AccountId: 011433970860
ContactId: 5b16ce47-58c3-4bd6-87c8-d597f718cda2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 567080 ms
Total Talk Time (AGENT): 199284 ms
Total Talk Time (CUSTOMER): 118089 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/5b16ce47-58c3-4bd6-87c8-d597f718cda2_20250428T19:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I'm calling to see if, uh, the medical plan that I have with you guys will cover me going to a local doctor.
[AGENT][POSITIVE] OK, yes, I can look up benefits for you.
[AGENT][NEUTRAL] And is this local doctor, is it just in office?
[CUSTOMER][NEUTRAL] Yeah, it's in his office, yes.
[AGENT][NEUTRAL] OK. Is it like a specialty doctor or physicians?
[CUSTOMER][NEUTRAL] Uh, yeah, he's just a regular family practice physician.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, that is uh 0224.
[CUSTOMER][NEUTRAL] 3388
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and then your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the mailing address we have on file?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK. And your email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me just one moment to look into your benefits.
[AGENT][NEUTRAL] OK, so this is not a guarantee of payment. This is just a verification of coverage.
[AGENT][NEUTRAL] So it looks like this is a hospital indemnity plan, so it only covers accident and sickness.
[AGENT][NEUTRAL] So if you were going into the physician's office, um, because of a sickness or an accident, that would fall under your outpatient benefit amount, and that is $75 per day, maximum of 6 days per calendar year.
[CUSTOMER][NEUTRAL] to the sickness.
[CUSTOMER][NEGATIVE] So what about just going for a well visit? You guys don't cover that?
[AGENT][NEUTRAL] So under this policy, it does not cover just wellness.
[AGENT][NEUTRAL] It would have to be accident or sickness.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Oh, that's not a good plan to have. You can't even go to a regular doctor for a checkup.
[AGENT][NEUTRAL] Yeah, well, unless you get in an accident, it could be.
[CUSTOMER][NEUTRAL] Um, well, cause I, I also called the, uh, that specific physician and I gave them, um, your company name as my medical and they said that they haven't heard of you and then I said, well, what can I do to see if, you know, my medical covers and they said to see if you guys um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess, uh, I forget what she said uh I think it's called the members of Lehigh Valley, so that's like their billing, uh, company, and if you guys, um, go through them or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, so this policy does not follow a network, so you could go anywhere.
[AGENT][NEUTRAL] Um, but it just has to be accident or sickness.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Hold on, let me look at your screening. Yeah, just a second, let me look at your screening benefit.
[CUSTOMER][POSITIVE] All right then. Well, thank you.
[AGENT][NEUTRAL] OK, just a minute. I did, so your policy has
[AGENT][NEUTRAL] Uh, screening benefit. Just a moment while I read this and see.
[AGENT][POSITIVE] It looks like you have extra coverage coverage for this policy.
[AGENT][NEUTRAL] OK. So it looks like you have a health screening benefit. There's a tier 1, tier 2, and tier 3.
[AGENT][NEUTRAL] So perhaps this office visit could be covered because it says we will pay the routine health screening benefit per day when the covered person receives an annual physical.
[AGENT][NEUTRAL] For the purpose of this benefit, this means the physician's fee only.
[AGENT][NEUTRAL] And then, uh, for tier two, it lists um a bunch of routine examinations that it may cover and preventative test.
[AGENT][NEUTRAL] And then for tier 3, it also has examinations listed and I can send this over to you.
[CUSTOMER][NEUTRAL] And then what?
[CUSTOMER][NEUTRAL] Um, OK, well, like I said, she just, um, asked if you guys.
[CUSTOMER][NEUTRAL] I'll go through that, um, billing company, the members of the Lehigh Valley.
[CUSTOMER][NEUTRAL] So I guess if you guys don't go or don't um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know, acknowledge that build and it all falls on me and I'm not trying to pay any extra money. I don't have to.
[AGENT][NEUTRAL] Right, um, so that just sounds like it's a network and we don't have a certain network that we go through.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But you guys just do pay for all that stuff as long as it's in that any one of those tiers it's covered then correct?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Do you want me to send you your policy certificate and it, it will list a bunch of these screenings and I can tell you what page and what to look for exactly so you don't have to go through every single page.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, OK, sure, please. Thank you.
[AGENT][NEUTRAL] OK, yeah, I'm just not 100% sure like exactly what you're going in for and.
[AGENT][NEUTRAL] I, you know, I don't wanna ask you those kind of questions so I can send that over. Let's see.
[AGENT][NEUTRAL] I want to make sure the email we have on file is the right one.
[AGENT][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Is that [PII]?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And I'll send that over right now, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that'll be it.
[AGENT][POSITIVE] OK. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] OK. Bye.