AccountId: 011433970860
ContactId: 484af38e-f153-43bb-904e-d47c7088b0e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452410 ms
Total Talk Time (AGENT): 172157 ms
Total Talk Time (CUSTOMER): 202658 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/484af38e-f153-43bb-904e-d47c7088b0e1_20250113T23:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hi, uh, [PII], yes. Actually, I'm calling on behalf of my husband who has insurance um through his employer. Uh, we had an appointment, well, he had an appointment for tomorrow, uh, for a physical, and um, they, they reached out and said that when they called to confirm the, uh, what he was what was covered, uh, the physical wasn't um covered. So could you explain um what he has? I guess he has like a limited plan or something like that.
[AGENT][NEUTRAL] OK, I can help you with benefits. Um, can you please give me your name and your callback number just in case?
[CUSTOMER][NEUTRAL] I'm, I'm
[CUSTOMER][NEUTRAL] OK. Mhm. Uh, my name is [PII].
[AGENT][NEUTRAL] OK, Miss [PII], what is your callback number?
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what is the policy number?
[CUSTOMER][NEUTRAL] Um, let's see where.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh 0 02539245.
[AGENT][NEUTRAL] OK, let me look that policy up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], is your husband there where I can speak to him and get consent to discuss the policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Hi, this is [PII] with APL.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, this is done only for the.
[AGENT][NEUTRAL] I'm doing
[CUSTOMER][POSITIVE] I'm good, I'm good.
[AGENT][NEUTRAL] Awesome, um, would you please verify your date of birth for me, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then also I'll need for you, for security reasons, can you please verify your address?
[AGENT][NEUTRAL] And your email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The um the address.
[AGENT][NEUTRAL] And then your street address?
[CUSTOMER][NEUTRAL] The street address.
[CUSTOMER][NEUTRAL] 11 [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And just the street name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. I appreciate that so much and then what is your cell phone number, sir?
[CUSTOMER][NEUTRAL] Right, let me tell you the phone number because he, he tells it a different kind of way. I'm sorry, um.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, what is it [PII].
[AGENT][NEUTRAL] OK, and then one last question for you, sir, um, can, is it OK if I speak to [PII] about your policy and give out information?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I'm OK with that.
[AGENT][NEUTRAL] OK, and how do I say your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, [PII], thank you so much for verifying the policy and giving me consent. You have a good rest of your night.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Thank you, thank you, and you too.
[AGENT][POSITIVE] Thank you, sir. OK, Ms. [PII], we're all set.
[CUSTOMER][POSITIVE] OK, hi. OK, good.
[AGENT][NEUTRAL] OK, so, um, you said that somebody had called earlier and stated that he doesn't have uh benefits for a physical?
[CUSTOMER][NEUTRAL] Yeah, actually he, he was all set for the appointment for uh for tomorrow. Um, the representative, the customer service rep reached out on Friday, uh, just to, to confirm, uh, ask a few questions regarding his policy because when she went to verify, um, you know, the, the services that were gonna be done, uh, they told her that, um, the physical was not covered because he was supposed to go get his physical done and all that.
[CUSTOMER][NEUTRAL] And maybe some other test.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So the physical was not covered on the policy. Let me look and see if I can see anything different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looking at it, I do see that he has, um, you guys are going to a physician's office?
[CUSTOMER][NEUTRAL] Yes, it was gonna be the physician's office.
[AGENT][NEUTRAL] Yeah, um, so his policy only covers for accident or sickness.
[CUSTOMER][NEUTRAL] So he accidents only in sickness, um.
[AGENT][NEUTRAL] Yeah, so if he goes to the physician's office for accident or sickness, he has a treatment benefit there, but it has to be for accident or sickness.
[CUSTOMER][NEUTRAL] OK, so his policy doesn't cover any even if he didn't go to a physician's office, is there some other place he could go and get like he, he needs to finish, um, he's new to the country, um, the public health is asking, well, immigration is asking that he get 22 more tests done, so we figured well since he, um, you know, have insurance, we just thought that it was any type of treatment would be covered or any type of services would be uh covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and you were correct when we first got on the phone. This is a limited hospital indemnity plan. So indemnity means that it's a set amount that's paid towards a covered procedure and on this on this policy, he has ER urgent care center, physician's office, physical therapy, but it has to be for acne, accident, or sickness.
[AGENT][NEUTRAL] This isn't a major medical plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So he can't get any type of physical TB tests, chest X-rays or anything like that.
[AGENT][NEUTRAL] Right, right. That all has to be done.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Yes, um, for accident or sickness.
[CUSTOMER][NEUTRAL] Um, so, OK, so he'll just be paying out of pocket.
[AGENT][NEGATIVE] Oh, I hate hearing that, but yeah, yes, ma'am.
[CUSTOMER][NEUTRAL] For like that
[CUSTOMER][POSITIVE] Yeah, oh dear, alrighty, OK, I just wanted to double check, uh, OK, thanks for clearing that up. Alright, thanks.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're so very welcome, Ms. [PII]. Thank you so much for calling APL. I hope you guys both have a blessed night tonight.
[CUSTOMER][POSITIVE] Same, same to you. Thank you so much.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.