AccountId: 011433970860
ContactId: 5dd46100-a5cf-4cd6-9d2f-a11e87182ae0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522869 ms
Total Talk Time (AGENT): 272467 ms
Total Talk Time (CUSTOMER): 182080 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/5dd46100-a5cf-4cd6-9d2f-a11e87182ae0_20250123T15:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, yes, ma'am. My name is [PII]. I'm calling from Tactile System Technology to check on a member's DME benefit, please.
[AGENT][POSITIVE] OK, I can help you with benefits for us. Can I please get your call back number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, the direct number here is [PII].
[AGENT][NEUTRAL] Thank you ma'am and then what is the patient's name?
[CUSTOMER][NEUTRAL] Um, it is, oh, I'm, I'm going to butcher her name. It's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what is the insured's um date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what's the insured's policy number?
[CUSTOMER][NEUTRAL] 025650007.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yes, that
[CUSTOMER][NEUTRAL] And you say your name's [PII]?
[AGENT][NEUTRAL] Yes ma'am my name is [PII].
[AGENT][NEUTRAL] So I do see a Quadria, Quadria would say Ms. [PII]. I do, I do see Ms. [PII].
[CUSTOMER][NEUTRAL] I know, I was like uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, she does have an active policy and her effective date is, let me look and see because she's a dependent, let's see, her effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait a minute, yeah, [PII].
[CUSTOMER][NEUTRAL] Oh, she just came effective, huh?
[AGENT][NEUTRAL] [PII] yeah just became effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh mhm.
[CUSTOMER][NEUTRAL] Now, is this like um calendar year type of uh benefit?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Can I, can you tell me if it's like, um, if this is like a commercial HMO, PPO, POS type of plan?
[AGENT][NEUTRAL] So what it is, it's it's uh this is just to verify her coverage it's not a guarantee of payment it's a limited policy that's for hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It helps if she has to go into the hospital. Um, she has a, let me pull her benefits up real quick. She has a hospital admission benefit one day per calendar year of um $500 for that first day. And then she has a benefit of 30 days of confinement for 18 hours or more that pays $50 per day.
[AGENT][NEUTRAL] Um, she does, she does have outpatient, um, accident and sickness on this plan to be used in the ER, urgent care center, physician's office or physical therapy center. And that's $50 that pays $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does she have any um DME benefits at all under this plan?
[AGENT][NEUTRAL] Uh, that is durable medical equipment. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] Let, let me pull in her actual policy and look to see if durable medical is on this.
[AGENT][NEUTRAL] Because that's usually a a separate rider and I wanna see if she has that.
[CUSTOMER][NEUTRAL] Oh my gosh, excuse me.
[AGENT][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEGATIVE] Uh, that time of the year where it just like, um, it's you're just getting sick.
[AGENT][NEUTRAL] Yes, it's so cold outside that everything makes you just feel ooky.
[CUSTOMER][NEUTRAL] I know.
[AGENT][POSITIVE] You just wanna, you wanna be a sloth and stay in the house and stay warm and not worry about going outside.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You know, we, um, we're in the office like twice a week and the rest were at home. And Tuesday was so cold. They're like, um, you can just stay home. You don't need to come in. And I'm like, thank God, cause I was not feeling good. So I still have to go in tomorrow, [PII] day tomorrow, and I'm like, can I just stay in, please? Cause I feel like when you're sick and you're outside and it's so cold, it just makes you feel worse.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Then when you're in the warmth, yeah.
[AGENT][NEUTRAL] Maybe you can write them and just tell them you haven't been feeling well and you don't think you need to be out in the cold.
[CUSTOMER][NEUTRAL] I know, or even be around people. I don't want anybody else to get sick, right.
[AGENT][NEUTRAL] And I'll just work from home so I don't get anybody sick.
[CUSTOMER][NEUTRAL] Right
[AGENT][POSITIVE] Yeah, we did that too um we used to go in once a week and then they made it to where we'd have to come in at all except for once a quarter, so that's really nice.
[CUSTOMER][POSITIVE] That is really nice. I think that's how our, our, um, place is starting next month. They just want us to come two days a month, which is, I'm happy about that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I, so far, I'm, I'm scrolling through her schedule of benefits and I don't see durable medical equipment yet, but I'm, I'm looking.
[AGENT][NEUTRAL] I'm, I'm not quite to the end yet.
[CUSTOMER][NEUTRAL] So it sounds like maybe this is just um
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] The you said plan type is indemnity.
[AGENT][NEUTRAL] Yes, so that's the indemnity is just a set amount for a covered procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, for hospital.
[AGENT][NEUTRAL] Right. And she has emergency room, urgent care, physician's office, physician, she has physic physical speech or occupational therapy, diagnostic. OK. This is breaking it down for me, but I'm not seeing durable medical equipment.
[CUSTOMER][NEUTRAL] It looked, yeah.
[AGENT][NEGATIVE] No, I don't see durable medical equipment at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, sounds like there's no, no coverage for durable. Not at this time anyways, it sounds like.
[AGENT][NEUTRAL] Right, if she goes to the physician's office, it pays $50 per day for a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or she has it done in an urgent care facility, that's the same thing, $50 per day for a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it'll pay because it's an indemnity.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Even if it's only $15 for the procedure or for the whatever, it still will pay $50.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Um, no, [PII], do you see any other benefits that she might have like, um,
[CUSTOMER][NEUTRAL] Any other benefits at all besides the uh this American Public Life Insurance?
[AGENT][NEUTRAL] Uh, let me see if she has any other plans with us, is that what you're asking?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] She has
[AGENT][NEUTRAL] She has an accident policy. That's the only other thing that would help with medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it would have to be, it would have to be a true accident.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I thought. I, I thought I called because this didn't look like she has DME benefits and I just wanted to make sure I was looking at it right. And um [PII], can I grab the first initial of your last name?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, it's [PII]
[CUSTOMER][POSITIVE] All right, thank you. And if you have a reference number I can grab that too.
[AGENT][NEUTRAL] Yes ma'am, you can use my name.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK, awesome. All right, I think that's all I need. Thank you so much for your help. I appreciate you.
[AGENT][POSITIVE] You're very welcome you have a good rest of your day and I hope you get to feeling better.
[CUSTOMER][POSITIVE] All right, thank you so much. Have a great day. Bye.
[AGENT][POSITIVE] You too. Thanks for calling APL. Bye-bye.