AccountId: 011433970860
ContactId: a8e3a10a-2269-432d-9c12-fd1b0d93a180
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695840 ms
Total Talk Time (AGENT): 224670 ms
Total Talk Time (CUSTOMER): 254055 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/a8e3a10a-2269-432d-9c12-fd1b0d93a180_20250107T20:09_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I know this is a long shot. This is [PII] with Webb. Is [PII] available?
[AGENT][NEUTRAL] Um, let me take a look at that for you, and you said this is [PII] with who?
[CUSTOMER][NEUTRAL] Web TPA.
[AGENT][NEUTRAL] Web TPA and you're looking for and then do you have a last name for [PII]? I think we have a couple of them.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Novice where she's the only one that ever calls us, but it's OK. I don't know. I can give you the member's ID number.
[AGENT][NEUTRAL] OK, what's the member's ID number, my friend?
[CUSTOMER][NEUTRAL] 021-71067.
[AGENT][POSITIVE] Perfect and.
[AGENT][NEUTRAL] Their first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][POSITIVE] Beautiful. And how can I help you with her?
[CUSTOMER][NEUTRAL] OK, so what do you guys have that you send them regarding their policy?
[AGENT][POSITIVE] That is a wonderful question.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] I appreciate you asking. I'm gonna find out for you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I am reaching out to ask and then in the meantime I'm gonna start digging through all of our correspondence to see if I can find that out for you.
[CUSTOMER][NEUTRAL] Yeah, because I mean I look in what we have, you know, I mean we just have the list of what pays out I mean and it's a limited medical plan. I don't know her daughter's like she should be getting paid her indemnity benefit. I'm like, well it's a limited medical indemnity. It's not a like she just doesn't get it this benefit, I mean.
[CUSTOMER][NEUTRAL] The providers bill us and we pay them her benefit like.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] It's not the type of benefit they're thinking of, you know, so I'm like I don't know what she's reading because she's like, I read her plan and it says that, and I'm like, mm, OK, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's find out.
[CUSTOMER][NEUTRAL] I was just like
[CUSTOMER][NEUTRAL] I'm like uh.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And I don't know if you guys even have a list because we're not able to like send them the whole list. I went over and told her it pays this much a day for hospital it pays this much it pays this much, you know, um.
[CUSTOMER][NEUTRAL] But she wants a print out of that too.
[AGENT][NEUTRAL] Yeah, um, OK, so I have a, I mean, I don't know if we're like supposed to give them. I did see the last policy certificate we had on file and I think they get mailed out to them when they're.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Generated was from.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2022 is the most recent one.
[AGENT][NEUTRAL] My guess is it's gonna be this policy certificate.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, why don't we have that.
[AGENT][NEUTRAL] But
[CUSTOMER][NEGATIVE] That's so weird.
[AGENT][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] Yeah, we don't have anything like that.
[AGENT][NEUTRAL] OK, so yes we do send them the policy certificates when it is generated, but I, it looks like we only send them to the insured like we're only able to send them out to the insured on file.
[AGENT][NEGATIVE] Um, but it's just like 32 pages explaining their benefits.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][POSITIVE] That's good and that's what she's looking at.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Is there anything you want me to like look at on here and like tell you what I'm seeing?
[CUSTOMER][NEUTRAL] Do you have a schedule of benefits where it states um like we that it pays 300 a day for hospital room and board.
[CUSTOMER][NEUTRAL] For 30 days, do you have any of that language?
[AGENT][NEUTRAL] OK, let me check and see if there is any. I do wanna let you know any information I give you over the phone. I'm sorry, I just have to say this is a verification of coverage and never guarantee of payment, um.
[CUSTOMER][NEGATIVE] Yeah, no.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I see that we have um policy says daily room and board and indemnity benefit um $300 it says lower high so I guess I can't tell if their plan is a lower or high plan um but $300 maximum days per confinement 30, maximum confinement days per calendar year 60 days.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so that's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yep
[CUSTOMER][NEUTRAL] Right, so, so is that in there in the packet that you send them?
[AGENT][NEUTRAL] Yes, it's, um, it looks like it's on page 25 of the packet we send them.
[CUSTOMER][NEUTRAL] OK, I'll put that here um.
[CUSTOMER][NEUTRAL] OK, so she already has it.
[CUSTOMER][POSITIVE] That's kind of what I wanted.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, to know because.
[CUSTOMER][NEUTRAL] That process gonna have you send that to her.
[CUSTOMER][NEUTRAL] Um, yeah, yeah.
[CUSTOMER][NEUTRAL] But I'm just curious as how they think.
[CUSTOMER][NEUTRAL] They can get because I mean if the hospital sends us a claim we're gonna pay the hospital.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And I'm like, well, did you sign a paper stating that they could bill your insurance because that's where you go and you say no, I'm gonna bill my insurance.
[AGENT][NEUTRAL] Yeah, absolutely, because it's like the whole point of an indemnity policy just in general is like that money goes to you and you can pay for like food or childcare lost wages more than like pay the hospital.
[CUSTOMER][NEUTRAL] Because he could bill
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] That's where I think that.
[CUSTOMER][NEGATIVE] They went wrong, but like I don't have anything that I send them that they.
[CUSTOMER][NEUTRAL] Like claim forms that they could submit their own claims.
[AGENT][NEUTRAL] Hm, um, I don't know if, yeah, I was about to say like I don't know if any of our claim forms would.
[CUSTOMER][NEUTRAL] OK, I'm gonna go with my manager.
[AGENT][NEUTRAL] Be this like if they would overlap or be the same.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm going to look at my claim forms online and see if any of them like mention that they're for this type of policy real quick.
[AGENT][NEGATIVE] I always open up the wrong tab though.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, I'm not seeing anything on my claim form where it would have like a remit where it says that it shares with you, and I only have one claim form for hospital indemnity, so I'm not certain it would work for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's all right.
[CUSTOMER][NEUTRAL] I'm gonna get with my manager and see.
[CUSTOMER][NEUTRAL] Um and see what he has or knows about and then we'll reach back out to you guys if we.
[AGENT][NEUTRAL] I'm I was sorry. I wish I had all the answers for you.
[CUSTOMER][NEUTRAL] Need anything else.
[CUSTOMER][POSITIVE] You did, you did very well though.
[AGENT][NEUTRAL] Um, is there any
[AGENT][POSITIVE] OK, I'm very glad.
[CUSTOMER][POSITIVE] You did just fine.
[CUSTOMER][NEUTRAL] You did fine, yeah, no, it's good. No, so I put that in there but she does already have that and yeah, my manager is gonna be giving her a call back anyway so um I'll just say that she already has the schedule of benefits because she wanted that sent, so no worries on that, but that's what I was calling for. But yeah, I was just thinking that well I, I was just telling her that maybe just get an itemized statement and send it in with the diagnosis.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then we would pay out benefits um.
[CUSTOMER][NEUTRAL] That's what I was telling her because I'm like I don't see a claim form in our stuff for them to submit anything, so.
[AGENT][NEUTRAL] No, and it's so crazy like the crossovers. I don't know. I mean, I'm new to the to the insurance world, so like having different companies that we like partner with but then like we kind of do different stuff also makes it a little confusing I'm sure as well.
[CUSTOMER][NEUTRAL] But I'll ask him about a claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I know, yeah, and over here web TPA I do, I do a whole bunch of different limited medical groups and so yeah, everything's different, everybody's different than what they do, yeah, but.
[CUSTOMER][POSITIVE] Alrighty. Well, thank you very much.
[AGENT][POSITIVE] Yeah it's my pleasure thank you for giving us a call and I hope you have such a wonderful day.
[CUSTOMER][POSITIVE] Nice talking to you.
[CUSTOMER][POSITIVE] All right you too thank you again alright.
[AGENT][POSITIVE] My pleasure. You take care. Bye-bye.
[CUSTOMER][NEUTRAL] Alright you too bye bye.