a network and you're welcome to use any provider.
[CUSTOMER][NEUTRAL] OK, so once I figure out the plan, like, will they tell me, and I see a provider I wanna um go to, do I have to pay a co-pay or anything?
[AGENT][NEUTRAL] OK, so we're not a major medical plan we are an indemnity policy, which means that you have like um supplemental benefits for your policy and let me actually, I have that pulled up, but let me go back to it real quick, um, so I can give you information on those benefits.
[AGENT][NEUTRAL] And while it's loading, I do wanna let you know that any benefit information I give you over the phone today is always just a verification of coverage it's never a guarantee of payment.
[AGENT][NEUTRAL] Um, so let me take a look at these benefits with you, so it looks like.
[AGENT][NEUTRAL] It's a lot of scrolling, OK, um, so the way it works is like you have some inpatient and outpatient benefits so if you're admitted to a hospital, um, you get like an admission benefit that's $500 right? And then if you're confined to a hospital like you're there daily, you have a benefit that's $50 a day that you can use up to 30 days in the calendar year um if you become.
[AGENT][NEUTRAL] Um, admitted to an ICU center, you have a benefit that pays up to $100 a day, um, for up to 20 days per calendar year and so.
[AGENT][NEUTRAL] What's different about this versus major medical is that you just have like a set amount of what your benefit can be in a calendar year and it is.
[AGENT][NEUTRAL] Like that's the benefit so say you go to a physician's office because you're sick, you got the flu and you're not feeling well, um, and you have to go to the doctor. You have a benefit at a physician's office for accident or sickness up to $50 a day, and it's 4 times a year you can use that. So, um, you could receive a benefit or if your provider filed the claim they would receive that benefit of the $50 say you go and you have to have like.
[AGENT][NEUTRAL] A CAT scan or an MRI you have like a diagnostic um testing and benefit, a diagnostic testing benefit that gives you up to $100 a day per test but you only have it once a year. So it's supplemental in the fact that it's gonna pay um closer to a lump sum benefit amount in some situations or up to a certain amount of money and then that benefit is utilized um for your calendar year.
[AGENT][NEUTRAL] Uh, does that make sense?
[CUSTOMER][NEUTRAL] Um, somewhat, yeah, OK, so, so, so let me ask you this, so out of pocket, do I have to pay anything out of pocket?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah you might have to pay out of pocket depending on what you see so say you're going outpatient to a doctor's office and it's just your annual wellness exam, right? Like you just go every year and they check you so you don't have a wellness benefit on here so you might have.
[AGENT][NEUTRAL] To pay out I'm not sure exactly if you have other benefits through benefits in a card but just through our policy is all I can speak on but you might have to pay out of pocket because your benefit doesn't qualify um you also have a.
[CUSTOMER][NEUTRAL] 77, OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Let's see, like a surgical benefit in a facility you can use up to once a year. So say you need to go have a surgery done and you use that benefit and you hit it, it happened once a year and then later on in the year, you have a second surgery.
[AGENT][NEUTRAL] Um, well, you know that this benefit was only utilized once in a calendar year, so you might not have any benefits payable for that second surgery. So it's just kind of having that idea of what your benefits are, how much they pay, and how many times you can use them, and then.
[AGENT][NEUTRAL] Keeping track of oh OK I can I can go see somebody in an urgent care 4 times in a calendar year. This is my 5th visit, so now I'm not gonna have benefits in an urgent care, you know, for the remainder of the year, so I won't have that $50 to help cover any costs and so it's just kind of keeping track of it like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Now is, now, how can I actually like see a list of
[CUSTOMER][NEUTRAL] Um, like what.
[CUSTOMER][NEUTRAL] I am covered on
[AGENT][NEUTRAL] OK, yeah, absolutely. Did you get your policy certificate mailed out to you in the mail?
[CUSTOMER][NEUTRAL] I for
[CUSTOMER][NEUTRAL] Um, are you referring to my card, my APL?
[AGENT][NEUTRAL] No, it would have been like a 37 page document, but we do have them available online.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] So what I can do is I can email you um like the instructions for how to set up and use our online portal and our online portal is gonna have all of your benefit information that breaks down like your detail of benefits um and then if you ever needed your ID card it's also on the online portal but it has like all of your information there.
[CUSTOMER][NEUTRAL] OK, my last question um before you send that. If I wanted to cancel this, will I be able to?
[AGENT][NEUTRAL] Uh, to transfer it you said?
[CUSTOMER][NEGATIVE] No, cancel.
[AGENT][NEUTRAL] Cancel. OK, if you do choose to cancel it you can cancel um you would cancel through benefits and a card. They are the ones that organized to the benefits and so you'd have to reach out to them for for cancellation. I have their contact number and I can include that in the email for you if you want it, but I do wanna let you know that their office isn't open today due to inclement weather.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then are there any other questions you have?
[CUSTOMER][NEUTRAL] No, no, that's it.
[AGENT][POSITIVE] OK, [PII], if you find yourself having other questions, you are more than welcome to reach on out and we'll be so happy to help you out um I'll go ahead and I'll send out that contact information for you uh for benefits and a card and I will.
[AGENT][NEUTRAL] Um, also make sure you have that user guide to set up the online portal if you choose to keep these elected benefits and then that way if you need information or you wanna look at your policy documents you have access to it and it's right there at your fingertips.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then as I think I just asked, but you can just tell me um if I didn't, but is there anything else I can do to to help you or take care of you today?
[CUSTOMER][POSITIVE] No. Thank you so much.
[AGENT][POSITIVE] It's my pleasure thank you for calling ATL and you have a wonderful day.
[CUSTOMER][NEUTRAL] Alright you too.
[AGENT][POSITIVE] Thanks bye bye