AccountId: 011433970860
ContactId: e1777cd4-6a37-4b20-8453-3326f48dc2dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 564849 ms
Total Talk Time (AGENT): 389386 ms
Total Talk Time (CUSTOMER): 157001 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/e1777cd4-6a37-4b20-8453-3326f48dc2dd_20250110T16:11_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII], um, with the care team. I was just hoping you could help me. I have some conflicting information on it, HI policies benefits, and I was hoping you could help me. There's no policy, sir, um.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have, I'm looking at policy number 256.
[CUSTOMER][NEUTRAL] 7206.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Mhm. And under Pitsit, I just wanna make sure I'm reading this right, like I'm not, if I'm reading something wrong, I definitely wanna know. Um, I'm seeing the outpatient accident and sickness PT. Is that PT physical therapy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, um, and so it covers it up to 4 times a year for up to $30.
[AGENT][NEUTRAL] Correct, $30 per visit up to 4 visits per year. Mhm.
[CUSTOMER][NEUTRAL] Visits per year. So there's just a note on file where the provider called and asked about PT benefits, and we quoted them that there was it was a non-covered service.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And so now the providers um told the insured like, hey, it's not covered, but the insured called and got that it was. So she's calling back and I was like, well, if it's conflicting, let me check in with somebody. I wanna make sure I'm reading my stuff right.
[AGENT][NEGATIVE] That's not good.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely. No, yes, so you are correct that is for PT. So they have ER physician's office, which is the PO and then urgent care, which would be the UC and PT. So, um, that PT is for physical therapy, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If I'm not mistaken, I would have to go and find us a, a policy, but if I'm not mistaken, it does not cover like occupational therapy or speech therapy, it's just physical. But I, again, yeah, I would have to, you know what, before you relay that information, let me just go out and find that really quick.
[CUSTOMER][NEUTRAL] Just physical.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEGATIVE] Cause I would sure hate for you to relay anything like that and then I'm wrong.
[AGENT][NEUTRAL] Because some of them will cover.
[AGENT][NEUTRAL] And then some of them don't let's see, uh, 751.
[CUSTOMER][NEUTRAL] That's one of those where every policy is different things gets a little tricky, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It really does. And, and then it's just like, oh man, and looked at this wrong.
[AGENT][NEUTRAL] Oh goodness, OK, so let's see.
[AGENT][NEUTRAL] We have.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Plan to see class.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have access to the GRPIS screen?
[CUSTOMER][NEUTRAL] Yeah, GRPIQ. I don't know what the IF screen is.
[AGENT][NEUTRAL] OK, so that's just group information. I don't know if you guys have that, but if you, OK, so if you go to tab number 7 where it says product benefit.
[CUSTOMER][POSITIVE] Yeah, I do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] When you look over there, those are their proposals and everything, sometimes the master policy, even though it's not uploaded for this policy specific, it the master policy will be uploaded also um you can get a description of what the benefit is that.
[CUSTOMER][NEUTRAL] That is the, uh, pardon my, that's
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] Ah, that's good.
[AGENT][NEUTRAL] And then sometimes under PIBFT I don't know if you guys know this as well there's a tab that says try new PIBFT and it will.
[CUSTOMER][POSITIVE] Oh, I go into that all the time. I love it.
[AGENT][NEUTRAL] Yeah, so it will give you, you know, if you look at the description sometimes it will give you a more in depth description of what that is. This one doesn't it just says outpatient accident and treatment benefit so you just kinda have to assume or know.
[AGENT][NEUTRAL] Um, so yeah, but this screen, the, the group I have, um, it's basically group information and this is where I go if I ever need to find a policy. They of course do not have their master on on base, but that doesn't mean that I don't have access to an HR policy. I was just gonna try there first, but if you ever need any information that you can't find on PIBFT or on that specific policy, sometimes you can find it there.
[CUSTOMER][POSITIVE] Holy smokes, OK, that's awesome. I will absolutely I put that in one of, I have an Excel sheet of like um Lion screen sheet sheets and I added it in.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect. OK, so let me see now if I actually can find you.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] Some language on this so that we can look at it. Let's see here.
[AGENT][NEUTRAL] Um, go over to compliance and let's look at some policy er, OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Just looking at these policies search the other day and sometimes I can pull them right up and sometimes it takes me just a minute to actually remember where the heck I'm looking for everything.
[CUSTOMER][NEUTRAL] So then with this one like it's not in the in the tab 7 so do you do the.
[AGENT][NEUTRAL] There
[CUSTOMER][NEUTRAL] Are you looking through like the brochures like that through that thing or?
[AGENT][NEUTRAL] You can, yeah, you can look at brochures, um, let's see, are they benefits in a card? Usually these policies are, but.
[CUSTOMER][NEUTRAL] Isn't it doesn't it when it ends in a B, it's benefit. I don't know. I just guessed.
[AGENT][NEUTRAL] Yeah, usually it is, usually it is, um, I just, I was still in that group so I wasn't 100% OK, yeah, I do see that be there so yeah you can um go out there and so when you go, let's say they were issued this and what um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Don't know that that matters, but we'll go ahead and pull it up anyway, so plan 2.
[AGENT][NEUTRAL] And when we look at the description, it's taking a minute.
[AGENT][NEUTRAL] I don't know where you live, but I live in like Northeast [PII]. I, I say Northeast, it's more central [PII], and we've gotten our first snow in probably 7 years. So everything, including our bodies, I think are moving slow today.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We're all just kind of like uh.
[CUSTOMER][NEUTRAL] I feel like
[CUSTOMER][POSITIVE] My computer really does know when it's cold out, like it's aware, it knows what's going on and it makes you pay for it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For sure it for sure it's just like mm, not, not crazy about this and I'm like, I feel you, but I, I kinda need to get some stuff done today um let's see, OK, so it does say pays the applicable per day benefit when a covered person receives treatment in an emergency room, the urgent care physician's office, or physical speech occupational therapy facility due to an injury or covered sickness. So it actually does. So this one does cover speech and occupational. It's just listed.
[CUSTOMER][NEUTRAL] Speech, occupational, physical therapy, but it has to be due to an accident or sickness.
[AGENT][NEUTRAL] Or sickness. Mhm. It has to be, well, and, you know, we have to be careful with our language because it says accident, but it's bodily injury.
[AGENT][NEUTRAL] That's very specific. Are you familiar with like the.
[AGENT][NEUTRAL] The difference between the two?
[CUSTOMER][NEUTRAL] No, not really.
[AGENT][NEUTRAL] OK, so they are called accident policies which I think causes a lot of confusion for both providers and insured, um.
[AGENT][NEUTRAL] An accident, obviously, you can fall. Oh, that's an accident. You didn't do it on purpose, you know, um, bodily injury per our policies is that there's actual damage to your body because of the occurrence. So,
[CUSTOMER][NEGATIVE] I think she said something was wrong with this rotator cuff.
[AGENT][NEUTRAL] OK, so that.
[AGENT][NEUTRAL] That could fall under either one honestly depending on how they code it so um.
[CUSTOMER][NEUTRAL] I'll just let her know it's all gonna be based on how the claim comes through, um, but that, that benefit is there for physical therapy, speech therapy, or occupational therapy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. And I would say due to injury or sickness, um, instead of accident, yeah, cause like I said, with him having a rotator cuff issue, that would be technically, um.
[CUSTOMER][NEUTRAL] Injury or OK, accident.
[AGENT][NEUTRAL] I, I would say it would meet definition for injury. Um, but then you have to look on the flip side that it has to be due to an accident. Like is it just wear and tear or which then, right. So, but because this one covers sickness or injury, it's, there's a, it's so much broader.
[CUSTOMER][NEUTRAL] Or did something happen?
[AGENT][NEUTRAL] Of coverage than just one or the other so as long as you say injury or sickness, I feel like we shouldn't have any problems but again it's gonna uh it all we have to look at how they code it when it comes over, but that is covered um under this particular policy.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much for helping me go through that and find that all and I just want to make sure, especially with the conflicting like remarks that I'm new, I wanna make sure I'm giving the right information.
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Yeah, of course, anytime, anytime you got any questions let us know.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. I really appreciate you. Thanks. You too. Bye-bye.
[AGENT][POSITIVE] You're welcome. Have a good one, [PII].
[AGENT][NEUTRAL] All right, bye.