AccountId: 011433970860
ContactId: 8fc352f8-e579-4eef-ade6-bc75be537ad0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451829 ms
Total Talk Time (AGENT): 176405 ms
Total Talk Time (CUSTOMER): 192435 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/8fc352f8-e579-4eef-ade6-bc75be537ad0_20250106T16:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hello [PII], good morning. My name is [PII], and uh, I'm a broker with APL, um, and I did enroll uh a group for the Medli 9 group me, and they, uh, I have basically a question about the plan, um, that is it cover uh covering like the, um, office visit and uh dermatologist visit and things like that or no?
[AGENT][NEUTRAL] OK, so I'm sorry, what was your name again?
[CUSTOMER][NEUTRAL] So my name is [PII]
[AGENT][NEUTRAL] Uh-huh, and the last name?
[CUSTOMER][POSITIVE] So [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And did you say that you were the agent for a group?
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK, and is this a new group or an existing group?
[CUSTOMER][NEUTRAL] It's an existing group. I can give you the group number if you want.
[AGENT][NEUTRAL] OK, please.
[CUSTOMER][NEUTRAL] 268667
[AGENT][NEUTRAL] OK, thank you. So give me a moment, ready to get the group information pulled up, then I will have to verify some things with you first for security, so just one moment please.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if you could verify the name and address of the group, please.
[CUSTOMER][NEUTRAL] So it's Anatomy 1212 LLC.
[CUSTOMER][NEUTRAL] And the address, OK, let me find out that here because there are a couple ones it'd be the [PII] address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So it should be the [PII].
[AGENT][NEUTRAL] OK, thank you. And then your email address and company name, please?
[CUSTOMER][NEUTRAL] The the company name you said?
[AGENT][NEUTRAL] Yes, your company name and then your email.
[CUSTOMER][NEUTRAL] So it's Anatomy, uh, my, uh, oh, my company name. OK. So it's uh Bell and Lyons Insurance.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then the email that we would have for you?
[CUSTOMER][NEUTRAL] Uh, and, uh,
[CUSTOMER][NEUTRAL] To be contact at [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying that. So you're wanting to know regarding the policy, the policy that one.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Let's see, this is what the
[CUSTOMER][NEUTRAL] Yes, so I explain to you what, uh, yeah, I explain you what happened. Some of the members went to the dermatologist, so he did pay like a $180 visit and he thought like, you know, the gap insurance will cover.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The deductible, you know, so the 100 and the visit the copay visit. So I wanted to know like if uh if if this is something that the plan do cover or not.
[AGENT][NEUTRAL] OK, which plan are they enrolling under? The inpatient?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm, so.
[AGENT][NEUTRAL] 1250 or the 2000 plan?
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] So let me check, it should.
[CUSTOMER][NEUTRAL] Uh, let me see this one.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So that I make sure that I look at the correct information for you.
[CUSTOMER][NEUTRAL] Yeah. Mm.
[CUSTOMER][NEUTRAL] That should have the
[CUSTOMER][NEUTRAL] Actually here it doesn't say which one it says the med link 9 group.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I can give you the the member name and you can check which plan you have, but uh.
[AGENT][NEUTRAL] OK, so this member already, OK, so you're calling on behalf of someone who already has a policy?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. What's the last name or, yeah, what's the last name?
[CUSTOMER][NEUTRAL] Get
[CUSTOMER][NEUTRAL] So, so [PII].
[AGENT][NEUTRAL] OK, thank you. And first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And as you know, any information I provide for you really is a verification of benefits and not a guarantee of payment. So what is his date of birth to make sure I'm looking at the correct number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, I, I don't have that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] I have his address. I don't have his date of birth.
[AGENT][NEUTRAL] You said you do have his address, but not his date of birth?
[CUSTOMER][NEUTRAL] No. Yes, I have the address. I have the last four of your Social Security. I have phone number.
[AGENT][NEUTRAL] That's fine. The last 4 of his social will be fine. Yeah, just the, the last 4 of his social.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So under this plan, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. And under the other plan, it does?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] No. It doesn't, no. I was just curious. I didn't realize the member already had a plan and I could see that they have two different benefit options available to them. But no, sir, this particular plan doesn't, either one of them does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, it
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Do you have plans that do cover for group office visits?
[AGENT][POSITIVE] Now I can connect you over to broker resources for you to discuss any other options um for benefits for the group if you would like for me to do that, [PII], I'd be more than happy to connect you with one of them.
[CUSTOMER][NEUTRAL] Mm, no, it's, it's fine anyways like they're already enrolled so it's not gonna be for now, but OK, so it does not cover the office visit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. All right. I, I will tell them. So it's, it's not covering any, but it, it's covered the rest hospital and everything, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right. For treatment, we can review any treatment within the physician's office. However, the visit, the office visit itself is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got it. OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you very much. Thank you.
[AGENT][POSITIVE] All right. Well, you're certainly welcome. So can I help you with anything else today?
[CUSTOMER][POSITIVE] No, thank you. I appreciate it. Thank you very much.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.