AccountId: 011433970860
ContactId: 6582a474-137b-4102-aad4-1e4065d2cfd4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430899 ms
Total Talk Time (AGENT): 228147 ms
Total Talk Time (CUSTOMER): 263711 ms
Interruptions: 13
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/6582a474-137b-4102-aad4-1e4065d2cfd4_20250625T20:12_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Hey [PII], uh, I'm calling to understand better kind of like what my insurance is covering, um.
[CUSTOMER][NEUTRAL] Do you need information specifically uh. Yeah, the policy number is 02624189.
[AGENT][NEUTRAL] Yes, please. Um, if I could have your policy number and may begin with a 01 or 02.
[CUSTOMER][NEUTRAL] What was the other thing you needed? Uh, near, near Vediger is my name, and what was, sorry, you, you sound very muffled like in the background or something. It's very hard to.
[AGENT][NEUTRAL] I, I just needed uh to verify your name and a phone number, please, sir.
[AGENT][NEUTRAL] Uh, your, your date of birth, please, and a phone number?
[CUSTOMER][NEUTRAL] [PII] and the phone number is the one I'm calling from [PII].
[AGENT][POSITIVE] Thank you for me, and I do apologize. It sounds like I've got an echo that I'm here that I'm hearing as well, so I'll try to give you your benefits. Um, you have a policy that went into effect on [PII].
[CUSTOMER][NEUTRAL] Did I just show you who you have like like I'm gonna cover it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] There's gonna be 3.
[CUSTOMER][NEUTRAL] I I think that I got here and now.
[AGENT][NEUTRAL] [PII] and what this is is it's a secondary or gap insurance and what we do is we pick up the deductible.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Co-payment or co-insurance from your major medical, um, so for example, if you were in the hospital for whatever reason, uh, we would pay up to $3500 for hospital stays, um, you know, where you're in the hospital for 18 hours or more, uh, if you had a, an ambulatory, uh, surgery or if you needed an ambulance, if you needed cancer treatments, labs, durable medical, um, diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So what about, yeah, so what about like clinical laboratory tests.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, we would pay that's outpatient hospital and we would pay up to $3500 for that. So you, you have two banks of money. The inpatient bank is, uh, for inpatient hospital, of course you have $3500 for that and for outpatient services such as you described, you also have $3500 in two separate banks of money.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] So, so you're mentioning inpatient and outpatient. I'm trying to understand cause I'm currently, I'm not going to the hospital, but uh I'm going to do like my physical annual exam and those involve like blood tests and urine tests and uh usually those, um, if I have a zero deductible, then I don't have to pay for them. But I wanna understand if those, I, I asked for the first insurance that it's under the deductible, I wanna make sure that you guys, that also goes under what you are covering.
[AGENT][NEUTRAL] Well, yes, treatment within your, within your physician's office is covered. Now, normally this, this is for accident or sickness. So if we're talking about your normal wellness of the exam, that probably will not be covered. But for sickness or accidents, um, we do cover treatment within your physician's office.
[CUSTOMER][POSITIVE] It is so pretty I mean it's pretty so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, there's I need to to buy the extra here in the book.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we just don't cover the office visit copay. So are, are you talking about a wellness visit?
[CUSTOMER][NEUTRAL] No, no, not the not the.
[CUSTOMER][NEUTRAL] Not the co-pay, not the co-pay, just like the other tests that the doctor prescribes that I have to take.
[AGENT][NEUTRAL] Yes, normally we will, we will, we will pay those up to $3500 per calendar year, but your normal, but your annual wellness exam is not going to be covered on this policy, sir. This is for sickness or accident.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry, can you repeat that? Sorry, just because you're, you're a bit muffled. Can you repeat that a bit slower, please?
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] Yeah, I'm sorry. I keep getting an echo back and forth from um uh so you nor your yearly.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Wellness exam, your annual exam.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] is not covered on this policy. This is for accidents or sickness.
[AGENT][NEUTRAL] So if you went to the doctor for a sickness, that, that would
[AGENT][NEUTRAL] That's going to be what we, what we cover. We don't cover your annual wellness exam, so the test, it is, it is for your wellness exam, that probably will not be covered.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] I come up here.
[CUSTOMER][NEUTRAL] OK, so it's basically only if I'm like about to die going to the hospital, it sounds like, or I have some kind of a surgery.
[AGENT][NEUTRAL] Well, if you
[AGENT][NEUTRAL] If you, if you went to the ER or the urgent care, if you went to the doctor because you had a cough, um, that, that is what this is for, uh, we do cover the labs and things like that, but if the only time that you go to the doctor is it just for a wellness visit, this this is not going to be covered on this policy.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK. OK, I see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can help with?
[CUSTOMER][NEUTRAL] OK, um, and.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, no, not really, I'm just like trying to understand that the company just moved shifted insurances and portrayed this to be like the best thing ever, and I'm basically finding out it's gonna cost me way more than it did before, so I'm just like trying to understand, maybe I'm misunderstanding, I'll, I guess I'll, cause I'm, I'm gonna see my doctor this this week and it's like regular.
[CUSTOMER][NEUTRAL] Appointments that I go to, it's not anything special. And but those usually are used to be covered by my insurance. So I don't, I'm trying to understand.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Basically, what is, what is being dropped between the between the chairs or through the cracks, essentially. And you're basically telling me that regular appointments to the doctor or not, like, I mean, not, not the actual appointment, but like anything that the doctor will prescribe, like I have to take regular medical tests, like blood tests, that those are not covered.
[AGENT][NEUTRAL] Is it, is it for an illness, sir? I is it for an illness or is it, is it just for a normal wellness test?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, it's, it's for preventative care. It's preventative care.
[AGENT][NEUTRAL] OK. Well,
[CUSTOMER][NEGATIVE] Oh no
[AGENT][NEUTRAL] If it's
[AGENT][NEUTRAL] If it's, um, the, the only thing that this doesn't really cover is if you just go in for your annual checking.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But if you're, if you're having to go to the doctor on a regular basis.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For a diagnostic test.
[AGENT][NEUTRAL] Then that is covered.
[CUSTOMER][NEUTRAL] So as long as it's so if it falls under diagnostic, it is covered. That's what you're saying.
[AGENT][NEUTRAL] Yes sir, yes, if it's preventative, then it's not, you know, if it's, if it's just, um, uh, like your normal, like a wellness, your annual exam, that sort of thing, those aren't covered, but if this is if it's like diagnostic testing that you're going in for a particular reason now that that's uh that is the outpatient that's considered outpatient hospital which is uh your physician's office and that's covered up to $3500 per calendar year.
[CUSTOMER][NEUTRAL] OK, yeah, uh.
[CUSTOMER][NEUTRAL] I can't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][POSITIVE] OK perfect
[CUSTOMER][NEUTRAL] Last year.
[CUSTOMER][NEUTRAL] OK, OK, OK, thank you. OK.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][POSITIVE] OK. That, that, that helps.
[CUSTOMER][POSITIVE] No, I think, I think that's it for now. Thank you so much for your help.
[AGENT][POSITIVE] OK, thank you for contacting AP.