AccountId: 011433970860
ContactId: a947dce0-7be3-4b55-a1e3-dbf8d871980d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389769 ms
Total Talk Time (AGENT): 177956 ms
Total Talk Time (CUSTOMER): 144235 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/a947dce0-7be3-4b55-a1e3-dbf8d871980d_20250410T16:24_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm, I'm trying to
[CUSTOMER][NEUTRAL] I have an appointment coming up um and they told me that.
[CUSTOMER][NEUTRAL] I had to reach out to you guys to.
[CUSTOMER][NEUTRAL] See if it was covered or get like pre-authorization or figure out like how to do the reimbursement.
[AGENT][NEUTRAL] OK, so our policies don't require pre-authorization. So let me take a look at your information. Could I get your name and
[CUSTOMER][NEUTRAL] It might
[AGENT][NEUTRAL] Could I get your name and a callback number?
[CUSTOMER][NEUTRAL] Yep, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you have your policy number with us?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 956.
[CUSTOMER][NEUTRAL] 00
[AGENT][NEUTRAL] OK. And [PII], if you could verify your date of birth.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah, your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much for verifying your.
[AGENT][NEUTRAL] Uh, policy and so you first want to see if the service is covered.
[CUSTOMER][NEGATIVE] Yeah, sure, I mean, I don't, I don't think it is this, this limited benefits plan is so confusing even the doctor's offices I go to don't know how to navigate it.
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I don't really understand what you know the point of having this even is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I guess yeah just trying to see if it's see if it's covered or see if I can will be reimbursed or or what's gonna happen if I do it.
[AGENT][NEUTRAL] OK, I can take a look at your policy for you. And what type of services is this for?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, it's a endoscopy and a colonoscopy, uh, both of them together.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know, cause it says like, it's so confusing, like for, like if I had cancer or something, it says that, you know, everything is covered or whatever, like it's so misleading and confusing and
[CUSTOMER][NEGATIVE] I'm concerned that something is wrong with me like that and I, I can't even get access to healthcare like I can't even, I work in healthcare and I can't even get access to it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see. So this is gonna be done in an outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, yeah, this is a limited medical plan.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, surgery.
[AGENT][NEUTRAL] OK, it looks like the policy would not cover the outpatient.
[AGENT][NEUTRAL] Uh, facility for endoscopy.
[AGENT][NEUTRAL] Um, let me.
[CUSTOMER][NEUTRAL] What, what does it cover? Can I, could you send me a list, you know, something that shows me.
[AGENT][NEUTRAL] surgery.
[AGENT][NEUTRAL] Yes, so we can uh send you a copy of your policy that lets you know what, you know, what's covered, how it's covered, um.
[AGENT][NEUTRAL] I can do that. Uh, let me look here.
[AGENT][NEUTRAL] If you could verify your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I will go ahead and put in a request to have a copy of your policy sent to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can it be emailed to me? I'm in [PII]. That's my uh claim residence.
[AGENT][NEUTRAL] It can, yeah, it can. So what is your, if you could verify your email address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, OK, that is what we have on file, so I will go ahead and have that uh emailed to you, a copy of your policy emailed to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, you have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] Actually, there is, um.
[CUSTOMER][NEUTRAL] So with this plan, is there like a an out of pocket maximum? Is there a maximum deductible?
[AGENT][NEUTRAL] Uh, the policy does not have a deductible. There is a maximum benefit amount per, per, you know, per the service. So you'd have to, for instance, a physician office visit, your policy will pay $50 for the visit and you have 4 of those to use a calendar year. Please be advised verifying benefits is not guaranteed payment. So it's
[AGENT][NEUTRAL] Usually like a per day benefit. I'm looking at most of the uh the payments or the coverage, they're like per day, um benefits and so the policy will pay that amount for the cover service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So like if I got sick and went to the hospital and had a $100,000 bill, there's no maximum there's, I just am responsible for everything.
[AGENT][NEUTRAL] If you do what? I'm sorry.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For what type of service?
[CUSTOMER][NEGATIVE] If I, if I did a service any service, if I, if I ended up with a bill for, you know, a crazy amount, there's no maximum that I pay and then like everything else is covered, it's just.
[AGENT][NEUTRAL] No, there's a maximum we pay. Yeah, so it's the max the maximum payment is our payment.
[CUSTOMER][NEUTRAL] Day to day.
[CUSTOMER][NEUTRAL] Oh yeah, that makes.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I will get, uh, put the request in and you should get the uh copy of your policy within 24 hours.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You too.