AccountId: 011433970860
ContactId: cc687c26-8389-4b31-94d3-03798836c94e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603750 ms
Total Talk Time (AGENT): 364256 ms
Total Talk Time (CUSTOMER): 168516 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/cc687c26-8389-4b31-94d3-03798836c94e_20250311T19:00_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I mean, um, I wanted to give you my name and my, um, member number and stuff, and I wanted to ask you about the benefits on this insurance.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, it's in my husband's name, but I'm insured under it too. Um, my name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what is your callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you say you do have the policy number or you don't have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have the policy number it's um 025174775.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and I need uh to verify your date of birth and mailing address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My date of birth is [PII] and mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you. You say you have benefits about your ben um questions about your benefits, correct?
[CUSTOMER][NEUTRAL] Yeah, it's insured under my husband's the name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, how may I assist you with the benefits this one?
[CUSTOMER][NEUTRAL] Um, I wanted to see what this insurance actually covers and the benefits that come with it because I didn't quite understand it.
[AGENT][NEUTRAL] OK. All right. So this policy is one of our secondary supplemental plan to the major medical. So it's to help with the high deductibles, co-payment, and co-insurance from your major medical. And let me just go over the benefits or where you can use this. And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] So, um, with this one you have in-hospital benefits. In hospital benefits is if you're in the hospital 18 hours or more, either in observation or hospitalized. Um, this one has a benefit of, let's see, 2500.
[AGENT][NEUTRAL] 100 per calendar year for inpatient.
[CUSTOMER][NEGATIVE] You're breaking, you're breaking up really bad. I can't understand you, you're breaking up.
[AGENT][NEUTRAL] I'm fine.
[AGENT][POSITIVE] I'm sorry for that. Um, let me see.
[CUSTOMER][NEUTRAL] It has in hospitals benefits, you said?
[AGENT][NEUTRAL] Yes, in hospital benefits, which is if you're in the hospital 18 hours or more.
[AGENT][NEUTRAL] That's in hospital.
[CUSTOMER][NEUTRAL] 18 hours.
[CUSTOMER][NEUTRAL] One more, and what does it cover?
[AGENT][NEUTRAL] OK, that's a maximum of 22,500 per covered person per calendar year, and this is to help out with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][POSITIVE] OK, max, OK, per year, and it helps um with the co-pay.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And the, uh, and what else?
[AGENT][NEUTRAL] Deductibles.
[CUSTOMER][NEUTRAL] The what?
[AGENT][NEUTRAL] Deductibles, deductibles.
[CUSTOMER][NEUTRAL] Deductible.
[AGENT][NEUTRAL] And co-insurance.
[CUSTOMER][NEUTRAL] So for instance, if I was admitted in the hospital longer than 18 hours,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It would cover the copay, which was $300 on my policy, I think.
[AGENT][NEUTRAL] Correct. That's if you're hospitalized or if you're in the hospital 18 hours or more, yes, it will cover um if the co-payment is 300, then it will cover the 300. If it's like 1000, it will cover that 1000. Now, you do have a deductible. There's a calendar year deductible 5.
[AGENT][NEUTRAL] 100 that you need to meet before we pay out of that 2500. So the 1st $500 you're responsible. So just an example, if this is the first time you're using this policy during the year and you go to the hospital and they leave you in the hospital on observation and they charge 1500, then you're going to be responsible for the 1st 500 and we'll go ahead and pay the other 1000.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, but once you meet that, mhm.
[CUSTOMER][NEUTRAL] Well actually, I need, I need to give this card to like if I, to the hospital, say emergency room, I need to get it to my doctor's office.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, so, OK, I, I think I understand that. Um, as far as going to your doctor and stuff like that, how does it cover that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this one, let me see. I don't think it covers the office visit but it covers procedures. Let me go ahead and double check on that just to make sure. Um, let's see, um, regular office stations.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Does it cover the procedures while you're in the hospital, in hospital?
[CUSTOMER][NEUTRAL] So like CT scans and all that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. Yes, while you're in the hospital, um, it covers anything that is in that inpatient stay. Now, you do have outpatient benefits. Outpatient benefits is when you're in and out of the hospital. So that, that will be a separate benefit, which is also 2500, and this one is for emergency rooms.
[AGENT][NEUTRAL] Diagnostic centers or diagnostic testing, um, treatment in a physician's office, like if they do a sonogram, ultrasound, x-ray, anything that in the office that is not the office visit, um, physical therapy, sleep studies, um, let's see, urgent care.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, treatment for mental emotional disorder.
[AGENT][NEUTRAL] Those are all gonna be covered.
[CUSTOMER][NEUTRAL] Is there any way that you can, you can email all this as you're telling me, can you email all that to me about what it covers?
[AGENT][NEUTRAL] Yeah, we have several, yeah, we have several options on how to get this information. I can go ahead and email you a copy, um, but you can always get this as well through the website if you register in [PII] or we can send it by mail. So you just need a copy email to the email address on file.
[CUSTOMER][POSITIVE] Yes, if you will, it's um we got [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, we have Mr. [PII]'s um email.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Send it, send it to my email, um, if you will.
[AGENT][NEUTRAL] Um, let me see if we can because it's the usually send it to the main holder. Let me double check on that. OK, one moment.
[CUSTOMER][NEUTRAL] I'll give you mine.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't think we can change that unless it's to the main holder we can just send that copy of the.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] So any, anything medical that uh that I do, I need to present this card along with my medical card.
[AGENT][POSITIVE] your medical. Correct, yes, that is correct, yes.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we can send this by mail, by fax. It has to be to the fax or to the email address on file to the main holder's email address.
[AGENT][POSITIVE] I can do that and you can probably get it from him.
[CUSTOMER][NEUTRAL] Can you send it, can you send it through the mail?
[AGENT][NEUTRAL] Regular mail? Yes, I can send it through regular mail. Let me go ahead and.
[CUSTOMER][POSITIVE] Yeah, just send it through regular mail cause um that's easier.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, or you can always go to the website and have Mr. his word, um register and you'll be able to see this information as well and also follow up with the claims if you need to do that. Um, so let me go ahead and send the request one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I got under [PII] and register.
[AGENT][NEUTRAL] Yes, you go to [PII] and you're gonna click on sign in, it's gonna take you to the page where you can register.
[CUSTOMER][NEUTRAL] It says find what?
[AGENT][NEUTRAL] Sign in.
[CUSTOMER][NEGATIVE] OK, fine, yeah. You're breaking up bad. That's why I keep asking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's fine. No worries. Uh, yeah, I'm not sure what's going on. Um, yeah, it doesn't sound like that in my end. I'm not sure why is it sounding like that, um, but I want.
[CUSTOMER][NEUTRAL] Are you on a cell phone?
[AGENT][NEUTRAL] No, uh uh
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] No, this is company.
[CUSTOMER][NEUTRAL] Yeah, that's strange.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You uh you're breaking up real bad.
[AGENT][NEUTRAL] Mm, um, I went ahead and requested that, um, certificate to be sent out to you by mail. Um, you usually get this within 5 to 7 business days, but again, if you need this, um, faster, just go to our website and register and you'll be able to see this information.
[CUSTOMER][NEUTRAL] OK, alright, y'all don't cover like dental, y'all just medical.
[AGENT][NEUTRAL] Correct. No, no dental, no vision, no hearing. It's just gonna be regular medical.
[CUSTOMER][POSITIVE] OK, regular medical. OK, all right. Thank you for the information.
[AGENT][NEUTRAL] You're welcome and thank you for calling APL. You have a good afternoon and I'm sorry for the phone. I'm not sure what's going on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you.