AccountId: 011433970860
ContactId: c42dcc54-b89c-467a-8ad3-e4f3629fee8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411109 ms
Total Talk Time (AGENT): 170652 ms
Total Talk Time (CUSTOMER): 127518 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/c42dcc54-b89c-467a-8ad3-e4f3629fee8d_20250408T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have a question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I have an American life, a public life. My question is, um, are you guys covered the surgery for the eye?
[AGENT][NEUTRAL] I would have to check it um on your policy to see if it covered anything with eyes. I'm not certain. Do you have a policy number?
[CUSTOMER][NEUTRAL] Well, I have a um vision card from your company from my work and the health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy. The policy for the health is um
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] It's 024.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] 565.
[AGENT][POSITIVE] OK, thank you so much. Let me pull this up here. Give me just one moment.
[AGENT][NEUTRAL] And can I get your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then I'll need to verify your date of birth and address.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] Address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much. So let's see here.
[AGENT][NEUTRAL] OK, so the only thing that I see under.
[AGENT][NEUTRAL] The exclusions on the medical would just be dental treatment. I don't see anything listed.
[AGENT][NEUTRAL] For any sort of eye.
[AGENT][NEUTRAL] Um, it does have an exclusion, like if it was cosmetic surgery or anything like that, but if it's a surgery, uh,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's, it's like a
[CUSTOMER][NEUTRAL] It's a Cadillac surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] So I don't think that would be considered any sort of cosmetic because that's like surgery to restore.
[AGENT][NEUTRAL] Um, to a normal like function.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] Um, the
[CUSTOMER][NEUTRAL] Means any kind of surgery you guys not cover this insurance?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So, your plan has a surgical and anesthesia benefit on it of $1000. So, it does have a surgery benefit on it. Um, the most that the plan's gonna pay towards surgery and anesthesia cost would be $1000.
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] $1000.
[CUSTOMER][NEUTRAL] OK, because this insurance from the company is not for, uh, it's for my company.
[CUSTOMER][POSITIVE] That's why I wanna make sure.
[CUSTOMER][NEUTRAL] If the, if you guys cover this this surgery, because
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] If you want the provider to contact us to to just verify the benefits, they can, but we don't have any way of knowing what the cost would be total for the surgery needed. Um, we can only just advise on what the benefits are for the plan.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. This one is called for life, like a health um insurance, not for vision, right?
[AGENT][NEUTRAL] Right, this isn't a vision plan. This is just a um limited benefit medical plan. That's what this is.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] So, I don't know if your employer is offering dental or excuse me, vision, um, also.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] With another carrier.
[CUSTOMER][NEUTRAL] Yeah, they do. But yes, they have um Metlife.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So what that plan, if you have vision with MetLife, um, I don't know if that plan would cover anything under the vision. You would have to contact them to see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I just called the house first before I call.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so your limited benefit plan is only, it's gonna pay a maximum of $1000 towards any surgical and then the anesthesia. That's, that's what's included in this portion.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][MIXED] OK, it means you guys can cover $100,000. But other than that, it's on my pocket, right?
[AGENT][NEUTRAL] Mhm. It's not gonna cover any more than that. Correct.
[CUSTOMER][NEUTRAL] OK, OK, OK, I'm gonna call the patients uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Anything else I can check?
[CUSTOMER][POSITIVE] Thank you so much. You have a wonderful day. Mm.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Goodbye.