AccountId: 011433970860
ContactId: c6164073-193a-4846-8ed0-917e990190d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1490439 ms
Total Talk Time (AGENT): 557935 ms
Total Talk Time (CUSTOMER): 358457 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/c6164073-193a-4846-8ed0-917e990190d6_20250521T14:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII]. I'm calling from a broker's office. Uh, we were recently assigned as the agent of record of one of your groups, and I need more information on the plan they have. They did send me some information, but, but I still need some other, I, I still have other questions because they're up for renewal and I'm just getting a pre uh presentation ready for them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have the group number?
[AGENT][NEUTRAL] Or the name of the group? OK, OK, what is that?
[CUSTOMER][NEUTRAL] Yes, I have the group.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's 21867.
[CUSTOMER][NEUTRAL] And the name is [PII].
[AGENT][NEUTRAL] OK LLC, OK, and who you said your name is [PII]. What broker's office are you with?
[CUSTOMER][NEUTRAL] Delmar Insurance and Services with [PII].
[AGENT][NEUTRAL] Delmar, OK.
[AGENT][NEUTRAL] Got you. OK, that's one with [PII]. Alright, and what, so yeah, they're up for renewal for 61. What information were you needing?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, first, I need to know if this uh plan, cause I was reading the, the plan summary they sent me, it's very uh basic uh and uh it doesn't mention it, it mention or mentions urgent care facility, but it does not mention ER. Does it cover ER?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, hang on, I can tell you. Give me one second.
[AGENT][NEUTRAL] Let's see, so under the outpatient benefits it has hospital emergency room.
[AGENT][NEUTRAL] Urgent care facility.
[AGENT][NEUTRAL] Surgery in a hospitable outpatient facility or freestanding outpatient surgery center, diagnostic testing in a hospital facility or MRI facility.
[AGENT][NEUTRAL] Outpatient treatment for a mental or emotional disorder in a hospital outpatient facility, physical therapy, and ambulance. All of that's listed under the outpatient benefit.
[AGENT][NEUTRAL] So, yeah, emergency room. Mhm, mhm.
[CUSTOMER][NEUTRAL] Yeah, I have that here.
[CUSTOMER][NEUTRAL] Yeah, but my question is, does it cover emergency rooms?
[AGENT][NEUTRAL] Yeah, it's just, it's that first bullet, if you're looking at the same thing that I was looking at and where it has it listed out, it says hospital emergency room. Did you say that on there?
[AGENT][NEUTRAL] Is that on the brochure that you're looking at?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I see. OK, so that is covered at the same rate that it covers the rest, uh, 25 up to.
[AGENT][NEUTRAL] Yeah, it's all lumped in. Mhm, yes, yes, all of those benefits go into the 2500, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And also, um, I don't see any infusion therapy or durable medical equipment. Those are not, uh,
[AGENT][NEUTRAL] Uh, let me look, let's see, let me see, let me see, make sure they don't have any writers for any of that stuff.
[AGENT][NEUTRAL] Does that mention it, but let's see, hang on.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] There we go durable medical equipment. Let's see hold on definitions.
[AGENT][NEUTRAL] The medical equipment.
[AGENT][NEUTRAL] OK, outpatient coverage charges do not include charges for durable medical equipment.
[AGENT][NEUTRAL] So correct, it doesn't have that on that portion of the policy. I'm just looking to see if it's.
[AGENT][NEUTRAL] Covered anywhere else.
[CUSTOMER][NEUTRAL] Yeah, no, it doesn't say anything about that.
[AGENT][NEUTRAL] Yeah, it's not covered under the outpatient, so I guess if they were in the hospital cause that's what it said it excluded durable medical equipment. I'm just looking under to see if there's anything.
[AGENT][NEUTRAL] Hang on one second
[AGENT][NEUTRAL] See what's up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Outpatient does not cover durable medical, but
[AGENT][NEGATIVE] charges do not include durable medical equipment.
[AGENT][NEUTRAL] Oh yeah, I don't see that that's covered.
[AGENT][NEUTRAL] Enter
[AGENT][NEUTRAL] Just look at one other thing, one more thing.
[CUSTOMER][NEUTRAL] Mhm. It's not.
[AGENT][NEUTRAL] Yeah, I just wanna make sure I'm not missing one or the other.
[AGENT][NEUTRAL] Equipment is following it? So how is it defined in the policy.
[AGENT][NEUTRAL] Medical equipment that can withstand repeated use is not disposable as used to service medical purposes with race with treatment.
[AGENT][NEGATIVE] Not in use of apps or signs inappropriate da da da da da. So what is this under? Is this under section?
[AGENT][NEUTRAL] Those are the definitions.
[AGENT][NEUTRAL] So it is defined in the policy, but it's not, it says it's excluded from the outpatient benefits.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So yeah, I don't see it being covered on, uh, it's not covered as the physician, under the physician expense, it doesn't cover it, and it also said under outpatient. It's not excluded from the outpatient portion of the policy.
[AGENT][NEUTRAL] Let me just look at one other thing. Sorry, give me just a second. I wanna see what the brochure has on it. I'm looking at the actual policy certificate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, my computer is decided to be a little slow. Bear with me just a second here.
[AGENT][NEUTRAL] OK. Oh my goodness, me forever to get there. Give me just a second. I'm pulling up the brochure here. I just wanna make sure I'm not overlooking anything.
[AGENT][NEUTRAL] On this particular certificate, OK, here we go. Let's see outpatient covers one that doesn't say anything about durable medical equipment.
[AGENT][NEUTRAL] Oh no, it does not cover, it doesn't cover it. No, you're correct. It's not on the brochure, it's not on the policy, so no, it doesn't cover it.
[CUSTOMER][NEUTRAL] It's not covered right. OK. um.
[AGENT][NEUTRAL] Yeah, I don't see it.
[CUSTOMER][POSITIVE] Thank you for checking that. And uh let me see what I need. I need some.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So then it does say under um
[CUSTOMER][NEUTRAL] On the, on the outpatient benefits, it says that uh physical therapy facility, physical therapy facility. Does that include chiropractic therapy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see if it defines that. Let me see.
[AGENT][NEUTRAL] Let me go back to that policy.
[CUSTOMER][NEUTRAL] Cause physical therapy could be chiropractic therapy might be part of the physical therapy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, they're usually considered two different things. Let me see if it even excludes, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK benefits exclusions let's see.
[AGENT][NEUTRAL] Physical therapy. Let's see. Uh, the treatment of physical dysfunction or injury at a physical therapy facility by the use of therapeutic exercise and application of a modality is intended to restore or facilitate normal function and development. Physical therapy does not include kinesiology, speech or occupational therapy, or equipment recommended use or purchase for.
[AGENT][NEUTRAL] Oh, I use a physical therapy facility. So it says a physical therapy facility, it doesn't say chiropractic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right. So I would say the chiropractor, uh, chiropractor is, it's an exclusion.
[AGENT][NEUTRAL] I guess, yeah, cause it doesn't define it, you know, it doesn't even mention chiropractic on here.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] Exactly, yes, it doesn't. So let me see something else, um.
[CUSTOMER][NEUTRAL] Physical therapy, it is included. No, no chiropractor.
[AGENT][NEUTRAL] Yeah, let me just, let me ask one of our claims people real quick just to make sure because I mean it doesn't say the way I'm reading the policy, um, it doesn't say chiropractic it says physical therapy facility, so I think if it's chiropractic facility, it might not be covered, but let me ask real quick, do you mind? Hold on just one second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, no, no, no, no. And, and now that you have them on the phone, if, if you can ask them, the other question I had, if it covers lab testing at independent labs because this one says that it is cover diagnostic testing in a hospital outpatient facility, but I wanna know if, if it, if that includes an independent lab, you know, they have independent labs like.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Lab testing. Mhm.
[AGENT][NEUTRAL] Like on an out on like on an outpatient facility. Yeah, it says independent lab facility. It says a lab facility that is not in a, that is not a physician's office, hospital, or MRI facility. Its purpose is to furnish results of diagnostic lab tests and not to directly use tests to treat a patient. So it looks like that is, but I'll clarify.
[CUSTOMER][NEUTRAL] Uh-huh, like 2.
[CUSTOMER][NEUTRAL] Yeah, like.
[AGENT][NEUTRAL] Um, I'll clarify that because that is listed down below.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They list that, I don't even see that listed on that section. So yeah, let me ask. Yeah, hold on just one second. I'll ask about the physical therapy in the lab.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] Broker Resources. I have a question, a general question on Melink 8. Can you help me?
[AGENT][NEUTRAL] I'm trying to, I've got a, yeah, let me give you a policy number. Uh, let's see, 1,731,960.
[CUSTOMER][NEUTRAL] OK. Do you have a
[CUSTOMER][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back?
[AGENT][NEUTRAL] Yeah, I'm in broker resources here at APL like, um, you can, um, find me on like [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just have a generic question. I've got a broker on my other line, but I'm not transferring her. I just I'm asking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the name?
[AGENT][NEUTRAL] Uh, my name or the broker's name?
[CUSTOMER][NEUTRAL] The uh policy the insured's name.
[AGENT][NEUTRAL] Uh, sorry, I, it's on IV Acosta.
[CUSTOMER][NEUTRAL] OK, and what's your question?
[AGENT][NEUTRAL] So my question is, on physical therapy, I'm reading the policy and it doesn't say chiropractic, it says it has to be a physical therapy facility. Am I correct that chiropractic wouldn't fall under that?
[CUSTOMER][NEUTRAL] Right, chiropractic wouldn't be covered under this policy because they don't have the OTR writer, only physical therapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's what I thought.
[AGENT][NEUTRAL] OK, and then the other question I also show it doesn't cover durable medical either. I see they don't have that, but the other question is lab, like a freestanding lab.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, like if they have to go to like Vlo or something like that.
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEGATIVE] It's not covered. They don't have that lab writer.
[AGENT][NEUTRAL] OK, that's what I thought.
[AGENT][NEUTRAL] The lab, so they'd have to have the lab writer and the OTR writer for the chiropractic, and they'd have to have the DME writer for the DME, correct?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, perfect. That is all I needed. Thank you so much.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK, thank you. Sorry for, thank you for holding. OK, I confirmed with the adjusters. The chiropractic is not covered under, under the policy, and the lab would also not be covered because it's not listed on there. And the DME is also not covered.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the lab is not covered in an independent facility, uh, the chiropractor is not covered. And what was the last thing you said?
[AGENT][NEUTRAL] Durable medical equipment. I just had to reconfirm that the durable medical equipment was not either.
[CUSTOMER][NEGATIVE] Oh, that's terrible.
[CUSTOMER][NEUTRAL] Yeah, OK, perfect. All right. So now, the other question, oh thank you so much for checking that out with me. Uh, the other thing I'll have is they sent me a, they sent me a plan summary, like the one you said you, you have probably with some rates. Uh, the renewal for this group is 61, so I don't know if the rates they give me are renewal rates or they're the current rates. I have um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Let me pull up the renewal information that was sent out. Let me pull up the renewal. Give me just a second here.
[CUSTOMER][NEUTRAL] I don't know if you have a.
[AGENT][NEUTRAL] So you know the rates for the renewal, but who knows, let's see.
[AGENT][NEUTRAL] So do we send you, I know we sent the renewal, did you get something with the rates attached?
[CUSTOMER][NEUTRAL] Uh, well, yeah, I got, I got uh the plan summary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has the rate on one of the pages they have, it has rates, so, but I don't know if those are the renewal rates. Let me see if it has a date. Maybe I missed that. Uh, no, only has the name of the company but does not have a date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I know they have to submit their renewal, but that's a good question. I said I know we asked for the paperwork, so I don't know.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] What those cur those rates are gonna change until it's been processed. Let me double check. Hang on just a second. Let me get somebody on my team to see if they know.
[CUSTOMER][NEUTRAL] Maybe it's been that right.
[AGENT][NEUTRAL] She's like, bear with me just a second. I'll see what she says.
[AGENT][NEUTRAL] You have a presentation with the group today?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Did you say you had a presentation with this group? Is that for today?
[CUSTOMER][NEUTRAL] Yes, no, no, I don't, if it's, well, they're, they're waiting for it, the agent is waiting for it. Yeah, so.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you, got you, got you.
[AGENT][NEUTRAL] Makes sense.
[CUSTOMER][NEUTRAL] Yeah, some work.
[AGENT][NEUTRAL] She's typing back and just see what she says.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, she said we have to do some research, so what we'll do is, um, have that information sent to you. They don't think it's gonna change, but we'll need to double check on that because we don't have that information up front apparently. So where would you like us to email that to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh you can send it to [PII]. That's spelled [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it's a [PII] not [PII] [PII].
[AGENT][NEUTRAL] [PII]. OK. OK, I'll, we'll have it sent to you here in just a bit, OK?
[CUSTOMER][NEUTRAL] Yeah, it's a hyphen.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you very, so you're gonna send me uh the renewal package then, then I can compare it what I the current rate so.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, we'll send you the rate so that you can see because you have the renewal information, right? You have the, the, the group participation form and all of that you don't have any of that? OK, I'll go ahead and send you all of that. OK, I'll send you the renewal information and then the rates are gonna come different because it's coming from a different area so that'll be sent to you separately, OK.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, I don't have.
[CUSTOMER][NEUTRAL] OK, and if you can add the last invoice because I wanna know who's involved.
[AGENT][NEUTRAL] OK, last invoice, yeah, I can give you a group detail report and I can give it, excuse me, I can't talk. I can send you the group detail report that shows everybody that's enrolled in the copy uh uh the most current billing statement, OK?
[CUSTOMER][NEUTRAL] That would be that.
[CUSTOMER][NEUTRAL] Yeah, the last one.
[CUSTOMER][POSITIVE] Perfect, perfect. Thank you so much. Thank you for all your help.
[AGENT][POSITIVE] OK. You're most welcome. Absolutely. Is there anything else? OK, you too. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye now.