AccountId: 011433970860
ContactId: c8caaa44-61fd-4bd1-b019-288f56d54932
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317600 ms
Total Talk Time (AGENT): 244633 ms
Total Talk Time (CUSTOMER): 62353 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/c8caaa44-61fd-4bd1-b019-288f56d54932_20250131T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] Thank you [PII] how are you? I'm doing well.
[CUSTOMER][NEUTRAL] I'm good. I have uh [PII] on the phone and he's calling. He's got a doctor's appointment and he's wanting to know what's covered under this policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And all this information has been verified.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, and that is his callback number listed there, the [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And OK, let me just make sure I have him. [PII] and where and he's been, uh, verified, [PII].
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][POSITIVE] OK great.
[CUSTOMER][NEUTRAL] Alright, thank you, and here he is [PII] mhm.
[AGENT][POSITIVE] You're welcome. Alright, thank you.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm in the hospital indemnity claims department. So [PII] transferred you over to me. I understand you have some questions about your coverage. Is that correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I will, I got a doctor's appointment Monday and I just wanted to know um.
[CUSTOMER][NEUTRAL] Will I have to make a copay or?
[AGENT][NEUTRAL] OK, let me pull up your policy and it's um let me just ask you a few questions. It is an office like an office visit with a a physician?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Your doctor, OK. And it, um, can you tell me is the um is the appointment, is the diagnosis or the issue, your condition, is it an accident or an uh illness like sickness?
[CUSTOMER][NEUTRAL] No, it really it's just a checkup.
[AGENT][POSITIVE] OK, so kind of like an annual exam? Oh bless you.
[CUSTOMER][NEUTRAL] Excuse me, I'm sorry.
[CUSTOMER][NEUTRAL] Uh yes, ma'am. Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] OK, so kind of like an annual exam. OK, so let me pull up your excuse me, let me pull up your policy, we'll go over the benefits just to let you know this is a verification of your coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So, um, this, this policy you have with us is it, it's called a limited medical hospital indemnity plan.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So this is, it is limited medical coverage so you don't you don't have a copay um or deductible to meet under this plan. Um, it, this plan is not like a comprehensive major medical plan, it is limited benefits. So just so you're aware of that. Now, do you know if the um physician that you're seeing, do you happen to know if they participate with um the multi plan?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Network
[CUSTOMER][NEUTRAL] Um, yes, ma'am.
[AGENT][NEUTRAL] They do OK alright so and um also Mr. [PII] can you tell me when you signed up for this plan, did you sign up for just the um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the hospital indemnity or did you also opt in for the MEC Wellness?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, MSU Wellness.
[AGENT][NEUTRAL] OK, so you do have the, the, the wellness plan in addition to this plan, is that right?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] OK, all right, so what that means is under that MEC wellness you do have wellness benefits that would cover you for um like your preventative visit screening exam. Unfortunately I don't have um exactly what those benefits are, but you do have a well a wellness and diagnostic testing benefit under this hospital indemnity, so you're kind of double covered if it is a preventative visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, and this policy for um wellness and or a test. So in other words, if you go to the physician, you're doing the annual exam, we'll pay a $75 benefit for that exam and if there's any testing that's done that's under that preventive diagnosis, um, you'll be covered up to the $250 amount. So what that means is, um, if they do say like a um.
[AGENT][NEUTRAL] For usually for men they kind of do sometimes a PSA screening or maybe even a screening, uh, like lab work, um, as long as it's done in the physician's office, it would be considered under that wellness and uh test benefit so it would pay $75 for the exam and then it will pay additional $75 for each uh wellness test you have up to that $250 maximum.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK. Now, if, um, just to give you a little bit more information, if it's an office visit with the physician, you're covered um for 5 visits, and that would be like for an illness or a sickness. Um, that would cover you up to 5 visits and again, that would be a $75 benefit. And that's for, like I said, uh uh that outpatient sickness rider. So, um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You'll have that benefit as well and like I said it covers up to 5 visits per person per calendar year.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Now did you have any other questions?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Uh, no, ma'am. You've covered everything. Thank you.
[AGENT][POSITIVE] OK, you're so welcome, Mr. [PII]. Thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Thank you bye bye.