AccountId: 011433970860
ContactId: afac96f6-3a91-44df-841d-ee542dc865f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436549 ms
Total Talk Time (AGENT): 291234 ms
Total Talk Time (CUSTOMER): 87793 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/afac96f6-3a91-44df-841d-ee542dc865f1_20250121T16:12_UTC.wav
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[AGENT][POSITIVE] Hey, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I'm, I was trying to set up an appointment with um.
[CUSTOMER][NEUTRAL] One of the providers on the list and they said they couldn't find.
[CUSTOMER][NEUTRAL] American public life on there.
[CUSTOMER][NEUTRAL] On the in their system for for insurance to set the appointment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you have your, do you have your policy number handy and I can take a look and see what we're looking at here.
[CUSTOMER][NEUTRAL] And I don't
[CUSTOMER][NEUTRAL] Yes, uh, it's D.
[CUSTOMER][NEUTRAL] 43
[CUSTOMER][NEUTRAL] 73
[CUSTOMER][NEUTRAL] 252 8.
[AGENT][NEUTRAL] Alright, so that the number is actually gonna be the member ID for like the multi-plan and 90 degree benefits, but we'd have like another number on the card. It's typically like 6 to 8 digits. It might see like certificate number or member ID.
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, yeah, yep, it's 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 80575.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you very much and let me get that pulled up for you, my friend.
[AGENT][NEUTRAL] And would you be able to verify for me, pretty please, your um
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Your first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you so much. And would you also be able to verify for me, pretty please, uh, just the mailing address on file?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. I see that all right here and the last thing, sir, is if you could verify for me that I'm so sorry, that email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so, um, your policy with us, I'm showing it's a hospital indemnity policy, so we actually don't have a network on this policy um we are able to honor your benefits um as long as it's within the purview of your policy wherever you end up going because it's a supplemental plan um if you want like your provider can call us and we can verify your eligibility and let them know the same thing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I don't know if you particularly like, um, if it's their first time submitting a claim with us they would just submit their W-9 with us and that's all we need to make benefits payable because we don't have a network but again like if they called us we could let them know that as well.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is that just why I just wanna see a doctor for like a visit that does that count as that too or?
[AGENT][NEUTRAL] Well, so we're your supplemental policy. Let me take a look actually at um your benefits because I don't have them pulled up. One second.
[CUSTOMER][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] It looks like you have some benefits as far as um outpatient if you're sick and then um wellness and diagnostic, um that could benefit you.
[AGENT][NEUTRAL] Um, in a doctor's office, and actually the snapshot is really limited, so I'm just gonna open up the whole policy document. One second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so, um, it looks like if you are
[AGENT][NEUTRAL] You do have an outpatient benefit as far as sickness, and it's like 5 visits per calendar year. Um, and then if you are in a setting where you need wellness or diagnostic testing, um, whether that's just your wellness exam or a diagnostic test, I, I, I'm not exactly sure everything that falls under it, but like, you know, perhaps like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A strep test or an X-ray or something like that, um, where they're like looking for something that's wrong with diagnostics. Um, you do have benefits there. Um, but it is, I do wanna let you know this policy is like a supplemental policy. So, um, it's not major medical, it's not gonna offer full coverage. It is just going to offer like those limited benefits um throughout the calendar year for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, OK, so it doesn't have just regular checkups and stuff. It doesn't cover that.
[AGENT][NEUTRAL] No, no, um.
[AGENT][NEUTRAL] It does not, it, you have benefits like if you get confined to a hospital, you get paid out a daily amount. Um, same thing if you're confined to an ICU or a coronary care, you have like a benefit there that pays you daily. Um, the first time you get admitted to a, a hospital in the calendar year, you have like a lump sum payment. If you have surgical or anesthesia, you know, you have benefits there that can help you. Um, and so,
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So it's supposed to, it's just kind of like the idea is to like supplement um some medical expenses that out of pocket cost more than cover all of it. Um, so you do have benefits like outpatient sickness and your wellness and diagnostic. And so your wellness exam, you know, like when you go to your doctor just every day or whatever your once a year one,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And they just do your like examination and check on you, you know that could fall under the wellness exam benefit and you could get a little benefit from that um but it might not cover your consultation fees or those sort of things. Does that make sense?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Yeah, yeah, yeah, yeah, so it's too late. My work wouldn't fix that, huh, it's too late. It's past.
[AGENT][NEUTRAL] I mean, you can always talk to your, um, what do you mean like the benefits gone?
[CUSTOMER][NEUTRAL] The benefit time right?
[CUSTOMER][NEUTRAL] Well, because I, I want the regular like I go and they cover like my check on like you know have a copay for $10 you know, that kind of thing.
[AGENT][NEUTRAL] Oh, like a major medical insurance? Yeah, so I'm not exactly sure what your company offers, so you could check with them and see if they have a major medical provider. Um, absolutely, um, you could check with that. I, unfortunately, I don't know. I just know that we're a supplemental, um, what we offer at APL, you know, we offer cancer policies and these hospital indemnity policies, disabilities, um, we are the right of them, but there we don't offer any major medical services.
[CUSTOMER][NEUTRAL] That's not
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, alright, got it. All right.
[CUSTOMER][POSITIVE] OK. All right, thanks.
[AGENT][POSITIVE] Hey, it's my pleasure, [PII]. Is there anything else I can do to take care of you today?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Well, you take care. Thank you for calling APL and you have a fabulous day.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] All right you too bye.
[AGENT][POSITIVE] Thanks. Bye-bye.