AccountId: 011433970860
ContactId: 8ed2eeda-e24f-4152-8c9a-30012be22f93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1054530 ms
Total Talk Time (AGENT): 418289 ms
Total Talk Time (CUSTOMER): 559195 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/8ed2eeda-e24f-4152-8c9a-30012be22f93_20250110T16:06_UTC.wav
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[AGENT][POSITIVE] Thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, I'm trying to get the eligibility and benefits department.
[AGENT][NEUTRAL] OK, I can help you with the eligibility and benefits today. Um, may I have your name, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII]. My husband has the insurance. His name is [PII].
[AGENT][NEUTRAL] OK, perfect. And then what is the policy number for your husband?
[CUSTOMER][NEUTRAL] Uh, policy number 025.
[CUSTOMER][NEUTRAL] 67
[CUSTOMER][NEUTRAL] 206.
[AGENT][POSITIVE] Perfect, thank you so much and
[AGENT][NEUTRAL] All right, thank you so much, Ms. [PII]. Would you be able to verify for me just your husband's and your date of birth, both of you?
[CUSTOMER][NEUTRAL] OK. This is [PII]'s [PII] [PII].
[AGENT][POSITIVE] Thank you so much, Ms. [PII], and if you could also verify for me the mailing address we have on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Wonderful, thank you. And then lastly just that uh the mailing address we have.
[CUSTOMER][NEUTRAL] That should be the same.
[AGENT][POSITIVE] Oh, I'm so sorry. I did say the email address, I is what I meant to say.
[CUSTOMER][NEUTRAL] Oh sorry. It's probably.
[AGENT][NEUTRAL] No, you're OK. I said it wrong.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][POSITIVE] Perfect. It is that one [PII].
[CUSTOMER][NEUTRAL] I don't know which one they used.
[AGENT][NEUTRAL] And then let's see, you guys are current and active. It looks like this policy has been in place since [PII] of last year and.
[AGENT][NEUTRAL] I show that you all are active and then this policy with us is a limited hospital indemnity policy, and let me pull up those benefits and I can talk you through some of them if you'd like. Is there any benefit in particular you're like wondering about or just kind of all of them?
[CUSTOMER][NEUTRAL] Yeah, physical therapy.
[AGENT][NEUTRAL] Physical therapy. OK. Let me take a look at that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I called before we got the cards and everything, and they told me it covered physical therapy. And then the physical therapy is telling me they, you guys said you don't.
[AGENT][NEUTRAL] OK, so it looks like what I'm seeing is, um, and I do want to let you know that just any benefit information I give you over the phone is always just a verification of coverage and never a guarantee of payment. Um, but what I'm seeing is that you guys have an outpatient accident and sickness treatment benefit, and it looks like it covers physical therapy 4 times a year for up to $30 a visit.
[CUSTOMER][NEUTRAL] Now, is the place that I'm going to,
[CUSTOMER][NEUTRAL] It covers them, I should say, as that or whatever. It's called read rehab or physical therapy.
[AGENT][NEUTRAL] Yeah, absolutely. So, um, we don't have a network, so we'll work with any provider and then as far as that goes, Ms. [PII], if they submit the claim, we'll pay the money to them, and if you submit the claim, we'll pay the money to you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] OK, they're gonna send it to you, but they're saying now that you're not gonna cover it. I mean, you will not cover physical therapy. I said, well, I called before and they said, fine.
[AGENT][NEUTRAL] Let me take a look. Um.
[CUSTOMER][NEUTRAL] Cause I'm supposed to go Monday and they want to call before I come Monday to make sure.
[AGENT][NEUTRAL] You know what, let me, I'm just gonna put you on a brief hold just because I'm seeing something conflicting and I'm going to, um, I'm gonna reach out to somebody else and just see if they see if what I'm looking at is the same thing, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, perfect. I'm gonna put you on a quick hold, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Spring.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII], um, with the care team. I was just hoping you could help me. I have some conflicting information on it, HI policies benefits, and I was hoping you could help me. There's no policy, sir. um.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have, I'm looking at policy number 256.
[AGENT][NEUTRAL] 7206.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm. And under Pitit, I just wanna make sure I'm reading this right, like I'm not, if I'm reading something wrong, I definitely want to know. Um, I'm seeing the outpatient accident and sickness PT. Is that PT physical therapy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, and so it covers it up to 4 times a year for up to $30.
[CUSTOMER][NEUTRAL] Correct, $30 per visit up to 4 visits per year, mhm.
[AGENT][NEUTRAL] Visits per year. So there's just a note on file where the provider called and asked about PT benefits, and we quoted them that there was, it was a non-covered service.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And so now the providers um told the insured like, hey, it's not covered, but the insured called and got that it was. So she's calling back and I was like, well, if it's conflicting, let me check in with somebody. I want to make sure I'm reading my stuff right.
[CUSTOMER][NEGATIVE] Not good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Absolutely, no, yes, so you are correct that is for PT so they have ER physician's office, which is the PO and then urgent care which would be the UC and PT. So, um, that PT is for physical therapy, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I'm not mistaken, I would have to go and find us uh a policy, but if I'm not mistaken, it does not cover like occupational therapy or speech therapy, it's just physical, but I again, yeah, I would have to, you know what, before you relay that information, let me just go out and find that really quick.
[AGENT][NEUTRAL] Just physical.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEGATIVE] Because I would sure hate for you to relay anything like that and then I'm wrong.
[CUSTOMER][NEUTRAL] Because some of them will cover.
[CUSTOMER][NEUTRAL] And then some of them don't let's see, uh, 751.
[AGENT][NEUTRAL] That's one of those where every policy is different things gets a little tricky, you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It really does and and then it's just like, oh man, and looked at this wrong.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh goodness OK so let's see.
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][POSITIVE] Plan to see class.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have access to the GRPIS screen?
[AGENT][NEUTRAL] Yeah, GRPIQ. I don't know what the IF screen is.
[CUSTOMER][NEUTRAL] OK, so that's just group information. I don't know if you guys have that, but if you, OK, so if you go to tab number 7 where it says product benefit.
[AGENT][POSITIVE] Yeah, I do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] When you look over there, those are their proposals and everything, sometimes the master policy, even though it's not uploaded for this policy specific, it the master policy will be uploaded also um you can get a description of what the benefit is that.
[AGENT][NEUTRAL] That is the, ah, pardon my, that's.
[CUSTOMER][NEUTRAL] Yeah, yep.
[AGENT][POSITIVE] Hot, that's good.
[CUSTOMER][NEUTRAL] And then sometimes under PIBFT I don't know if you guys know this as well there's a tab that says try new PIBFT and it will.
[AGENT][POSITIVE] Oh, I go into that all the time. I love it.
[CUSTOMER][NEUTRAL] Yeah, so it will give you, you know, if you look at the description sometimes it will give you a more in depth description of what that is. This one doesn't it just says outpatient accident and treatment benefits, so you just kinda have to assume or know.
[CUSTOMER][NEUTRAL] Um, so yeah, but this screen, the, the group I have, um, it's basically group information and this is where I go if I ever need to find a policy. They of course do not have their master on on base, but that doesn't mean I don't have access to an HR policy. I was just gonna try there first, but if you ever need any information that you can't find on PIBFT or on that specific policy, sometimes you can find it there.
[AGENT][POSITIVE] Holy smokes. OK, that's awesome. I will absolutely, I put that in one of, I have an Excel sheet of like um Lion screen cheat sheets and I added it in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect. OK, so let me see now if I actually can find you.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Some language on this so that we can look at it. Let's see here.
[CUSTOMER][NEUTRAL] Um, go over to compliance and let's look at some policy search, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Just looking at these policy search the other day and sometimes I can pull them right up and sometimes it takes me just a minute to actually remember where the heck I'm looking for everything.
[AGENT][NEUTRAL] So then with this one like it's not in the in the tab 7 so do you do the.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] Are you looking through like the brochures like that through that thing, or?
[CUSTOMER][NEUTRAL] You can, yeah, you can look at brochures, um, let's see, are they benefits on a card? Usually these policies are, but.
[AGENT][NEUTRAL] Isn't it doesn't it when it ends in a B, it's benefit, I don't know. I just guessed.
[CUSTOMER][NEUTRAL] Yeah, usually it is, usually it is, um, I just, I was still in that group so I wasn't 100%. OK, yeah, I do see that be there so yeah you can um go out there and so when you go, let's say they were issued this and what, um.
[CUSTOMER][NEUTRAL] Luxury.
[CUSTOMER][NEUTRAL] Don't know that that matters, but we'll go ahead and pull it up anyway, so plan 2.
[CUSTOMER][NEUTRAL] And when we look at the description, it's taking a minute.
[CUSTOMER][NEUTRAL] I don't know where you live, but I live in like Northeast [PII]. I, I say Northeast, it's more central [PII], and we've gotten our first snow in probably 7 years. So everything, including our bodies, I think are moving slow today.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We're all just kind of like oh.
[AGENT][NEUTRAL] I feel like
[AGENT][POSITIVE] My computer really does know when it's cold out, like it's aware, it knows what's going on and it makes you pay for it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For sure for sure it's just like mm, not, not crazy about this and I'm like I feel you, but I, I kinda need to get some stuff done today um let's see, OK.
[CUSTOMER][NEUTRAL] So it does say pays the applicable per day benefit when a covered person receives treatment in an emergency room, the urgent care physician's office, or physical speech occupational therapy facility due to an injury or covered sickness. So it actually does, so this one does cover speech and occupational. It's just listed.
[AGENT][NEUTRAL] Speech, occupational, physical therapy, but it has to be due to an accident or sickness.
[CUSTOMER][NEUTRAL] Or a sickness mhm it has to be well and you know we have to be careful with our language because it says accident but it's bodily injury.
[CUSTOMER][NEUTRAL] That's very specific. Are you familiar with like the.
[CUSTOMER][NEUTRAL] The difference between the two?
[AGENT][NEUTRAL] No, not really.
[CUSTOMER][NEUTRAL] OK, so they are called accident policies which I think causes a lot of confusion for both providers and insured, um.
[CUSTOMER][NEUTRAL] An accident, obviously, you can fall. Oh, that's an accident. You didn't do it on purpose, you know, um, bodily injury per our policies is that there's actual damage to your body because of the occurrence. So.
[AGENT][NEGATIVE] I think she said something was wrong with this rotator cuff.
[CUSTOMER][NEUTRAL] OK, so that.
[CUSTOMER][NEUTRAL] That could fall under either one honestly depending on how they code it so um.
[AGENT][NEUTRAL] I'll just let her know it's all gonna be based on how the claim comes through, um, but that, that benefit is there for physical therapy, speech therapy, or occupational therapy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm and I would say due to injury or sickness um instead of accident yeah because like I said, with him having a rotator cuff issue that would be technically, um.
[AGENT][NEUTRAL] Injury or, OK, accident.
[CUSTOMER][NEUTRAL] I, I would say it would meet definition for injury, um, but then you have to look on the flip side that it has to be due to an accident like is it just wear and tear or which then, right, so, but because this one covers sickness or injury, it's, there's a, it's so much broader.
[AGENT][NEUTRAL] Or did something happen?
[CUSTOMER][NEUTRAL] Of coverage than just one or the other so as long as you say injury or sickness, I feel like we shouldn't have any problems but again it's gonna uh it all we have to look at how they code it when it comes over, but that is covered um under this particular policy.
[AGENT][POSITIVE] OK, perfect. Thank you so much for helping me go through that and find that all. And I just want to make sure, especially with the conflicting like remarks that I'm new, I want to make sure I'm giving the right information.
[CUSTOMER][NEUTRAL] Yeah, of course.
[CUSTOMER][NEUTRAL] Yeah, of course, anytime, anytime you got any questions, let us know.
[AGENT][POSITIVE] Perfect. Thank you so much. I really appreciate you. Thanks. You too. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome have a good one, [PII].
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Hi, Ms. [PII], are you still there with me?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Hey, I deeply appreciate your patience. I just wanted to reach out to somebody else where there was conflicting information. I didn't want to give you anything wrong. So we looked at the policy and like we read the policy, like the language in it, and it is that coverage is there. It's gonna cover um physical therapy, speech therapy, or occupational therapy um due to injury or sickness.
[AGENT][NEUTRAL] Um, granted, it's all gonna be based on always anything I say is verification of coverage and not a guaranteed payment. It's really gonna be how that claim form comes in when it comes in, how they process it, um, but that, that benefit is there to use up to 4 times a year and it will provide up to $30 each time.
[CUSTOMER][NEUTRAL] OK. See, mine, I had a knee replacement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um I'm having to go for it. Um I had it back on my other insurance when I was working, and they took care of it and everything. Well, I got laid off. So I need the physical therapy.
[CUSTOMER][NEGATIVE] You know, cause it's not right and it's um not bending like it's supposed to.
[CUSTOMER][NEUTRAL] So that's why I'm wondering if maybe they're not going to do it because of I had it through another insurance or what?
[AGENT][POSITIVE] Yeah, so I mean you're definitely covered on our policy, um, I would.
[AGENT][NEUTRAL] I would say, I mean, always make a claim. I guess this is how I see it, like, you're always welcome to submit a claim. I don't process claims, so I can't tell you exactly how that's gonna go, um, but I do see the physical therapy benefit here for you and
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's I don't know, I'm always just a fan, like file a claim, um, it could go either way, but at least you filed it and you, you know, instead of not submitting it and missing out on a chance that you had benefits payable.
[CUSTOMER][NEGATIVE] Yeah, but I don't, I mean, I hate to have to pay for it for myself, you know what I mean?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know how much it is, and I, it's probably expen[PII]. I know everything is. But, you know, I guess that's what they're checking too.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEGATIVE] Cause they're saying somebody said that they are not going to take care of it.
[AGENT][POSITIVE] Yeah, I am really sorry that that was given and if you need um maybe have the provider give us a call back, um.
[CUSTOMER][NEUTRAL] That's why they
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] And yeah, have the provider give us a call back or encourage them to at least submit the claim through and to see, you know, what happens after that first claim and it will maybe give you a basis of like what you can expect, um, but I definitely encourage you to submit the claim either way. It does look like there is a benefit there. I don't know without seeing a claim form, whether or not it's covered, but like you certainly have a benefit you can try to, you can try to take advantage of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] OK. I'll call them back then. Thank you.
[AGENT][POSITIVE] Hey, it's my pleasure, and if there's anything else we can do to help you, Ms. [PII], please let us know, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] All right, my pleasure. I'll talk to you soon.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] OK bye.