AccountId: 011433970860
ContactId: 9b7aaf66-5578-4ec3-9d09-cacb585ae3e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602380 ms
Total Talk Time (AGENT): 293403 ms
Total Talk Time (CUSTOMER): 274918 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/9b7aaf66-5578-4ec3-9d09-cacb585ae3e5_20250123T18:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] I'm alright. Could you please look at a policy? I wanna make sure I'm not overlooking something because what I see on PIBFT does not reflect what this policy certificate is showing me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the policy?
[CUSTOMER][NEUTRAL] I don't think it is 241-740-4 for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get all this pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I don't wanna transfer her but I don't wanna give her any incorrect information.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You know, it looks like according to her policy.
[CUSTOMER][NEUTRAL] That is just like for confinement according to how I'm interpreting it. However, there's all of these other benefits on PIBST, but I don't see these amounts.
[CUSTOMER][NEUTRAL] Broken out into her
[AGENT][NEUTRAL] Yeah, I see what you're saying um.
[CUSTOMER][NEUTRAL] And so I don't, you know, she's she called about a claim status which we've handled that but then she was like, you know, then she had some additional questions and I was telling her that, you know, immunizations aren't covered and so she was wanting to know about like lab work. Well, I don't think lab work is covered, but um.
[CUSTOMER][NEUTRAL] I was looking at the policy er and then I was looking at PIBF2 and I'm like, well what I I don't know.
[AGENT][NEUTRAL] Yeah, cause even when you go to her policy that was uploaded in [PII], it doesn't have all of these surgery benefits listed either.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Jesus. This group is
[AGENT][NEUTRAL] OK hang on let me.
[CUSTOMER][NEGATIVE] This group is a not this BWA association, it's, it's every call is a problem every every call.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEGATIVE] That sucks.
[CUSTOMER][NEUTRAL] Every and so I don't.
[AGENT][NEUTRAL] Let's see they have.
[AGENT][NEUTRAL] I was trying to see if like there was any amendments or routers that would be the reason for all the extra benefits. OK, so I do see a general anesthesia benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But again, no real surgery is listed.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] What about office visits?
[AGENT][NEGATIVE] That's on the [PII], but it's not.
[CUSTOMER][NEUTRAL] See, I'm looking, which is.
[AGENT][NEUTRAL] It's not on the [PII].
[CUSTOMER][NEUTRAL] Right, it says that all that's been removed. What I'm looking at on the [PII] 1 that was uploaded.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It has all this stuff in there about this section being removed.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] The like
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Like number 6.
[CUSTOMER][NEUTRAL] Under group hustle indemnity amendment writer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I see, I see.
[CUSTOMER][NEUTRAL] Number 6 says that section 5 of both policy and certificate is removed in its entirety.
[CUSTOMER][NEUTRAL] We will pay the outpatient uh per day when treatment due to an injury or covered sickness is so is that not saying that it was removed? I mean, it says it's removed in its entirety.
[AGENT][NEUTRAL] OK, so let's start up at the top on that. So under number one it says the following benefits are added to the schedule that's where her surgery is at. So accident and sickness surgery, there's the inpatient, there's the outpatient, and what we pay, whatever, and then the general anesthesia and the ICU and then text is added 3 section 5 benefits is removed and replaced with following with the following, so that's text.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Number 5 definitions basically being redone. OK, the following text in the outpatient accident and sickness treatment benefit.
[AGENT][NEUTRAL] Oh, it's just text so where it says we will pay the applicable outpatient accident and sickness treatment per day when treatment due to an injury or covered sickness is received by a covered person in a physician's office and then right up under the next one it says and replaced with the following we will pay.
[AGENT][NEUTRAL] And basically they just reworded it so it's not that offices have been removed they just change they changed the language is what it is.
[CUSTOMER][NEUTRAL] So I mean,
[CUSTOMER][NEGATIVE] So I don't even need to that policy is not even the full, I mean, I need to look at.
[CUSTOMER][NEUTRAL] To see a breakdown of like how much
[CUSTOMER][NEUTRAL] An office visit is and how I really need to look at the first one that was issued for her, is that correct?
[AGENT][NEUTRAL] Um, let me look and see if it matches what we do have in PIPFT.
[CUSTOMER][NEUTRAL] Yeah, cause it's
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] HCB.
[AGENT][NEUTRAL] Because it looks like they just changed language it doesn't look like they changed actual benefits they just updated the language based on that amendment. So in the previous one.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. So she does have a physician's office, but lab work isn't covered. I mean, that's not something that's covered anyway. OK, well, I'll just.
[AGENT][NEUTRAL] No, yeah, so the physicians is 50 and if you look at the outpatient and sickness and PIBFT is 50 as well. So it does line up, they just updated the language in [PII] policy.
[CUSTOMER][NEUTRAL] Max and 3, that's.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Well, it would have been nice to update the [PII] policy to include all of the benefit information.
[AGENT][NEUTRAL] I know I don't know why they didn't go ahead and put all of that up there, but I guess it's because they have that amendment writer but yeah all those benefits that you see are at at the end, basically they're not on the schedule.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] She.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she has emergency room, urgent care physician's office, speech, physical, or occupational therapy. Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And in addition to the other stuff, the confinement admission and intensive care.
[AGENT][NEUTRAL] Yes, mhm, and the inpatient outpatient surgery.
[CUSTOMER][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] Yeah, see, so they added that because
[AGENT][NEUTRAL] Because yeah, when you look under that uh-huh they added that that's under number one of that, um, amendment so they added that so the ICU, which I think was on the schedule actually um was it.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Mm mm. Well, not on the first one.
[AGENT][NEUTRAL] Yeah, it's on the 2nd 1, but it says, so the ICU, that's confinement, but they added an ICU admission benefit.
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] It's on the
[CUSTOMER][NEUTRAL] It doesn't happen.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] And then um and then the surgery of course, there's inpatient and then there's outpatient in a.
[AGENT][NEUTRAL] Facility and then there's outpatient in a physician's office and then there's the general anesthesia.
[AGENT][POSITIVE] Yeah, so these are additional benefits.
[AGENT][NEUTRAL] That were added to the other stuff.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] The hospital and
[CUSTOMER][NEUTRAL] Mm, hold on.
[CUSTOMER][NEGATIVE] I'm so confused because I like it has $2000 for the intensive care. I don't see that anywhere.
[AGENT][NEUTRAL] That's, that's for the admission. That's that number one under the amendment. So it's, it's just like hospital like hospital admission. So if they're admitted to ICU they would get that, but they only, it's not payable on the same day as like hospital admission or any confinement. It's going to be.
[CUSTOMER][NEUTRAL] But it's
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I see, I see that, mm.
[AGENT][NEUTRAL] They're admitted and confined.
[AGENT][NEUTRAL] And it's only payable once per period of confinement when they're in the ICU but it's not gonna be payable in addition to.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I mean, I, I'm, I'm trying to follow what you're saying, [PII], honestly, but this is so confusing.
[CUSTOMER][NEGATIVE] Uh, to me, it is so confusing because I'm.
[CUSTOMER][NEUTRAL] When she looks at her policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To see what her, uh, I don't know, let's just say.
[CUSTOMER][NEUTRAL] Her ICU benefit is and PIBFT IC 2000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's for the admission.
[CUSTOMER][NEUTRAL] But I don't
[CUSTOMER][NEUTRAL] But I don't see that in her policy certificate that she would be looking at.
[AGENT][NEUTRAL] So if, if she's looking at the [PII], she's gonna have to look at that amendment. It's, it's under the amendment. So on page, what is it?
[CUSTOMER][NEUTRAL] 8 or 1.
[AGENT][NEUTRAL] Hang on, let me get to it, so I'm on the [PII] and the amendment is on page.
[AGENT][NEUTRAL] It's listed as page one, but it's going to say group hospital indemnity amendment so you know it's 28 of 30 it's 28 if we're looking at all pages combined.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] The total page number.
[CUSTOMER][NEUTRAL] OK, yeah, that's fine. I've got it. I got it. OK, so let me just try, let you, and I don't know what she can and can't see out in the port. This is that, see that's really confusing for an insured. It's confusing for me.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] OK, alright, let me see if I can help her again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But I appreciate you so much in, in looking at that. OK. Talk to you later. OK, [PII], thanks. Bye.
[AGENT][POSITIVE] No problem. No problem. OK.
[AGENT][NEUTRAL] Uh, uh-huh.
[AGENT][NEUTRAL] Bye.