AccountId: 011433970860
ContactId: 4fbfe60c-35fb-49e1-acfc-08786633b7ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 913179 ms
Total Talk Time (AGENT): 394009 ms
Total Talk Time (CUSTOMER): 187018 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/4fbfe60c-35fb-49e1-acfc-08786633b7ed_20250521T19:39_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Are you
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Are you a real person?
[AGENT][POSITIVE] Yes, yes, I'm real.
[CUSTOMER][POSITIVE] OK, sorry, you have such a beautiful voice.
[AGENT][POSITIVE] Oh, thank you. I'm real, I promise.
[CUSTOMER][NEUTRAL] OK. Uh, can you help me, I don't know what kind of benefits I have in this benefits and card, um, but there's a few things that I'm trying to clarify.
[CUSTOMER][NEGATIVE] If anything could be upset and not paid out of the pocket.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, one is, one is the um
[CUSTOMER][NEUTRAL] Uh, it's ultrasound.
[AGENT][NEUTRAL] OK, does your card have a uh number on it, like a policy certificate number or a um
[AGENT][NEUTRAL] Yeah, there should be a certificate number on it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, it's 02.
[CUSTOMER][NEUTRAL] 466135
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was your first and last name?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] And can you give me your date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what is your address?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, and then lastly your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And in case we get disconnected, what's a good telephone number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. OK, and you're checking on ultrasound?
[CUSTOMER][NEUTRAL] Yeah, I'm just trying to, like, is there any way to check what kind of, I mean, I know there's not a lot at all, but like what kind of benefits are there are?
[AGENT][NEUTRAL] Uh, yeah, let me um pull up your benefits.
[AGENT][NEUTRAL] Um, I can send you like a certificate schedule that shows your schedule of benefits if you'd like me to do that.
[AGENT][NEUTRAL] Um, I can send it to your email or we can go over on the well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, if you can send it to me to the email and then, then we can quickly, like, I can scan and we can go over it, that would be great.
[CUSTOMER][NEUTRAL] Sorry, are you still there?
[AGENT][NEUTRAL] Yeah, I'm still here.
[AGENT][NEUTRAL] Uh, let's see, so let's see, we've got
[AGENT][NEUTRAL] Uh, I just have to extract it out of the policy so you can just see the overview of what's covered. Um, let me see.
[AGENT][NEUTRAL] Do you have access to a laptop or desktop?
[CUSTOMER][NEUTRAL] I do. Mhm.
[AGENT][NEUTRAL] OK, um, there is an option to creating an account online through our online portal, um, that has your entire policy certificate, um, uh, and the portal, and then that's also where you can upload claims for reimbursement.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you interested in doing that or do you want me to just send you over the schedule benefits page?
[CUSTOMER][NEUTRAL] Uh, yeah. Is this like, would I have to go to [PII]? Is that where I'm going for it?
[AGENT][POSITIVE] Yeah, it's actually secured. [PII].
[CUSTOMER][NEUTRAL] Oh, I don't have that link.
[AGENT][NEUTRAL] OK, I'll put it in the, uh, I'll put the instructional guide and then also, um, that link in the email, um, if you'd like to, you know, sign up for the portal. So let me send this.
[CUSTOMER][POSITIVE] Yeah, that would be good, yeah.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] So, are you having an, an ultrasound at the hospital or is this gonna be done in the doctor's office, or?
[CUSTOMER][NEUTRAL] It's gonna be done in the doctor's office?
[AGENT][NEUTRAL] Um, I know for this policy, so diagnostic testing is a benefit and covers up to $250 and this is not a guarantee of payment, it's a basic outline of the policy. Um, so it pays up to $250 but it does specify only MRIs, CAT scans, um, are covered under that benefit.
[AGENT][NEGATIVE] So, ultrasound actually would not be covered under it.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, let me send this to you real quick.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, you should be receiving that in your email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but let's see, let me make sure that that's correct.
[AGENT][NEUTRAL] Yeah, diagnostic testing, it will only cover an MRI, CAT scan, and colonoscopy.
[AGENT][NEGATIVE] So ultrasound would actually not be covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it does have benefits for, let's see what else we've got and um.
[AGENT][NEUTRAL] Um, there's a surgical benefit that pays $1000 and then anesthesia pays 25% of that.
[AGENT][NEUTRAL] There is an outpatient sickness writer, so that would pay $75 per visit to the doctor.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] If you're confined in the hospital, it would pay $50 per day.
[AGENT][NEUTRAL] Uh wellness exams pay $75.
[AGENT][NEUTRAL] Um, and then there's a first occurrence benefit that pays $500 if you're inpatient in the hospital.
[AGENT][NEUTRAL] And then an ICU then.
[CUSTOMER][NEUTRAL] So, is there anything?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] What is under wellness diagnostic test benefit rider?
[AGENT][NEUTRAL] So the diagnostic test is just the MRI, CAT scan, and colonoscopy, and then wellness would be like any preventative service, like your annual physical exam, your annual well woman exam, so preventative tests. So because it's so like your wellness, so there's no diagnosis. It's not because you're sick or experiencing symptoms or anything. It's just your routine screenings you can get.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, uh, could we
[CUSTOMER][NEUTRAL] Question on the
[CUSTOMER][NEUTRAL] Any lab tests that are covered?
[AGENT][NEUTRAL] There's no lab tests covered under this policy. Now, you do have, um, do you have your ID card?
[CUSTOMER][NEUTRAL] Uh, yeah, they just send it to me, yeah.
[AGENT][NEUTRAL] OK, so there is a limited plan that could potentially cover some of these things. Um, on the front of that card, you should see medical ID number and it starts with a D as in dog.
[AGENT][NEUTRAL] That is part of your 90 degree benefit plan which is not us, we're APL, so we do the plan that I just sent you, but 90 degree does do a benefit and you could call them and see if they what they cover. Um, I don't have access to what they cover, so and that number would be actually the customer service number on the back of the card, that [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you give them that number, that D 412-033-45, they could tell you what's covered under that. There might be some lab or ultrasound benefits under that policy possibly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, this is like farm.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Eve, is that
[AGENT][NEUTRAL] So the Farmval will be if you need like prescription drugs. So if they prescribe you any medication, that's what that's for, the Farmmaval.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And then you also have the virtual care, um, that's the benefit where you just talk to the doctor on the telephone or by video, like a kind of like FaceTime. Um, and usually those kind of benefits, that's just gonna cover like, say you have a cold or something, um, something real minor, um, that's usually what what those cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, what am I trying to figure out, like, is there any way I can do like a lab test?
[AGENT][NEUTRAL] Yeah, there might be um under this policy that we're talking about, there's not, but there might be under that.
[AGENT][NEUTRAL] Uh, medical ID that starts with a D [PII].
[AGENT][NEUTRAL] Possibly under that. I'm just not sure what it covers, so.
[AGENT][NEUTRAL] And let me make sure I don't see anything else under your policy. Maybe I have a different policy.
[CUSTOMER][NEUTRAL] I, I, I don't see, yeah, I don't see that the number.
[AGENT][NEUTRAL] Um, do you see the plan, it says limited benefit hospital indemnity?
[AGENT][NEUTRAL] On the front, it says APL and then group Creative circle has your name and then coverage.
[AGENT][NEUTRAL] Policy start number, effective date, plan.
[AGENT][NEUTRAL] And then right under that and real small script is medical ID. Do you want me to send you a copy of this card?
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK, OK. No, no, no, no, yeah, it's so small. Sorry. Yes, medical ID.
[AGENT][NEGATIVE] No, yeah, it is, it is really small. I don't know why they put it so small, they're just trying to fit everything in, um.
[AGENT][NEUTRAL] So that ID number goes with the number on the back, the [PII].
[AGENT][NEUTRAL] That's who you would call to find out what does that plan cover, cause I'm not sure what that covers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not related to us. They just put it all on one card, so.
[CUSTOMER][NEUTRAL] Oh, OK. OK, got you. OK.
[CUSTOMER][POSITIVE] Thank you, though. Thank you so much for uh walking me through.
[AGENT][NEUTRAL] Sure. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] I doubt it that it covers anything, but who knows.
[AGENT][POSITIVE] I'd definitely call and see if it does. I can also transfer you if you'd like me to.
[CUSTOMER][POSITIVE] If you can, yeah, that would be great.
[AGENT][POSITIVE] OK, let me get you transferred over there and um thank you for calling APL and I hope you have a good day, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Thank you for calling the pharmacy and member help desk. This call may be monitored or recorded for quality and training purposes. If this is a medical emergency, please dial [PII].
[AGENT][NEUTRAL] OK, sorry, I had the wrong number. Let me get, get the right number typed in here, just a second.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card members.