AccountId: 011433970860
ContactId: 61d66144-7197-4e97-90dd-bc3a12ec73a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609140 ms
Total Talk Time (AGENT): 399695 ms
Total Talk Time (CUSTOMER): 107422 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/61d66144-7197-4e97-90dd-bc3a12ec73a5_20250317T18:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um, yes, this is [PII], and I was just trying to figure out what, what are my coverages for. I was trying to find more about my insurance and what do I have and
[AGENT][POSITIVE] OK. Oh, sure. Yes, I can assist you with benefits, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] What what
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] OK, 02593167.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] And what else was it?
[AGENT][NEUTRAL] The email address on file.
[CUSTOMER][NEUTRAL] So this is [PII].
[AGENT][POSITIVE] Perfect. Thank you. All right. And do you have like a specific question about the benefits or you need a full breakdown?
[CUSTOMER][NEUTRAL] Really, I need a full breakdown because I don't really know what it covers and don't covers or anything.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me go ahead and give you this information. And before I give you benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can also find this information through our website if you would like to register. OK.
[CUSTOMER][NEUTRAL] Let's see, and I need to um come to the website as well whenever you finish.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready, OK?
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] All right. So you have hospital admission benefit. The hospital admission benefit is 1000 per day, and that's 1 day per year.
[AGENT][NEUTRAL] You also have confinement benefits. The confinement benefit amount is $100 per day, maximum of 30 days per year.
[AGENT][NEUTRAL] Um, you also have intensive care.
[AGENT][NEUTRAL] We cover $200 per day, maximum of 20 days per year.
[AGENT][NEUTRAL] Um, you have rehabilitation benefits of $50 per day, maximum of 30 days.
[AGENT][NEUTRAL] You also have accident and sickness surgery benefit.
[AGENT][NEUTRAL] So for the surgery, if it takes place in the hospital freestanding surgical center, we cover 1000 per day, maximum of 1 day per year.
[AGENT][NEUTRAL] If it's a small surgery done in the office.
[AGENT][NEUTRAL] Then it's 250 per day maximum of 2 days.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] Um, for the additional, mhm, go ahead.
[CUSTOMER][NEUTRAL] Mm, I was this.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK. For the additional benefits, we have emergency room which we cover $100 per day, maximum of 2 days.
[AGENT][NEUTRAL] Urgent care, $100 per day, maximum of 4 days.
[AGENT][NEUTRAL] Physician's office, including um PCP regular doctor or specialist, is $100 per day, maximum of 4 days.
[AGENT][NEUTRAL] Speech or um physical or occupational therapy is $60 per day, maximum of 4 days.
[AGENT][NEUTRAL] Um, you have diagnostic testing um for a medical imaging test, uh, which is an MRI or a CT scan. It's $200 per day, maximum of 1 day.
[AGENT][NEUTRAL] And if it's a follow-up study, it's $50 per day maximum of 1 day.
[AGENT][NEUTRAL] You also have benefits for prescriptions. Um, this benefit is paid directly to you. You just send us the receipt of the payment for the medication and the claim form and we send $20 per day, maximum of 15 days.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] You also have benefits for ambulance.
[AGENT][NEUTRAL] If it's a ground, it's $200 per day, maximum of 1 day. It's, if it's per air, it's gonna be $400 per day maximum of 1 day.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then you have preventative elective surgery, which is like colonoscopy, it's $100 per day maximum of 1 day.
[AGENT][NEUTRAL] If it's in a hospital or outpatient facility, if it's in an office, it's $500 per day, maximum of 1 day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And it looks like you have an additional benefit for a critical illness.
[AGENT][NEUTRAL] Um, the critical illness, if it's invasive cancer, it's 100% pain, if it's a heart attack, uh, permanent damage due to a stroke, major organ failure, and stage renal failure, they cover 100%. The benefit amount is 5000. If it's a carcinoma in sight two is paid 25% of that 5000.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And it looks like that's all the benefits on your policy.
[CUSTOMER][NEUTRAL] OK, um, how do you go about finding a claim for any of this? Do you?
[AGENT][NEUTRAL] OK, so to file a claim, all you need to do is send a claim form together with an itemized bill. The itemized bill, you need to find it uh through your provider of service and it has to have the charges, diagnosis codes and procedure codes.
[AGENT][NEUTRAL] To be a fully itemized bill and then the claim form you can find it on our website at [PII]. That same website [PII] is the one that you need to go to register. You will click on sign in and you can create your account and you can submit the claim. If you create the account, you can submit it electronically to the policy.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] I'm trying to figure, OK, do it don't have any type of disability or whatever when you off for work and anything.
[AGENT][NEUTRAL] Um, let me check if you have a disability policy. This one is just medical, um.
[AGENT][NEUTRAL] Let's see, you do have an additional disability policy with us. Um, let me check the disability benefits. One moment, it's a separate policy.
[AGENT][NEUTRAL] Alright, and you can see all your policies with us if you register they're all gonna be there, OK? So you can go one by one and you can look at the information or submit claims if you need to submit claims for each one. let me see and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] waiting on the paperwork. One moment.
[AGENT][NEUTRAL] All right, so for the disability, you have a 7 day elimination period, so we will not pay um for the 1st 7 days we start paying on the 8th day and it looks like your monthly benefit compensation is $650 not exceeding 60% of your monthly compensation. It is going to be for a period of 90 days.
[AGENT][NEUTRAL] And again that's the 7 day elimination period for this one.
[CUSTOMER][NEUTRAL] OK, but I would have to go to the a.m. public and register and and apply all this, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you can go to the a.m. public and sign in and create your account to view all the benefit information. You can submit claims. If you need like cards for your medical, you can get cards for your medical or your dental, but you can always um see all your documents and the benefits on each one of them.
[CUSTOMER][POSITIVE] OK. Thank you. And um
[AGENT][NEUTRAL] It can make claims.
[CUSTOMER][NEUTRAL] I don't know what else to um
[CUSTOMER][POSITIVE] I'm trying to say, when is, when is my, and my and my insurance is still is still effective.
[AGENT][NEUTRAL] It's still showing active at the moment. Are you still employed with um
[AGENT][NEUTRAL] See what's the name of this one. So you're still employed with them. Yeah, as long as you keep the policy with staff uh pro uh through benefits in a car, then, um, your policy will continue. If you have any questions about cancellation or premium or anything like that, you will have to contact Benefits in a card. They're the ones that make changes if you need to make any change to the policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today? OK, any other information?
[CUSTOMER][NEUTRAL] Oh no, ma'am.
[CUSTOMER][POSITIVE] No, ma'am. That'll be all. Thank you.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] OK