AccountId: 011433970860
ContactId: da0b729f-8037-48d0-8cf1-2c89c82e6b23
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 954760 ms
Total Talk Time (AGENT): 424188 ms
Total Talk Time (CUSTOMER): 306005 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/da0b729f-8037-48d0-8cf1-2c89c82e6b23_20250306T16:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I was, I'm calling about uh my policy to see if something's covered under it for my wife. I think my wife is on all my uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My policies that I have with y'all.
[AGENT][NEUTRAL] OK, so you have a question regarding a benefit on one of your policies, is that correct?
[CUSTOMER][NEUTRAL] Sorry, what was that
[CUSTOMER][NEUTRAL] Hold on a sec.
[AGENT][NEUTRAL] I'm so sorry. I'm having trouble hearing you. Did you say that you have a question?
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][MIXED] Uh, it's still not a very good connection, but we'll do the best that we can.
[CUSTOMER][NEUTRAL] Can you, can, yeah, I had a question. Uh, my wife, let me find out what she's, what was it, [PII]?
[CUSTOMER][NEUTRAL] Uh, it was a colonoscopy she's going to, and I wanted to find out exactly, uh,
[CUSTOMER][NEUTRAL] If any of my policies had to pay out for doing that.
[AGENT][NEUTRAL] OK. So yes, sir, I can check some benefit information for you. And who am I speaking with, please?
[CUSTOMER][POSITIVE] So yes, so I can check the information for you.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] I'm sorry, what was your name again?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII] is the last name?
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] OK, Mr. [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number? One of them?
[CUSTOMER][NEUTRAL] No, I don't. I'm sorry.
[AGENT][NEUTRAL] OK, what is your full, are you the subscriber? Is the, are the policy for? OK.
[CUSTOMER][NEUTRAL] Yeah, uh, it's, it's my, it's, it's my policy, and she's under my policy.
[AGENT][NEUTRAL] OK, so for, what is your social security number, Mr. [PII], so I can locate your information.
[CUSTOMER][NEUTRAL] The policy that I have.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] out
[AGENT][NEUTRAL] OK, so give me a moment to get your information pulled up, Mr. [PII]. Then I will have to verify several things with you first, for security purposes and also any information that is provided today would 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] Uh, date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you. And your wife's name and date of birth?
[CUSTOMER][NEUTRAL] Wife is uh [PII] and it's [PII].
[AGENT][NEUTRAL] OK, so just one moment.
[AGENT][NEUTRAL] And then your home mail mailing address, please, Mr. [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. And the last piece of information to verify would be your email address.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, thank you. So just a moment please.
[AGENT][NEUTRAL] Yeah, Mr. [PII], give me just a moment because one of my screens is not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Working properly. I'm sorry.
[AGENT][NEUTRAL] OK, Mr. [PII], I'm so sorry that this is taking as long as it is, but I'm not able to fully access some information that I'm trying to.
[AGENT][NEUTRAL] Regarding some
[AGENT][NEUTRAL] Benefits on your hospital indemnity plan to see if there are any benefits on this. Is this, is she having this, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As like a screening or is this due to some complications she's having?
[CUSTOMER][NEUTRAL] Let me find out.
[AGENT][NEUTRAL] While this is still trying to
[CUSTOMER][NEUTRAL] Hey, what do you, what do you, uh, having this for a screening or complications or what?
[CUSTOMER][NEUTRAL] I guess it's a preventive screening.
[AGENT][NEUTRAL] I'm sorry, it's for what?
[CUSTOMER][NEUTRAL] Like a screening of preventive screening like she's um, yeah, well, like she's high, I guess high risk because her it's uh runs in the family.
[AGENT][NEUTRAL] A preventative, OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I just wanted to see uh.
[CUSTOMER][NEUTRAL] I mean, I don't know what's entailed with that as far as that. Like I think they run a camera or whatever.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] From what I understand, so I didn't know if that was a hospital. What, what exactly what kind of benefits y'all paid out because I had a, I had a surgery and I was telling her that, uh, they paid out $1000 and my, my hospital bill was for the hospital was $1300 so it actually it covered $1000 and I only paid out of pocket $300. So you never know, you know what I'm saying?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely. No, sir. So,
[AGENT][NEUTRAL] The, is she going to be having this done in like an outpatient facility?
[CUSTOMER][NEUTRAL] Let me ask because I don't know. I just was wanting to find out just in case something was covered.
[AGENT][NEUTRAL] OK. Because there's only, yes, sir. It's possible that there would be benefits regarding, again, it's just going to depend, depend on the charges that we receive.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Um, if, if it's considered a diagnostic testing, then there are not benefits for colonoscopy on this plan. So, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it falls under, if it were to fall under a surgery.
[AGENT][NEUTRAL] Her surgery benefit, then that could be, you know, possibly reviewed under that. And that benefit, you know, would be $1000 per day maximum 1 day per calendar year. But again, that we would just have to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's so so if she's gonna run a camera.
[CUSTOMER][NEUTRAL] It would just be, there would be no.
[CUSTOMER][NEUTRAL] There wouldn't be no but if she would have a type of surgery.
[CUSTOMER][NEUTRAL] Involved in that, then it would be $1000.
[AGENT][NEUTRAL] Yes, now it, well, what I'm saying is correct. It could be that is the max benefit on this policy for an outpatient surgery, if it's related to sickness. If it's a screening benefit, now there are not benefits on this policy for that. So again, it would just be dependent upon the information that we receive from the provider on their claim.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so yeah, uh, it's just the screening.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Yes, sir, so that would not be covered under this policy. Let me look to see if there's any other potential.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] But it, but just, just for future if something was like if she had to go in for a surgery.
[CUSTOMER][NEUTRAL] It would be $1000 maximum for like one day in a, in a facility.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Well, it would, again, that would be dependent on several different things, um, but that would be, yes, that is the benefit for something that is related to accident or sickness, uh, for a surgery benefit that's either done in, in the hospital, an outpatient facility, or a free-standing surgery center. If it's something that's done in a doctor's office, then that benefit is $500 per day and a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But give me just a moment to look to see if any of your other policies may have a benefit for
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it's a routine screening.
[AGENT][NEUTRAL] I'm gonna see if you have any possibly on one of your other policies. Give me just a moment.
[AGENT][NEUTRAL] Now while this information is loading, have you all ever set up your profile, Mr. [PII] in the online service center with APL so that you can have access to all of your information online?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I do, but sometimes when I go to look up, uh, like if I go to look up policies and what what payouts are sometimes it doesn't load all the time, so that's why I just call y'all to find out.
[AGENT][NEUTRAL] You did? OK
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And that's fine, but you're welcome to do that. Um, now, let's see.
[AGENT][NEUTRAL] And it's possible if it's a wellness test or routine, you know, screening.
[CUSTOMER][NEUTRAL] Yeah, I think it I think, I think it is covered under the wellness like but that I think that so I had submitted stuff for my wellness and I think it only paid out 50.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I was gonna say because that would be under your, well, under your critical illness.
[CUSTOMER][NEUTRAL] Uh, usually it pays out 100.
[CUSTOMER][NEUTRAL] Yeah, but I didn't wait.
[CUSTOMER][NEUTRAL] But what happened was is I didn't wait a full calendar year, right? It's what the lady I had when I had called to see what was going on and only paid out one but she was saying because I had to wait a full calendar year for me to resubmit but it's also if she would do like any kind of blood work or anything, it's it's separate so it's actually $50 per.
[CUSTOMER][NEUTRAL] Each policy I have.
[AGENT][NEUTRAL] Well, not each policy. No, sir, because they don't all have screening. Your, um, you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, well, the last time I had did it, I got $100 so it was $50 per whatever it was. One of the policies did have it, but I know the other two did.
[AGENT][NEUTRAL] OK, so you're, yes, you're in your
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] OK. So on your group critical illness, you do have the health screening benefit. That is one of the policies that has that.
[AGENT][NEUTRAL] And that's for a wellness test or routine physical exam or any general additional general medically accepted screening test received as an outpatient. And there's also a benefit on there for a mammogram.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So the benefit on that for the wellness, yes, sir, that is, and a colonoscopy is, provided that it falls under the well of screening, that is one of the wellness tests that's on there. And again, that benefit would be $50 and it is one test per calendar year. And there is a list of the different tests.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Within that, you know, policy certificate on your group critical illness policy, which I can give you that policy number if you would like.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] But some
[CUSTOMER][NEUTRAL] No, because what I do is I just submit it online and then it it it it it uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I don't wanna say that it, it charges against each different policy I got whether it pays out or not. So it applies to each, each one and then I guess this y'all just go through it and check and pay out on on whatever.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] When I, yes, sir, for the wellness benefits, that's what it does. The system will cross check each of your policies and so it does. It looks at each one if it
[AGENT][NEUTRAL] You know, and because when we file our wellness, it's the same thing. So I may get an explanation of benefits saying, you know, this policy that I personally have doesn't have a wellness benefit. And I'm like, OK, you know, I, I kind of really know that, but our system just double checks it anyway. So that's how this works for you as well.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, well that's all I have.
[AGENT][POSITIVE] OK, then. Well, if that's all I can help you with today, Mr. [PII], thank you again for calling APL and I hope that you and your wife have a very nice and safe day.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Yes, sir. You're welcome and thank you again for calling. Bye-bye.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Alright bye.
[CUSTOMER][NEUTRAL] If you were to have a surgery.