AccountId: 011433970860
ContactId: da1012a0-a426-4586-8944-9d972b59ad67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 571539 ms
Total Talk Time (AGENT): 217912 ms
Total Talk Time (CUSTOMER): 310683 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/da1012a0-a426-4586-8944-9d972b59ad67_20250402T20:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Hi, this is [PII]. Um, I have an insured [PII], Sarah, Sarah. Oh, PR team, OK. Oh my goodness. OK, I have an insured on the line with policy number 233-2107.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, Mr. [PII], um, callback number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, OK. I've given him the um benefits for surgery and anesthesiologist, which is $2000 for the max.
[CUSTOMER][NEUTRAL] Um, I've, I've been trying to explain to him, um, it depends on the type of surgery and then a portion of that goes to the anesthesiologist. He just needs a more, I guess, detailed explanation.
[CUSTOMER][NEUTRAL] Um, what I did do for him was give him our toll free number and he's supposed to have the doctor give us a call.
[CUSTOMER][NEUTRAL] To give us that procedure code but.
[CUSTOMER][NEUTRAL] Um, I've tried to explain to him the benefits, but.
[CUSTOMER][NEGATIVE] He's not clear.
[CUSTOMER][POSITIVE] If that makes sense, oh my goodness.
[AGENT][NEUTRAL] Oh, OK. Yeah, I can do my best, um, and try and help them the best I can. [PII], you can go ahead and transfer him through.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much [PII], one moment.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Hi, this is [PII] in the customer care team. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. My name is uh [PII], and um I, I was, uh, yeah, I was calling to, I visited my doctor today and uh he says that what I am going to need is a spi it's called the spinal cord stimulator.
[AGENT][NEUTRAL] Um, Mr.
[CUSTOMER][NEUTRAL] And uh my question was how much would they be able to cover.
[CUSTOMER][NEUTRAL] On a procedure such as that. I understand you can't give me an exact amount. So let me explain what I've understood from the lady that I just spoke to. Uh, uh, and you can verify if I've understood it correct. So the, the insurance would only cover up to $2000. Now, out of those $2000 it would include the anesthesiologist.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The the doctor who's going to do the procedure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um and when we're saying the doctor is gonna do the procedure that would include paying him or her.
[CUSTOMER][NEUTRAL] Plus the procedure, whatever cost comes out of the procedure. Is that correct?
[AGENT][POSITIVE] Mhm. That is correct, yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so there's, because this procedure, according to the doctor, based on what he's done in the past with insurances, it, it's about.
[CUSTOMER][NEUTRAL] Between $40,000 to $50,000 all everything.
[CUSTOMER][NEUTRAL] And it sounds like I would not be able to, you guys would not be able to cover that much, is that correct?
[AGENT][NEUTRAL] Yeah, no. So the important thing to understand about this particular plan that you have is it's called a hospital indemnity plan or a limited benefit medical. So what that means is it's not a major medical, it just pays the set amount.
[AGENT][NEUTRAL] Regardless, it just depends on what you're having done. So there's not a percentage. Most people that have major medical are used to like a PPO or an HMO plan where it's covering a percentage of the cost and then you have your deductible or co-pay that you're responsible for. That's not this type of plan. So that's why the ben that's why the benefit amount is strictly.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] $2000. Um, and that's just for surgery and anesthesia, period. It's not gonna pay anything over that, um, and it's not a percentage. It's that set amount.
[CUSTOMER][NEUTRAL] OK. Understood, understood. Uh, 11 question is, do you, anything based on your experience, uh, are there any, uh, plans or other, uh, insurance companies that would be a good fit for me to acquire?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, if I wanted to get this done and
[CUSTOMER][NEUTRAL] For what I need to get done? Or do you guys have a plan?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That could also offer that.
[AGENT][NEUTRAL] So we don't.
[CUSTOMER][NEUTRAL] That I would be able to do.
[AGENT][NEUTRAL] Yeah, we don't sell any sort of major medical. We sell like supplemental plans. Now, it looks like you have your plan through an employer, so you could reach out to the staffing um employer that you have the plan through to see if there's another medical policy that they offer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you're talking about doing.
[CUSTOMER][POSITIVE] Got it, yes.
[AGENT][NEUTRAL] Um, a major surgery kind of like that where it involves the spine, you definitely want some sort of more, in my personal opinion, if you want it, take it or leave it, you would want more major medical coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I, I, I, I respect your, your, your opinion, your experience and understanding that no, nothing inappropriate being said. And so, uh, do you know?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, no, I just, yeah.
[CUSTOMER][NEUTRAL] Yeah, because this is gonna, according to the doctor, it's about $50,000 including everything. Anesthesiologist, the, the doctor, and whatever procedure. And, uh, do you know of any, uh, companies that, that you can suggest for me to look into, to acquire an insurance that
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] could perhaps cover some of this for a major
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, procedures such as the one I, I, um, we're speaking about.
[AGENT][NEUTRAL] Yeah, you know, I mean, anything that I've had personally in the past is generally just always been offered through my employer. I don't have any sort of like experience as far as finding um a major medical, unfortunately, on my own. I've always just taken kind of what the employer has provided. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so, you know, I mean, I, I
[CUSTOMER][NEUTRAL] Oh, so I, I see what you say.
[AGENT][NEUTRAL] Yeah, I mean, I know of some company names just off the top of my head like United Healthcare, there's Aetna, there's Cigna.
[AGENT][NEUTRAL] Um, those are some other companies that offer major medical.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's, that's making sense to me, yes. Yeah, because this is, and I understand, based on the way the young lady explained it to me and the way you're confirming it, I understand what you're saying that this plan goes up to 2000, and, however, there are other companies that may, that I can look into, uh, that may be able to cover.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, uh, a bigger amount.
[AGENT][NEUTRAL] Right, and you could, right, and you could still keep this insurance as a secondary if you wanted to. You can have more than one insurance. So if you get another insurance, you could have that in this, and, you know, you, the provider and hospital could build both insurances to hopefully minimize the out of pocket cost.
[CUSTOMER][NEUTRAL] Or a procedures such as the one I.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, yeah, that makes sense. And yeah, it sounds like it's gonna have to be a big company, a bigger company, or a different company I should say, such as Aetna or.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, united
[AGENT][NEUTRAL] Yeah, you're just looking for, yeah, you're just looking for more of a major medical plan um in that type of circumstance.
[CUSTOMER][POSITIVE] OK, wow.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][POSITIVE] Well, uh, I appreciate your time and, um, yeah, I appreciate your time and the other young lady's time.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] I am going to have to
[CUSTOMER][NEUTRAL] I'm gonna have to do my homework and look into another uh insurance. All right.
[AGENT][POSITIVE] OK. Yeah, if you, if you have any other questions or concerns, feel free to give us a call.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] Thank you for calling. You're welcome. Have a good day.
[CUSTOMER][POSITIVE] So thank you so much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah.