AccountId: 011433970860
ContactId: a7ee3288-b1ff-45f5-9894-61c6ca46582d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512479 ms
Total Talk Time (AGENT): 192283 ms
Total Talk Time (CUSTOMER): 152308 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/a7ee3288-b1ff-45f5-9894-61c6ca46582d_20250609T21:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, how are you doing? I was calling, um, I currently have a policy with you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I was trying to, um,
[CUSTOMER][NEUTRAL] Get my daughter appointment set up for her uh yearly checkup with her doctor.
[CUSTOMER][NEUTRAL] And um I ran um
[CUSTOMER][NEUTRAL] The insurance that I have with y'all through them and they said it's not accepted. Um, do you have a list of like some type of list of doctors that I can see that do accept y'all or something like that or?
[AGENT][NEUTRAL] Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Mm let's see, OK, it is 02599417.
[CUSTOMER][NEUTRAL] And it does say group Hospital indemnity.
[AGENT][NEUTRAL] And your
[CUSTOMER][NEUTRAL] Um, so that's good for like her medical checkups and stuff like that, right?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Um, so it looks like, what was your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then, can you verify your address and your email address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, uh, let me pull up your policy and see what it covers. Um, anything I quote is not a guarantee of payment. It's a basic outline of your coverage.
[AGENT][NEUTRAL] Uh, let's see. And so you're just taking her for like routine checkups?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so it looks like under your policy.
[AGENT][NEUTRAL] Um, we have a physician office visit benefit that pays $75 per day. The maximum it will pay is $75.
[AGENT][NEUTRAL] And 6 days per calendar year.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] So what does that mean?
[AGENT][NEUTRAL] So the max we'll pay for a visit is $75. We won't pay any more than $75.
[AGENT][NEUTRAL] So whatever they charge, all we will pay is 75.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and let's see. So, and then also for this policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] can sure.
[AGENT][NEUTRAL] Um, we do have a screening benefit, so if they just, if she just goes in for a wellness exam.
[AGENT][NEUTRAL] It's like a well child, it pays $100 a max of 1 time per calendar year.
[AGENT][NEUTRAL] So that's the maximum that we'll pay.
[AGENT][NEUTRAL] So, um, let me pull up the card and see if there's a network, uh, list of providers. Let me get that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sometimes if they're not familiar with our insurance, they don't, they say they don't accept it, so, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and you don't, you don't have a network, so you can go to any doctor that will take the insurance.
[AGENT][NEUTRAL] Um, so, like I said, it's just, it's a very limited benefit that just pays a certain dollar amount for certain services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how does the dental visit work?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Um, we do your dental, uh, your vision. Um, I'm not sure who does the vision. Let me see.
[AGENT][NEUTRAL] Yeah, I don't show who administers your dental policy, or I'm sorry, your vision policy. We do your dental policy, um, that one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me get that pulled up.
[AGENT][NEUTRAL] So your dental policy looks like you and your child are covered, and on that policy,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so for that policy, you both have a benefit of $1250 payable per calendar year.
[AGENT][POSITIVE] And then like preventive services, that's gonna be your cleanings, your exams, those pay 100%.
[AGENT][NEUTRAL] And then any X-rays you get, um, X-rays, basic expenses like fillings.
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] Um, that pays 60% after a $50 deductible.
[AGENT][NEUTRAL] And then major expenses, that's gonna pay 40%, but there is a 12 month waiting period, so you have to wait 12 months before that will pay anything.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] And um you said for the other one on the uh like for the annual checkup.
[CUSTOMER][NEUTRAL] Uh, you said you only pay $100 towards it?
[AGENT][NEUTRAL] Yes, for routine services, yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, I need you
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] OK, yeah, because there's no company or nothing like that then, right?
[AGENT][NEUTRAL] No, there's not a co-pay, we just pay that flat dollar amount.
[CUSTOMER][NEUTRAL] 7404.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so basically we just gotta call around and see who accepts it.
[AGENT][NEUTRAL] Yeah, do you have a copy of your card?
[CUSTOMER][POSITIVE] You should have a new.
[CUSTOMER][NEGATIVE] No, I've never, I've never um got it.
[CUSTOMER][NEUTRAL] They, I just spoke to somebody um about an hour ago. They sent me a a copy on my email. That was about it.
[AGENT][NEUTRAL] OK, do you want us to mail you a hard copy or is the email OK?
[CUSTOMER][NEUTRAL] Uh, the email one is fine. I'm just trying to see how can I, how can I find, uh, positions that accept y'all insurance. It.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you'll just wanna give them that information just.
[CUSTOMER][NEUTRAL] Like
[AGENT][POSITIVE] I mean you, you can call and try to make an appointment and give them the information and then they can call us and we'll find it covered. I'm sorry.
[CUSTOMER][NEUTRAL] But you don't have a list.
[CUSTOMER][NEUTRAL] But, but, but you don't have a list of doctors that accept your insurance.
[AGENT][NEUTRAL] Um, no, cause you, you can see any doctor you like. So, but no, we unfortunately don't have a list of who accepts it.
[CUSTOMER][NEUTRAL] I did. Yeah, I already told them.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day.