AccountId: 011433970860
ContactId: b111d091-0cc2-4e80-aebd-7b4b84fb9c79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 664010 ms
Total Talk Time (AGENT): 292564 ms
Total Talk Time (CUSTOMER): 226980 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/b111d091-0cc2-4e80-aebd-7b4b84fb9c79_20250528T18:43_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have insurance through you guys and I wanted to confirm if, if, um.
[CUSTOMER][NEUTRAL] I get a procedure if there's gonna be a co-pay um or how much it would cost me um out of pocket, uh, and the procedure that I'm gonna be getting, um, is called.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Tra transthoracic transthoracic echocardiogram complete.
[AGENT][NEUTRAL] OK, so you have a question regarding your benefits on your policy, is that correct?
[CUSTOMER][NEUTRAL] Yeah, so I just wanna make sure before I go into the office that I'm aware prior to them saying, oh, when I get there they'll be like, oh, the co-payments $1000 or something, so I just wanna confirm before I do that whether or not I have to cancel the appointment or what you know.
[AGENT][NEUTRAL] OK, so I can help you with answering some benefits questions. Uh, first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] This is [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] My policy number is 02616992.
[AGENT][NEUTRAL] OK, thank you. So [PII], give me a couple of moments please to get your policy information pulled up. Once I do, I will have to verify several things with you first for security and then also any information that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and the phone number that we have on file for you is the same as the one that you gave to me so that is the best number that we should have, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much. Now [PII], have you ever set up your profile in our portal called the online service center?
[CUSTOMER][NEUTRAL] I have
[AGENT][NEUTRAL] You have set that up? OK, good, because that will give you access to your policy information and your ID cards so you can actually, you know, look up your information.
[AGENT][NEUTRAL] As well to see what is and what is not covered. Now, this is not a major medical plan that you have with APL. It is a limited benefit plan. So it does provide benefits for certain services. So again, you said that you're having, what type of test done?
[CUSTOMER][NEUTRAL] It's an echocardiogram complete. Uh, it's a transthoracic.
[CUSTOMER][NEUTRAL] T R A N S T H. I'm sorry.
[AGENT][NEUTRAL] OK just
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that's OK. You can go ahead.
[CUSTOMER][NEUTRAL] Do you want me to spell it?
[AGENT][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] OK, so it's about.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] No, you don't have to. That's OK.
[AGENT][NEUTRAL] I don't think I need for you to uh to yet, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so on this plan that you have with APL that is not one of the covered tests. Under your diagnostic testing benefit. The test under your diagnostic.
[AGENT][NEUTRAL] Benefits or MRIs, a CT or colonoscopy. Those are the three tests.
[CUSTOMER][NEUTRAL] OK, so you said uh MRI, colonoscopy, and which one?
[AGENT][NEUTRAL] Mhm. And a and a CT scan.
[CUSTOMER][NEUTRAL] And CT scan, OK, uh, I covered it.
[AGENT][NEUTRAL] Are they covered? Yes, so those are the those are the diagnostic tests that are covered under your policy, under this limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your, and your benefit for any of those tests would fall under um the diagnostic testing benefit and that is a maximum.
[AGENT][NEUTRAL] For your diagnostic testing benefits, let's see. One second. It's still trying to load my one piece of my information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the max benefit on those would be $250 and that's one test per calendar year.
[CUSTOMER][NEUTRAL] So question, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this test
[CUSTOMER][NEUTRAL] What does that mean when you say max benefit like uh huh.
[AGENT][NEUTRAL] That's the maximum that this plan would pay is $250 on one of those three tests per calendar year.
[CUSTOMER][NEUTRAL] OK, OK, now, OK, so I understand that, so, uh huh.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, no, so basically it says if, if I got an MRI, colonoscopy, CT scan.
[CUSTOMER][NEUTRAL] It's only covered for $250 for one of them per year, is that, is that correct?
[AGENT][POSITIVE] Yes, sir. That is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, OK, now when you mentioned that I'm on a limited insurance, so when I signed up for the insurance, this was the most, I tried to get the most expensive option. I think they had 2 or 3 options. So is there an option for me to change my insurance and pay the difference so that I have um.
[CUSTOMER][NEUTRAL] Things covered like an echocardiogram, for example.
[AGENT][NEUTRAL] Now, that would be a question for benefits in a card, because that is the enrollment company that you enrolled through for any type of coverage that you have and then they provide the different companies depending on what you've enrolled for with your information. So I will be happy to give you [PII] their phone number if you don't have it. I can connect you with one of their representatives so that you can see what other options may be available to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If you would like for me to do that.
[CUSTOMER][NEUTRAL] Yes, um, yes.
[CUSTOMER][POSITIVE] Yeah, so I can get the number and then you could also connect me that'll be fine.
[AGENT][NEUTRAL] Yeah, absolutely. So their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And again, that's for benefits and a card.
[CUSTOMER][NEUTRAL] OK, so [PII].
[AGENT][POSITIVE] Yes, sir, that is correct. Mhm.
[AGENT][NEUTRAL] And is there anything else, [PII], that I could help you with before I connect you with one of their representatives?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. Well, if that's all I can help you with today, then thank you again for calling APL and I hope you do have a very nice rest of your day.
[CUSTOMER][NEUTRAL] OK, so you're gonna transfer me, right? So.
[AGENT][NEUTRAL] I am, yes, sir.
[AGENT][NEUTRAL] That is what you wanted me to do it. OK, you're welcome. So one moment, please.
[CUSTOMER][POSITIVE] OK cool all right thank you.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol, your call may be recorded for quality control purposes.
[CUSTOMER][NEUTRAL] Thank you for calling S English. Please wait for the next available agent. You are the next caller in line. You may press.
[CUSTOMER][POSITIVE] Thank you for calling Benefits on a card. My name is [PII]. How can I assist you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] with APL. How are you today?
[CUSTOMER][POSITIVE] Good how about you?
[AGENT][NEUTRAL] I'm doing fine, thank you. So, I have an insured on the line who's wanting to find about um some other possible options for coverage for him.
[AGENT][NEUTRAL] His first name is [PII].
[AGENT][NEUTRAL] And his last name is spelled [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The last four of his social is [PII].
[CUSTOMER][NEUTRAL] OK, OK, in [PII].
[AGENT][NEUTRAL] I'm so sorry. What, what did you say, [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], the state.
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, yeah, if you want, um, you can just transfer him over because I have to ask him if he has experienced a quality life event because now he's out of the enrollment period, so he would have to qualify for certain things.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gotcha. OK. Well, are you ready to speak to him?
[CUSTOMER][NEUTRAL] To be. Mhm.
[CUSTOMER][POSITIVE] Yes ma'am, you can send him over.
[AGENT][POSITIVE] OK, [PII]. Well, thank you so much and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. OK, here comes [PII].