AccountId: 011433970860
ContactId: 6e4417b3-0f1d-4d29-87b8-d125618731eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444510 ms
Total Talk Time (AGENT): 214634 ms
Total Talk Time (CUSTOMER): 185270 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/6e4417b3-0f1d-4d29-87b8-d125618731eb_20250228T16:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um,
[CUSTOMER][NEUTRAL] My name is [PII]. Um, I am a permanent, I guess, member or you wanna view it. Um, I had a question about, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How this works out. Now, I understand whenever I initially signed up for it, um, I kinda look at it as the aspect of if I have to go to the ER or if I was admitted to the hospital, things like that. Um, but I was wondering, my spouse is also on the policy. She recently had surgery on her hand due to a, uh, a job injury.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now, as far as the, the portion for the um after the surgery, things like that, do you guys assist with that or are we, is, would she be eligible for like a claim because of that?
[AGENT][NEUTRAL] Um, for the surgery, you said, uh, for after the surgery?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am, because she's gonna be out of work and I understand it's not, I'm not looking at it as like a workman's comp thing, but I don't know if like she would qualify for additional benefits if that makes sense.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like disability you mean?
[CUSTOMER][NEUTRAL] Yes, ma'am, more or less.
[AGENT][NEUTRAL] OK, let's get your policies pulled up. We'll see what kind they are, and we can go from there. I'll see what kinds of benefits there could be, um, [PII], first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes ma'am, um, it's area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. You're ready?
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] 258
[CUSTOMER][POSITIVE] Uh, I'll make sure I get the right one.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I believe it's gonna be 258-2027.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick. [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] Yeah it's uh [PII].
[CUSTOMER][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Perfect. Thank you for verifying that information. OK, so this is a secondary medical policy. Give me just a moment, I'm going to get this pulled up here.
[AGENT][NEUTRAL] OK, you've got a couple policies with us, so let's take a look at the secondary medical first, um.
[AGENT][NEUTRAL] Did you, when she, did she have the surgery already? I'm sorry.
[CUSTOMER][NEUTRAL] Uh yes, ma'am. Um, so she had it, she had it yesterday and like I said, this was.
[AGENT][NEUTRAL] She did, OK.
[CUSTOMER][NEUTRAL] Work related, so, um, you know, like as far as like workman's comp, things like that. I, I don't know what you're doing about that part, but um I didn't know if there was like some sort of benefit because the fact that she's gonna be without work and with this, uh, you know, medical coverage if it will qualify her for anything.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure. So this particular policy doesn't uh have any sort of benefits as far as um disability or being out of work. Um, now, whenever she did go to have the surgery, did you give them this policy information?
[AGENT][NEUTRAL] As your secondary medical?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You know, honestly, I, I wanna say no, um, because she had it yesterday, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't, I don't think she takes her with her.
[AGENT][NEUTRAL] OK, the reason I ask is that this policy could help with that, um, as far as the policy or excuse me, the surgery and treatment, um, for the medical aspect of that, um, this policy is the outpatient benefit, it pays up to $250 per calendar day. So if there was any um co-pays or deductibles left over from your um primary, that could help towards that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But as far as anything additional, it doesn't look like this policy would cover that. Now let me take a look because you do have an accident policy.
[AGENT][NEUTRAL] And that could provide additional benefits and this was for [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][POSITIVE] OK, let me get this policy pulled up. She is covered under this one as well.
[CUSTOMER][NEUTRAL] Yeah, and honestly, I, I was, I, I assumed the, the, uh, medical aspect, that policy just because, um, you know, this was work related yeah I didn't know if uh
[CUSTOMER][NEUTRAL] That could even be looked at or possibly considered, you know, to fall in that category.
[AGENT][NEUTRAL] Sure, yeah, that one is strictly secondary medical, so its whole purpose is to help with co-pay, deductible and co-insurance after your major medical pays. It doesn't provide benefits outside of that. Um, and then I'm sorry, did you say that this was a work-related injury that she had?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know what kind of surgery it was that she had to have on her hand?
[CUSTOMER][NEUTRAL] Um, I think it was something on her, like within her nerves or something on her, her right forearm area. Um, I'm actually at work and she's at home right now. I can definitely find out, but I.
[AGENT][NEUTRAL] That's OK. Um, so if you can get that information and I can send you a copy of this policy too if you don't have it, [PII], because there are several um benefits, uh, accident-related benefits for your accident policy that you could file for um for some additional um.
[AGENT][POSITIVE] Financial relief. Um, and it does go very in depth as to all different kinds of um possible procedures. Um, but let me send this to you just so you've kind of got it. Um, and if you have any questions after looking at it, definitely give us a call back. Um, let's see, I can email it to you if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh yes, ma'am, please.
[AGENT][NEUTRAL] OK, the email I've got, it looks like it's through your employer [PII] at is it [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, OK, is that a good email to send this to?
[CUSTOMER][NEUTRAL] Uh yes, ma'am, please.
[AGENT][POSITIVE] OK alrighty I will get that sent to you um definitely give it a look, um, see if hers would fall into those categories and then if you need help filing those claims, um, we can help you out with that absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I appreciate it.
[AGENT][NEUTRAL] OK, was there anything else I could help you with?
[CUSTOMER][POSITIVE] Uh, no, ma'am. Um, you know, I see you, you were wonderful answer and everything that I could think of. I'm just
[AGENT][MIXED] Alright well glad to hear it. It is very confusing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, ma'am. That's why I kind of just, it popped in my head earlier, so, but I'll definitely make sure um cause I, I did receive the card, so um like I know I, I also received gay benefits and they always ask if I have like secondary um medical.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][POSITIVE] Yeah, OK, perfect.
[AGENT][POSITIVE] Alright, well let us know if you need anything else. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Part
[CUSTOMER][POSITIVE] Alright thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.