AccountId: 011433970860
ContactId: a90ace5a-102a-40e4-81db-ef7c175cb7e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 857780 ms
Total Talk Time (AGENT): 292190 ms
Total Talk Time (CUSTOMER): 209462 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/a90ace5a-102a-40e4-81db-ef7c175cb7e7_20250514T13:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning, so. How are you doing?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][NEUTRAL] I'm great, thanks for asking. So I have an insured on the phone. She's calling about a policy. She was calling to verify, to request a copy of her card. However, she wanted to verify, she had a question about a wellness visit and if she would be reimbursed for the um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] reimbursed for her wellness business, but
[CUSTOMER][NEUTRAL] It's a HR policy, but then she had other policies as well, so I'm not sure what she's inquiring about.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh, OK. Yeah, there's some HIs that have that wellness benefit. Yeah, those are the new ones usually.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK, I can help her. Do you have the policy number?
[CUSTOMER][NEUTRAL] Oh, cause
[CUSTOMER][NEUTRAL] She, when she, she lost me when she said she get reimbursed for it, so, cause I wasn't sure about that one like, I don't know, let me transfer you so they can better assist you, but it's 2506732. It's 2506732. And this is the spouse.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She's [PII].
[CUSTOMER][NEUTRAL] Yes, you, you, I've verified all of her information. I've requested her request for her card to be sent to the address that we have on file and I've sent it to her as well by email. So she has everything that she needs besides that benefit of question about the wellness.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK dokey, and what's.
[CUSTOMER][NEUTRAL] And her callback number?
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] It's [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, all right, thank you. I'm ready for this address.
[CUSTOMER][POSITIVE] Thank you so much. Have a good one.
[AGENT][POSITIVE] You're welcome. You too.
[CUSTOMER][POSITIVE] Hello Ms. [PII]. So Soul is gonna better assist you with your questions that you had in regards to your wellness, but thanks for calling APL. You have a great day. Thank you so much. You too.
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] You're welcome, thank you.
[AGENT][POSITIVE] Good morning, Miss [PII]. This is so in the care team. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][POSITIVE] I'm good, thank you for asking. All right, so, um, Ms. [PII] is letting me know that you're trying to get the benefits for your wellness and see um how to to get a reimbursement. Is that correct?
[CUSTOMER][NEUTRAL] Well, I was calling to find out how does that whole benefit of things work because I have to get a physical, a yearly physical, um, and so does my husband, but we wasn't sure um how does the whole process work.
[AGENT][NEUTRAL] OK, no.
[CUSTOMER][NEUTRAL] Cause I know it's not like typical insurance.
[AGENT][NEUTRAL] Correct, that is correct. Yes, let me go ahead and pull your benefits really quick and check under the wellness to see uh what type of wellness benefit you have with us and then we can go from there. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one doesn't have the wellness in it. Let me check the other policy. Bear with me. The HI, which is your hospital indemnity, doesn't have the wellness benefits. So let me check the other policy to see if there's a wellness benefit there, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] I'm still searching right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me try one more.
[AGENT][NEUTRAL] Ms. Here, do you mind if I put you on a uh on a hold for a minute? I'm not finding that benefit. I want to make sure that it's not a cover service, OK?
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Ms. [PII]. OK, yeah, this is a brand new policy. I do apologize. I found it. OK. So it looks like uh there's a health screening benefit, that's what is called a health screening benefit, which is, um, we reimburse $100 in one time per year per covered person. This is for any wellness test or routine physical exam.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you. OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] I'm sorry. OK, can you hear me now?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I can, yes, mhm.
[CUSTOMER][NEUTRAL] OK, my phone was breaking. Yeah, my, so you were saying, I'm sorry, I didn't hear the last part.
[AGENT][POSITIVE] Oh, OK, I'm so sorry.
[AGENT][NEUTRAL] Oh, it's OK, no problem. I can repeat it. OK, so you have a health screening benefit, which is $100 per day, maximum of 1 day per covered person per calendar year, and this is a reimbursement for any wellness test or routine physical exam.
[CUSTOMER][NEUTRAL] OK, and how do I, um, so what do I, so what do I need to do to get reimbursed?
[AGENT][NEUTRAL] OK, so for this one, this is a brand new one. OK, uh.
[CUSTOMER][NEUTRAL] See that work here for lab work.
[AGENT][NEUTRAL] Let me see if it's gonna be under wellness, which more than likely it is. Have you registered online, Miss [PII]?
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I have not.
[AGENT][NEUTRAL] I have not. OK. All right. That's the easiest way to do it. That's why I asked. OK, so there are several options. You can either submit a claim, which you can find the claim form to our website at [PII].
[CUSTOMER][NEUTRAL] What was the website again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, hold on, let me pull that up one moment.
[AGENT][NEUTRAL] Sure, yes, mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And that's [PII], correct?
[AGENT][NEUTRAL] Yes, like in the morning a.m. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'm in I'm in the website so I need to um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You will go to claims and forms and you will look for the hospital indemnity claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will just um let us know on the description that you're you're uh getting the um health screening benefit.
[CUSTOMER][NEUTRAL] OK. I'll do that. And um it doesn't cover, it doesn't cover labs, it just cover the wellness, correct?
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Um, let's see. It will be any wellness test. So basically, there is gonna be your Pap smear, mammogram, um, um, just anything that will detect any type of, um, wellness exams, and then routine physical is just the regular physical exam.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, let me see, let me see if there's anything here that says that it will cover labs.
[AGENT][NEUTRAL] No, it just says uh any or prevention of um it covers sickness, so it's just prevention testing.
[CUSTOMER][NEUTRAL] I would rather
[CUSTOMER][NEUTRAL] OK, so I probably will use the benefit for my mammogram because I'm overdue for one.
[AGENT][NEUTRAL] Oh, OK. Yes, and you can just go ahead and send us the.
[CUSTOMER][NEUTRAL] And I would just pay my physical out of pocket.
[AGENT][NEUTRAL] Mhm. And just ask for an itemized bill when you're done with that um test, so they can give you an itemized bill and you can send that information to us, OK?
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK, alright, I think that was the main thing that I needed to know was that part.
[AGENT][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] And, and this is for, this, is this for any doctor that we go to? It doesn't matter, the doctor, correct?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, it doesn't matter to the doctor. We don't have any networks. You don't need to follow any networks, so this is, you, you choose your own doctor. Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. OK, alright, that's what I wanted to know. Alright, so I'll make my husband's um physical and then I'll find out how much is his normal physical and then um we'll make the appointment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and I'm gonna go over this on the website as well.
[AGENT][NEUTRAL] OK, yes, and if you need to register you just go ahead and click on sign in instead of claim forms you go to sign in and just create your account. It's gonna be personal information, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now what is the number for customer care?
[AGENT][NEUTRAL] It's the same [PII]. I believe it's gonna be option number 2.
[CUSTOMER][POSITIVE] OK, alright, alright, thank you so much I really appreciate that.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye sir.
[CUSTOMER][NEUTRAL] Yeah