AccountId: 011433970860
ContactId: 993e2950-8cd6-4807-9e4f-fc2be672966f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1225819 ms
Total Talk Time (AGENT): 457788 ms
Total Talk Time (CUSTOMER): 371540 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/993e2950-8cd6-4807-9e4f-fc2be672966f_20250424T21:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes, my name is [PII], and I'm calling to see um
[CUSTOMER][NEUTRAL] Um, do my, um, I guess, do my insurance cover an MRI?
[AGENT][NEUTRAL] Uh, we can definitely take a look. Do you have your policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] Hold on, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, she just sent it to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh, I hate my phone like this.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] No, it just a benefit in the car home.
[AGENT][NEUTRAL] Does it say certificate number, anything like that?
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Uh, let's see, let's see, let's see.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] No, I don't see that nowhere. OK, so let me make sure I'm calling the right number, um.
[CUSTOMER][NEUTRAL] I have a benefit and a card, that's what it's called, and I had got an email cause I had just called them and saying that I had to, I guess I have to um
[CUSTOMER][NEUTRAL] I guess I have two I don't know what she was saying, but basically, um.
[CUSTOMER][NEUTRAL] She was saying that I have two providers or something like that, I guess. I don't know what she was talking about. I was at the doctor office at that time, um.
[CUSTOMER][NEUTRAL] And I was trying to get um
[CUSTOMER][NEGATIVE] I have to get knee surgery, but and I have to find out if I have cause I guess I'm not in the network with the people that called me, so she told me to call y'all to see but I don't see no, I don't even see that nowhere.
[CUSTOMER][NEUTRAL] I don't think I see benefit in the car, my employee number, ID number, is that what you're looking for?
[AGENT][NEUTRAL] What's the ID number? Does it start with a D like in David?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let's do a search by.
[AGENT][NEUTRAL] Your name or social, whichever you wanna give me, and try that way.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so last name is [PII].
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[CUSTOMER][NEGATIVE] Too old.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your first name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's try that and see what we find.
[AGENT][NEUTRAL] Does your card have any group number on it?
[CUSTOMER][NEUTRAL] Yes ma'am, 942 5.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It's searching here. I appreciate your patience.
[CUSTOMER][NEUTRAL] Yeah, OK, cause I, I know I was all over the place now.
[AGENT][POSITIVE] That's OK, no worries, of course.
[AGENT][NEUTRAL] OK. I think I found you here.
[AGENT][NEUTRAL] What is your uh date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I found you. And then what is, I just need to verify for security, please, your physical address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. All right.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] MRI's, let's see what your plan has for an MRI.
[AGENT][NEUTRAL] OK. So, medical imaging is covered under the plan, which does include MRIs, CAT scans, CT scans, things of that nature.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, it is a covered benefit.
[CUSTOMER][NEUTRAL] So, um mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So, um, if this is your only medical insurance that you have,
[AGENT][NEUTRAL] Um, this particular plan is gonna pay for the diagnostic testing. It's gonna pay $100 towards that test.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I know she gave me another number. She said, I had that one and 90 degree.
[AGENT][NEUTRAL] I don't know let's say.
[AGENT][NEUTRAL] So with us, you have this medical limited benefit plan. You have a dental plan with us, you have a life insurance, and then you have an accident policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is the knee surgery due to like an accident or anything?
[CUSTOMER][NEUTRAL] Um, uh, uh.
[CUSTOMER][NEGATIVE] Not, no car accident, nothing. No, this happened last year. No.
[CUSTOMER][NEGATIVE] But I can't work because of the, I guess, of the, it got worse since I started working.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] OK, let me pull up.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, OK. So, and then, uh, do you know if you're gonna be admitted to the hospital or is it just gonna be like an outpatient surgery?
[CUSTOMER][NEUTRAL] Um, from what I was told, he said it might, it, it should be an outpatient, but I know he said some I'm gonna be down for like 3 months.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, as far as the surgery goes, um, your medical plan you have with us, we'll pay $500 towards the surgery and the surgery, like whether or not it's a surgery center, physician's office, hospital, um, that's the max that it's gonna pay towards the actual surgery itself.
[AGENT][NEUTRAL] If you were admitted to the hospital, the plan pays $1000 towards that. But if it's not an admission and it's just like an outpatient surgery, the hospital admission benefit's not gonna apply, um, or, you know, anything like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm. So how do I, cause I, I, my, my next step is to get an MRI done. So who do, do, is that in my neck, so I, I live in [PII], but evidently I have to go to like another doctor to get, I went to the, I went to the doctor that covers my insurance, but I guess the MRI part.
[CUSTOMER][NEUTRAL] Um, I guess that's not in my network cause, um, what was it, um, East, Eastern, let's see.
[CUSTOMER][NEUTRAL] It was, I'm trying to see who called and they said that it was uncovering.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I say everything is so different now.
[CUSTOMER][NEUTRAL] Um, the, um, I guess that it was the hospital that called cause, um, it says, yeah, it says the hospital called me and they said that my health insurance wasn't gonna, um, cover.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And why?
[CUSTOMER][NEUTRAL] Anybody here?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK, so yeah.
[AGENT][NEUTRAL] So, let me.
[AGENT][NEUTRAL] So, because yeah, the card that I have is different, it sounds like than the one that you have. So if you have a, let me send this to you, let me email this to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because your policy number on here is the one that I pulled up. So if you have different benefits through 90 degrees, I'm not sure what that's gonna be, unfortunately.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like I don't I don't have that, um.
[AGENT][NEUTRAL] Info, but let me send you this card because this is the hospital plan card.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is your Gmail on here still good? It looks like it's um [PII] and then your first name?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see.
[AGENT][NEUTRAL] You need something to do an MRI.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] If that would be a lab or
[CUSTOMER][NEUTRAL] Everything's so different now. I remember when insurance would just pay everything and
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Man, I'm telling you, I am kind of learning that myself. So, um, I recently, let me just tell you, I recently changed to my insurance, OK? This is like a new employer for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm about your same age. I'm [PII], so, you know, it's like things start.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I don't even know, just not acting right when you hit [PII].
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Anyhow,
[CUSTOMER][POSITIVE] You're so right.
[AGENT][NEUTRAL] Girl, I had to go have an ultrasound on my abdomen cause I had some things going on.
[AGENT][NEGATIVE] Anyhow, this is probably too much information, you don't even care, but anyways, it was $700. It cost me $700.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Just to have an, yeah, just to have an ultrasound. It was just ridiculous. I just could not. I was like, what in the actual world? And that's, that's not even telling me, like, I mean, they even figured out what's going on yet. I mean, I'm afraid to know what's gonna happen after the fact.
[CUSTOMER][NEUTRAL] Jesus.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] And that's all the steps I had to take too like as far as in um my the well um last year I, I won't work last year but one place and I was like, well I need a little bit more money. Um, my mom passed and I was um [PII], and then my husband wound up passing in [PII], so.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I was like, I was like, it's time for me is I, I was like I need to be steady at one job, which I was at Master brand, but I wound up going, I wound up quitting because I was in a depressing mode. So go to megaor and it's like, it's like everything changed since I guess things have changed. Like you have to go through more procedures to the next procedure just to find out, you know, I went for.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm telling you.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And I'm thinking I will go for an MRI today cause I got an X-ray last week. He goes tells me, girl, I'm gonna give you this knee brace and um we have to go through the steps where we got to make sure your insurance is gonna cover the MRI and I'm like, huh, I'm thinking I was gonna get an MRI today. I've been out of work about 4 weeks and paying the pocket for my insurance. I've been paying out of pocket for my insurance to keep it, you know, keep it going. I'm like this is just crazy.
[AGENT][POSITIVE] I hear you. Look, I, I look, I, I, I sympathize. It's, it is, it really is, um.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm mm mm.
[AGENT][NEUTRAL] So, um, OK. Um, let me, so radiology is kind of what you're looking for, it seems like for an MRI. If it needs to be in network, it looks like multi-plan is who they say you can go to find a provider and network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me go to their website and just see if anything pulls up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I can give you maybe an address and a phone number, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I did, I just sent you the ID cards, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, and that ID card on it does have um.
[AGENT][NEUTRAL] There is an 800 number for multi-plan to find a provider it says a network on the c[PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I got an email.
[AGENT][NEUTRAL] So, there's nothing that comes up really by your zip code. Do you have a city that I can search by?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, well, I'm in [PII], but, uh, [PII].
[AGENT][NEUTRAL] Is [PII] the next closest to you?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let's try [PII] and see if anything comes up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So national and regional, that's cardiac. What is.
[AGENT][NEUTRAL] Right. The website, I'll be honest with you, isn't really pulling up a whole lot.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But there's got to be some sort of radiology place nearby. So, what I would do is contact multiplan. Did you get the email with your, um, OK, good. So that'll have on there, it has your policy certificate number, has the effective date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then if you want I can contact Multiplan and just transfer you to them, or you can call them if you don't have time to speak to him right now.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna call them.
[AGENT][NEUTRAL] OK, I would call them for in regards to like the provider and network um.
[AGENT][NEUTRAL] And they should be able to kind of give you an idea to, um, like I said, the plan does cover MRI like I see that in the certificate, um, it pays $100 towards that. So you can let them know. I spoke with them. Plan covers MRI. I know it pays $100 towards that. Can you tell me what, if any, my out of pocket cost would be, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Yeah, you're welcome and best of luck to you.
[CUSTOMER][POSITIVE] All right, and you have a nice day, ma'am.
[AGENT][POSITIVE] You too. Take care.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.