AccountId: 011433970860
ContactId: 49975d9e-d8a1-4f95-a32e-d4b3327bc6a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 971729 ms
Total Talk Time (AGENT): 409103 ms
Total Talk Time (CUSTOMER): 347988 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/49975d9e-d8a1-4f95-a32e-d4b3327bc6a2_20250205T21:47_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yeah, hi, I um recently started working at a company that has the benefit and card, um, and the Choice Plus indemnity is one of them, and I was wondering what kind of office visits were covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can help you. Um, what is?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Your name and then your policy number.
[CUSTOMER][NEUTRAL] Uh, well, I don't have a policy yet but I'm waiting to sign up, but first I wanted to know what's all covered.
[AGENT][NEUTRAL] OK, so if you're trying to enroll, did they give you a brochure?
[CUSTOMER][NEUTRAL] Yes, and now I wish I could find where I put it. Hold on one sec.
[AGENT][NEUTRAL] Yeah, because I wouldn't be able to assist otherwise if you had the brochure, it has the benefits on there and I can explain it that way.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, definitely. OK. 310.
[CUSTOMER][POSITIVE] Cool. I got it.
[CUSTOMER][POSITIVE] I'm great, so it's
[CUSTOMER][NEUTRAL] OK I have it just says Creative circle.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it says benefits within card APL.
[CUSTOMER][NEUTRAL] Is there somewhere where I would find this number?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] What document are you looking at now?
[CUSTOMER][NEUTRAL] Um, what it says here, it says benefits incurred benefits wizard specifically designed for creative circle.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I'm not sure where.
[CUSTOMER][NEUTRAL] The number.
[CUSTOMER][NEUTRAL] Of this would be, but it's.
[AGENT][NEUTRAL] I mean, does it have any benefits outlined on that document? Because usually when you enroll they'll give you a schedule.
[CUSTOMER][NEUTRAL] Yeah, I mean
[CUSTOMER][NEUTRAL] Well, yeah, so there's 2 of them, one of them.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, and I think they offer more than one option. That's why I was asking what benefit it's.
[CUSTOMER][NEUTRAL] Yeah, oh yeah, so I have, yeah, so I have two different ones so that there's there it lists here the, the stay healthy, the MAC, and then there's the preferred choice plus indemnity, oh my gosh, I can't say the word indemnity, and it has Ensure plus Basic, Insure plus enhanced, Esure Plus Premier.
[AGENT][NEUTRAL] Mhm. On there the document does it say like option 1 and then there's one for option 3 and then there's one for like option 5?
[AGENT][NEUTRAL] Because I think they offered 3 different policies.
[CUSTOMER][NEUTRAL] It gives a a
[CUSTOMER][NEUTRAL] Yeah, so it has like a a table and it will list, it lists some of it, you know.
[CUSTOMER][MIXED] Benefits like summary of some of the benefits, but it doesn't fully specify everything like my, for me, it's like what, like the
[CUSTOMER][NEUTRAL] These don't cover preventative care. I mean,
[CUSTOMER][NEUTRAL] Yeah, so what information do you need from me to to be able to, I guess, look that up because I, I don't know what number you would need to.
[AGENT][NEUTRAL] But you do have a schedule in and with benefits on it. Tell me what's on the what you have, what benefits are listed there?
[CUSTOMER][NEUTRAL] Give me more information.
[CUSTOMER][NEUTRAL] Well, it was the 3 that I that I gave you.
[AGENT][NEUTRAL] For instance, does it say office visit, $50 per day?
[CUSTOMER][NEUTRAL] Yes, OK, so.
[AGENT][NEUTRAL] Half, OK.
[CUSTOMER][NEUTRAL] Yeah, so it says, let's see, it, it will say physician's office $50. It depends, well, actually all of them are $50. So, is there any office visit like whether it's for psychiatry or it's neurology.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, whether it's a primary care visit or a specialist, the benefit is 50.
[CUSTOMER][NEUTRAL] OK, so that doesn't
[CUSTOMER][NEUTRAL] OK. I think that was basically my, my big question is a different cause it was just so general with the office visit and like that's not preventative, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it should
[AGENT][NEUTRAL] Right. That, that means.
[AGENT][NEUTRAL] Yeah though it doesn't cover preventive and it's 50 because whether you see a PCP or a specialist, it's the same benefit and it also should say how many visits uh there are per calendar year.
[CUSTOMER][NEUTRAL] It does not say that actually.
[CUSTOMER][NEUTRAL] So that's interesting, yeah, because like it, yeah, so I'm probably specifically my office is at 50/50 50, maybe it, it has it buried in fine print somewhere.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Give me a second.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] I've never worked with a plan like this before, so it's quite confusing.
[AGENT][POSITIVE] Yeah, I think they offer different policies, which is good.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking under the group and I see an option 1, option 3, and an option 5.
[AGENT][NEUTRAL] And so I'm gonna look at each to see if it mirrors what you have in your hand.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, this policy shows.
[AGENT][NEUTRAL] Um, there's a daily hospital confinement benefit. Do you see that on your document?
[CUSTOMER][NEUTRAL] Yes, that one's $50 or $100 or $200.
[AGENT][NEUTRAL] OK, and then there's an annual annual first occurrence hospital confinement benefit rider?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And then there's an intensive care, um, coronary care writer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][POSITIVE] And then the outpatient sickness benefit writer.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so you must have, this is option one that I'm looking at. Option one has a wellness and diagnostic benefit rider. So there is wellness under option one, and then there's a benefit for like if you had a surgery and then the anesthesiologist charge charges would be covered as well under this one. And under this one, the office visit benefit is uh $75.
[AGENT][NEUTRAL] Instead of 50.
[CUSTOMER][NEGATIVE] That's confusing.
[AGENT][NEUTRAL] Yeah, so this is a different policy. This is option one and I don't know if they're offering that one. Let me pull up the other policy number and see which one it is.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I mean, they're all, yeah, there's 3 of them. It's the what comes into place, like wouldn't a wellness exam be preventive care though?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It is, it is, it is. Uh, but all of the policies, um, let's see, this is an option 3.
[AGENT][NEUTRAL] Uh, this one does have a wellness benefit under it as well. So the wellness and the diagnostic testing benefit are combined. Does it give a max of 250 per calendar year?
[CUSTOMER][NEUTRAL] For diagnostic testing, yeah.
[AGENT][NEUTRAL] OK, I think wellness, well, it is together so.
[AGENT][NEUTRAL] Excuse me. So the wellness and diagnostic testing benefit?
[AGENT][NEUTRAL] I combined, um, and I believe there are only 3 diagnostic tests that's covered under this, this hospital indemnity policy, a CT scan, a colonoscopy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And an MRI and so let's say for instance you had to have one of those 3 tests done that one of those tests may eat up the 250, which is the maximum.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So you only cover 250 of it.
[AGENT][NEUTRAL] So the diagnostic testing benefit and the wellness benefit max of 250 is combined. So, the example that I was, you know, if, if you have one of those tests and let's say you, it eats up that 250, then that benefit is exhausted for the calendar year. So if you went to have your well [PII] check, it wouldn't be covered because it was exhausted with the diagnostic test or vice versa, or vice versa if you have your well woman checkup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, wow, that's good to know.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And you probably will exhaust it under there too, uh, maybe.
[AGENT][NEUTRAL] Excuse me, and then if you had.
[CUSTOMER][NEUTRAL] So mammograms aren't covered?
[AGENT][POSITIVE] Yeah, that's, that's wellness.
[CUSTOMER][NEUTRAL] OK, right, I was just because you said diagnostic testing and I don't know where mam mammograms like fall then.
[AGENT][NEUTRAL] Wellness.
[AGENT][NEUTRAL] Um, uh, yeah, mammograms are only diag diagnostic if they have to, if you have to go and do a second one because now they're looking for a medical concern. It's not that initial one that you get every year. If they find something or see something suspicious, it's then diagnostic. However,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] There's only 3 tests that are covered and that's not one of the 3, so.
[CUSTOMER][NEUTRAL] That's what I was gonna say, OK, interesting.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, so it wouldn't apply to the diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK. All right, well good to know.
[AGENT][NEUTRAL] Now that's option 3 and there's 1 more. Let me take a look at this one and I think you may be looking at option 5.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Still looking.
[AGENT][NEUTRAL] And the document that you have says $50 for the outpatient sickness right?
[CUSTOMER][NEUTRAL] Yeah, for the physician's visit?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now that's like listed under what's called group or accident though. I don't get that.
[AGENT][NEUTRAL] So group accident is another policy that we offer.
[CUSTOMER][NEUTRAL] Hey, that's what I don't, so this is what I'm, it doesn't make sense to me because, so this tables like split up like there's like this three categories preventative network required elixir like whatever that is and then there's additional value added services and savings, additional insurance products group hospital indemnity, and then additional insurance products group accident.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't, I don't understand, like, in my
[CUSTOMER][NEUTRAL] Do I have to get a dish, you have to get each of those or all those included?
[AGENT][NEUTRAL] I think it's your choice. So they have, they offer separate products. So the hospital indemnity is one product or one policy, then there is a separate policy, which is a group accident policy if you have any type of an accident, an accident. So two separate policies.
[CUSTOMER][NEUTRAL] They only give us 3 options. They give us.
[CUSTOMER][NEUTRAL] The basic, the enhanced, and the premier.
[AGENT][NEUTRAL] But I think that could be for the hospital indemnity, just for the hospital indemnity.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And but not for physician visits.
[AGENT][NEUTRAL] OK, so the hospital indemnity is what we were talking about. You said it was $50?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's under the hospital indemnity. So I'm trying to figure out, oh, I know what you're looking at. You're looking at the accident. I pulled up an accident policy in the physician's office. Does it say initial treatment within 30 days?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] It doesn't say it doesn't information. It just says $50. Like that's what I understand is like where am I getting covered for everyday visits like neurology and dermatology, psychiatry, anything like.
[AGENT][NEUTRAL] Yeah, you're looking, you're looking, yeah, you're looking at the group accident policy and not the hospital indemnity policy.
[AGENT][NEUTRAL] Well, you don't have the policy.
[CUSTOMER][MIXED] OK, but mine doesn't.
[AGENT][NEUTRAL] You have a schedule or like a brochure.
[CUSTOMER][NEUTRAL] Yeah, like, yeah, exactly, it's a, it's a summary.
[AGENT][NEUTRAL] Yeah, a summary, yeah, so I believe what you're looking at is the, the group accident only because I see the $50 for the physician's office.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And does it say initial treatment within 30 days under that?
[CUSTOMER][NEUTRAL] Nope, it doesn't give us any of that information.
[AGENT][NEUTRAL] Does it have a hospital emergency room uh under that document you're looking at?
[CUSTOMER][NEUTRAL] Um, uh, yes, it does, right, yes, it's in that list.
[AGENT][NEUTRAL] What does it say?
[AGENT][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] So hospital emergency room 250 for all three of those years.
[AGENT][NEUTRAL] OK, yeah, you, yeah, you're looking at the group accident policy which is totally different.
[CUSTOMER][NEUTRAL] So it's all on one page, you know, and that's what I'm
[AGENT][NEUTRAL] It's, yeah, it's kind of confusing, yeah.
[AGENT][NEUTRAL] And so before you had given me three categories, um, and I think that might be for the, the hospital indemnity.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, see, it has it all together. That's the, that's the thing is it's all little, it's in a table, right? And each of these have headings.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so it's unclear, like, cause they don't have anything else I can sign up for because, OK, it's not major medical. That's the one thing that they say. I have no idea what that means anyways.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Major medical is like Aetna, Blue Cross Blue Shield, Humana.
[CUSTOMER][NEUTRAL] But, so,
[CUSTOMER][NEGATIVE] Right, so how does they, how do they differentiate? Like what does it mean that it's not major medical? Is it not gonna cover my office visits?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the hospital indemnity policy is a medical policy. It's not a major medical policy though. That's what they're saying. It's not an Aetna or Cigna.
[AGENT][NEUTRAL] But it does have an office visit benefit under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I'm trying to look at one of these policies and kind of get as close to um.
[CUSTOMER][NEUTRAL] I think it's
[AGENT][NEUTRAL] Because I think you said there was like an insure plus or something like that.
[CUSTOMER][NEUTRAL] Yeah, there's 3 of them, like I, I wish I could send you.
[AGENT][NEUTRAL] What is, what, what are the benefits under that?
[CUSTOMER][NEUTRAL] Um, well, they're all, so they all offer the same ones. It's just the difference is the amount, typically. Like it's, it's just like, so for example, like the daily hospital con confinement, there's $50 100 dollars, or $200 per day.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Like that's the, the difference that they show here.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Yeah, so these all must be included.