AccountId: 011433970860
ContactId: 6da667c3-e0e8-4d2e-aab3-526a90278e4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1835770 ms
Total Talk Time (AGENT): 735028 ms
Total Talk Time (CUSTOMER): 433173 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/6da667c3-e0e8-4d2e-aab3-526a90278e4b_20250129T20:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, you guys are.
[CUSTOMER][NEUTRAL] Uh, benefits in a car or whatever, like you guys are an insurance company.
[AGENT][NEUTRAL] Yes, this is an insurance company.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] I'm, if I'm employed through [PII], that's the uh employer that I'm asking. I just need some information on benefits.
[CUSTOMER][NEUTRAL] Like how much
[AGENT][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Or not how much. I need, the guy told me to call you to ask what like the specifics are as far as their plans go.
[AGENT][NEUTRAL] Wait a minute, benefits in a card told you to give us a call to go over enrollment with us?
[AGENT][NEUTRAL] And the benefits
[CUSTOMER][NEUTRAL] Are you guys, are you guys, yeah, you're American public life. Well, I have, right?
[AGENT][NEUTRAL] Right, the reason I'm asking is because typically we would tell the caller to go to benefits in a car. So I'm trying to understand why they're sending you in circles.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Well, I asked him some questions like concerning uh.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] I have, I see a specialist and um I'm trying, I wanted to get the right insurance to be able to see them.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I needed uh questions answered on VIP standard like.
[AGENT][NEUTRAL] OK, so
[AGENT][NEGATIVE] So they should not have sent you to me, to us, um, because with benefits and a card, we can't even, we can't do anything without them letting us know their benefits and everything, they, you all have to even go through them to enroll and then they send it to us. So that's why I'm like, wait, what? So
[CUSTOMER][NEUTRAL] Well, I have, I have questions and I didn't write them down, but
[CUSTOMER][NEUTRAL] Um, they gave me the group, they told me to call these two numbers and then they gave me [PII]'s group number to give you and then um.
[CUSTOMER][NEUTRAL] Cause all he could tell me is that MAC is like preventative and physical care and stuff like that. And then um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I get that one, but the VIP standard and the classics, well, you told me the classics like surgery have and ICU so that's more of like hospital stuff. So I needed to know um
[CUSTOMER][NEUTRAL] What uh the standard does. But if you can't let me know, that's fine.
[AGENT][NEUTRAL] No, no, it's not. I, I can definitely check. It's just.
[AGENT][NEUTRAL] Like, you know how they give you the policies to pick from for your coverage.
[AGENT][NEUTRAL] We don't know what they're giving you until they send us, you know, the documentation that you're enrolling. That's what I'm saying. I don't have anything here. Let me see if there's a way for me. What's your group number?
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Um, 70035.
[AGENT][NEUTRAL] OK, and may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] 03 and it's [PII].
[AGENT][NEUTRAL] I'm sorry, the phone is breaking in and up. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you for that and may I
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hold on one second. And you said [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was [PII], right?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, I was looking to see if we have like a master policy or something I can read off to you because like I said, benefits in the card, they do all the enrollments and then send us the just the whatever you select. So this is what I um can do.
[AGENT][NEUTRAL] I can give benefits in a card, a call on the other line and connect you to and kind of I guess explain what you're looking for, um, enrollments, making changes to plans, all of that comes from them. So I don't, I'm sorry that they sent you back to us.
[CUSTOMER][NEUTRAL] It's OK. It's just, I, I, I guess, um, the one question I know, like, I don't know if you guys can answer, but I had a question on a medication.
[CUSTOMER][NEUTRAL] Uh, if it could be covered specifically because he told me that cause it says all meds are covered under form of available program either through predetermined pricing or discounts.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And he told me you could get 10 to $20 or $30 off a co-pay if it's covered or generic, but not a generic discount or something like that. But basically,
[CUSTOMER][NEUTRAL] I have a medication that I get at the place that I get my services from.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Can you tell me if it's covered or not?
[AGENT][NEUTRAL] So typically on our policies, because we're not, this is hard to do because there's so many plans that you can choose from.
[CUSTOMER][NEUTRAL] I know. I don't even know what I'm.
[CUSTOMER][NEUTRAL] Trying to ask, right, and it's like, I don't, I don't have any uh
[AGENT][NEUTRAL] So I can just say in general, even if you do have the outpatient prescription, um,
[AGENT][NEUTRAL] Like plan or benefit, um.
[AGENT][NEUTRAL] We don't cover the prescription itself, it's more of the administering of the prescription like where it's done.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There is like an outpatient prescription benefit that can be like a certain amount depending on what plan you, we need to get you the benefits in a card.
[AGENT][NEUTRAL] Let me do this. Do you, do you want me to try to give them a call so that they can
[AGENT][NEUTRAL] And try to explain what you're looking for because I'm kind of in the air because I don't know what plans they have for your company, you know what I mean, to that they've offered you to pick from.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, they, uh,
[AGENT][NEUTRAL] And so like I'm under.
[CUSTOMER][NEUTRAL] They told me that there's 3, there's the MEC, and he, this is the only thing that he told me and that's why he told me to call you for more information, but
[CUSTOMER][NEUTRAL] Uh, that the MEC is just more like preventative and physicals and stuff like that. And then I could get that and the VIP, which would be the better option because then I would get both things covered. But he didn't tell me anything about the VIP standard and the VIP classic just covers surgeries, rehabs, and ICUs. that's more hospital stuff. I need to know.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Will you guys cover the, cause I have one specific provider that I go to and it's the only one right now that I'm concerned about. I know that the other stuff matters, but
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I, I don't, I don't know what you guys would cover as far as like.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Like it's an addiction treatment place and I get the medication there. And since it's not like a prevent, I mean, uh, it could be, they do preventative measures there like blood pressure and stuff like that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I'm just wondering what you guys would.
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] Like pay is price.
[AGENT][NEUTRAL] Mentioning um classic and standard. So under the, I'm looking under your group, the plan like MEC all of that is different, but I do see classic and standard. I mean, I can pull up one of these policies and
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I can pull it up and see if that will help, um, you know, like one that says classic and one that says standard and look at the benefits, but I, that's still kind of in the blind, but I can, I mean, I can definitely do that if you want.
[CUSTOMER][NEUTRAL] Is it because, why is it in a blind because it's not like specifically to what I would need or, or what I would get if I
[AGENT][NEUTRAL] Right, because this is just other members in your group, like other employees in your group. I see where it says standard, like plan one standard, plan 2 classic, but what that means in reference to what he told you, I don't know because I don't know.
[AGENT][NEUTRAL] What it looks like on their side and then all I know is what it looks like when it gets to us. So I can tell you what I see under standard and classic, but if something is different when you speak with them, I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, it's, it's OK. Just, could you give me a general um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like understanding of, well, whatever you got, I understand it could be different.
[AGENT][NEUTRAL] So let me look. Sure.
[CUSTOMER][NEUTRAL] But of the first.
[AGENT][NEUTRAL] Let me look, um, I'm gonna do the standard first. Hold on one second.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let's hope that it's available on here for me to quote the benefits. Hold on one second.
[AGENT][NEUTRAL] OK, here goes one.
[AGENT][NEUTRAL] And I know we don't have a policy to pull up yet, but all the information provided is a verification of benefits, not a guarantee of payment. So this one I'm looking at is standard under your group. I'm going to the benefits now. OK, so like for example, the outpatient prescription drug benefit under standard is $10 per day with a max of 15 days per calendar year.
[CUSTOMER][NEUTRAL] So you guys would pay just $10 towards the prescription or it would be $10 for the prescription?
[AGENT][NEUTRAL] No, $10 towards it, like once you, once we receive the claim um for the prescription, you know, once you send it in or pharmacist sends it in, we would um pay up to $10 a day towards that prescription cost, whatever the total is.
[CUSTOMER][NEUTRAL] So, so when you mean per day, does that mean?
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] So if you have a 30-day uh max that you have, this policy pays a max of 15 days.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so I would pay $10 for.
[CUSTOMER][NEUTRAL] For 15 days.
[AGENT][NEUTRAL] The policy will pay up to $10 per day, 15 days max.
[CUSTOMER][NEUTRAL] So if they, if they prescribe me my prescription for 15 days.
[CUSTOMER][NEUTRAL] You guys would pay $10 for for it?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if it's like
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't know after they break it down, they'll see how much it is, you know, a day, and then of that the 10 will be paid for the standard, um.
[CUSTOMER][NEUTRAL] Is it $10 a day?
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Yes, $10 per day with a max of 15 days.
[CUSTOMER][NEUTRAL] And that's for a month?
[AGENT][NEUTRAL] Well, it's a max of 15 days per calendar year.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The whole year, it would pay $10 per day with up to 15 days for the whole year.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] What if you guys don't cover the medication?
[AGENT][NEUTRAL] If the policy doesn't cover the medication, um, if this is your only insurance, then they will have to figure out financial, um, like, you know, if they'll be able to assist you financially or I mean, I don't know what their options would be at that point, but if if it's not covered by the policy, then it could be patient responsibility unless they have other options.
[CUSTOMER][NEUTRAL] How can I tell if you guys will pres uh will cover that cert? I have one certain medication and I just need to see if you guys would.
[CUSTOMER][NEUTRAL] Touching at all, like.
[AGENT][NEUTRAL] We can't guarantee anything until we process the claim so that we can see the coding and everything that comes with it, but uh there would be no way to just say like we don't have a list of medications that we cover. We we process the claim and then depending on what they examine, they'll determine the payout, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to look at the um classic option?
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Um, well, does this, this, aside from medications, does it say what it, like,
[CUSTOMER][NEUTRAL] Like if I go into a doctor's office, do you guys, does that have a copay or do I, uh,
[CUSTOMER][NEUTRAL] Like, what's my out of pocket expense?
[CUSTOMER][NEUTRAL] Like, I don't know anything about it at all. All I know is it's 1622 a week and
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] 1622 a week. Let me.
[AGENT][NEUTRAL] Um, so the, so this is a hospital indemnity policy. So it's a limited medical policy. Um, it covers, I'm trying to get back to the coverage I I scrolled up, sorry, hold on one moment. It covers like if you're admitted to the hospital, the policy could pay up to $500 per day, um, that one day of admission.
[AGENT][NEUTRAL] If you're confined to the hospital, which is over 18 um consecutive hours, the policy could pay up to $50 per day with a max of 30 days per calendar year.
[AGENT][NEUTRAL] Ends on um
[AGENT][NEUTRAL] There's also accident sickness. So if you have, if you need surgery, um due to an accident or a sickness, there's coverage for that, um, outpatient treatment, emergency room, urgent care, the physician's office, physical speech or occupational therapy.
[AGENT][NEUTRAL] Um, there's diagnostic testing, um, and then there's riders here, but I don't know, you'll have to select those riders are additional benefits to your policy.
[CUSTOMER][NEUTRAL] Is there any way that you could email me these forms so I can look over them, or is
[AGENT][NEUTRAL] This typically comes from benefits in a card. I can't, this is someone else's policy. I can't email this. I can't send this to you. But I mean, if you, I do have the number that we call for benefits in a card, I can give it to you, um, but yeah, that's where we go for enrollment, changes, everything, it goes through benefits in the card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] I'll try calling them again and then they tell me to call back, uh, I will, but uh I need, I, I kind of want something in writing, so.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What was the number that you have for them?
[AGENT][NEUTRAL] We call [PII].
[CUSTOMER][NEUTRAL] OK, yeah, that's the number I have. I will, I'll try to call them back and see if I can get any more uh questions answered and then.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, because that if, if you enrollments and everything, like all of that is a part, everything that we're trying to
[AGENT][NEUTRAL] Get clarity on is a part of enrollment and only benefits in a card does their enrollment, so.
[AGENT][NEUTRAL] If you do have any issues or you know, they they're giving you pushback, um, you can let them know that you already called APL and they gave you the information that they have, but enrollments is too big, so I don't know why they're turning you away. And they also have um like brochures and things that they can send you like you're saying you need it in writing, you know.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] They have all that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just, just to make sure I.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I'm gonna put that I called and you guys said that
[CUSTOMER][NEUTRAL] That it's more questions that I should ask them.
[CUSTOMER][NEUTRAL] That you guys don't have
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] You only have, you have specific people that I know, never mind. I'll just tell them that you told me.
[AGENT][NEUTRAL] There's no, there, they, they handle the enrollment, so they should, if you were calling them to enroll, they would be they would be asking you like what do you want to enroll in, what's the, they have all that information because they have to do the enrollment. So they should not have turned you to us because those enrollment questions, they're the only one that can enroll, so they have all that.
[AGENT][NEUTRAL] Um, the information that I gave you, I just looked up your group and looked at standard and classic plans and and use that as a sample, but they have the information you're looking for.
[CUSTOMER][NEUTRAL] OK, uh, as far as with that all the stuff that you told me earlier, just the standard like the hospital identity policy ordemnity policy and the urgent care and like the admitted $500 and comply with that all just for the standard?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that was for standard.
[CUSTOMER][NEUTRAL] What does it say for the classic just so I have um.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so for classic.
[AGENT][NEUTRAL] Class, it looks the same as standard. Let me see what the prescription benefit is, 10 for 15. Yeah, that's the same. Hold on one second.
[AGENT][NEUTRAL] Sorry, some of the members don't have the policy certificates.
[AGENT][NEUTRAL] Available, so I got to go through to see who does. Hold on one second.
[AGENT][NEUTRAL] So, the benefits are, it looks like the benefits are the same for standard and classic. The difference is the riders, um, the additional benefits that you can um select.
[CUSTOMER][NEUTRAL] I don't know what that means.
[AGENT][NEUTRAL] Riders are additional benefits that you can add to your policy.
[AGENT][NEUTRAL] Um, that's the difference between the standard and the classic. I just looked at both of them, but the, like the hospital admission confinement, all of that's the same.
[AGENT][NEUTRAL] The prescription drug benefit, all of that is the same, but the benefit riders there, it looks like there could be more to choose from for the
[AGENT][NEUTRAL] Standard than classic.
[AGENT][NEUTRAL] But now those those rider options, that's all given from big because they have a, you know, what you can choose from.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] To the other place
[AGENT][NEUTRAL] Right, benefits in a card.
[CUSTOMER][NEUTRAL] OK, OK, um.
[CUSTOMER][NEUTRAL] Is it writer's RID or W or?
[AGENT][NEUTRAL] O R I D E R S.
[CUSTOMER][NEUTRAL] So it's like add-ons or something?
[AGENT][NEUTRAL] Yes, like, for example, the critical illness rider, um,
[AGENT][NEUTRAL] That's like if there's a heart attack, stroke, um, organ failure, all, all of that is included, um, there would be a payout like if it was you that was diagnosed, it could be up to $5000 and then there could be an additional payout for your spouse or children, um.
[AGENT][NEUTRAL] It just depends on the selection that you make. There could be other riders that they have available, but on this sample, they only chose that one. So when you call benefits in a card, you can ask them if there's other um
[AGENT][NEUTRAL] Rider options to add to your policy.
[CUSTOMER][NEUTRAL] OK, do you have anything on the Stay healthy, the MEC plan?
[AGENT][NEUTRAL] No, um, I'm not familiar with the MEC plans. That's.
[AGENT][NEUTRAL] Let me see if this is 90 degree benefits.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Let me try this one.
[AGENT][NEUTRAL] Yeah, MEC plan, um, if you have questions about that, um, I have the number for them as well.
[CUSTOMER][NEUTRAL] Is that a different number?
[AGENT][NEUTRAL] Yes, MEC um is basically
[AGENT][NEUTRAL] So, IMA is where your claims go when they're being filed. IMA reprices, see if there's any additional benefits or discounts, and then they'll send it to us to to finish processing. So MEC plans are together with IMA, um, that's who you would contact.
[AGENT][NEUTRAL] For questions about MEC because it's administered or given through IMA.
[CUSTOMER][NEUTRAL] OK. Um, what's the phone number?
[AGENT][NEUTRAL] So that number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty. Did you need me to transfer you over to Benefits and a card or IMA?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, could you transfer me to the benefits in the card?
[AGENT][NEUTRAL] Sure, um, before I do that, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Huh, thank you.
[AGENT][NEUTRAL] You're very welcome. Well, thanks for calling APL and hold on one moment for your transfer, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol precios.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][POSITIVE] Thank you for calling Benefits and a car.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from APL. I have a um insured on the other line. She's wanting to go through enrollment. She was told to give us a call, um, even though it does all the enrollment. She just needs some assistance and has questions.
[CUSTOMER][POSITIVE] No problem, you could go ahead and transfer her.
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] And may I have your name?
[CUSTOMER][NEUTRAL] Sure.