AccountId: 011433970860
ContactId: eec8c73f-c940-4e84-91f9-7c4ba1a842d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694299 ms
Total Talk Time (AGENT): 357338 ms
Total Talk Time (CUSTOMER): 201844 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/eec8c73f-c940-4e84-91f9-7c4ba1a842d3_20250107T15:17_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], my name is [PII]. Um, I believe I'm a member with APL. I just kind of wanted to go over, you know, or if there's a way I can find it online just like what coverage I have and deductibles and stuff like that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yeah, we could take a look and see what policies you've got with us, [PII]. um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah it's 254.
[CUSTOMER][NEUTRAL] 721.
[CUSTOMER][NEUTRAL] 0589
[AGENT][NEUTRAL] OK, thank you. Do you have a policy number?
[CUSTOMER][NEUTRAL] I, I not in front of me. I, I don't know. I, I've been trying to call just to get some more information, um.
[AGENT][NEUTRAL] Sure, OK, um, I can start using your social.
[CUSTOMER][NEUTRAL] OK, it's uh [PII].
[CUSTOMER][NEUTRAL] 16
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and [PII] what was your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] OK, I'm just gonna verify some information really quick. Um, can I get your uh date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, in [PII].
[CUSTOMER][NEUTRAL] [PII] yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Perfect and then last thing I need is the email address that we've got on file for you uh looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Should be [PII]. [PII].
[AGENT][NEUTRAL] Got it. OK, thank you for verifying that. So it looks like you've got two policies with us, [PII]. Uh, one is an accident policy, the other is our hospital indemnity, uh, which that is a limited indemnity medical plan. There's no co-pays or deductibles, um, essentially it just pays a set dollar amount, uh, per office visit or procedure.
[CUSTOMER][NEUTRAL] Oh, OK, um,
[CUSTOMER][NEUTRAL] Yeah, and that's just any offices if I go to a dermatologist or or if my wife goes to OBGYN or anything.
[AGENT][NEUTRAL] Let me take a look. Um, they are all very different, so let me see what is uh covered. Sometimes they're only for, you know, for example, if it's regarding a sickness or something like that. Let me get your policy pulled up here. Bear with me just a moment.
[CUSTOMER][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and uh while I have this information up, if you don't have it already, [PII], I can send you a copy of your ID card and a copy of the policy if you'd like.
[CUSTOMER][POSITIVE] Oh, I would love that, yes.
[AGENT][NEUTRAL] OK, yeah, um, did you want me to just email that to you?
[CUSTOMER][POSITIVE] Yes, you can email that yeah.
[AGENT][POSITIVE] OK, perfect. All right, give me just a moment here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like on this policy, you've got the outpatient sickness benefit. So that's gonna be the only office visit that would be covered if it's in regard to a sickness. So that would be a physician's office, urgent care, things like that.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] But everything else is going to be hospital confinement, um, intensive care, coronary unit, and then you've got a surgical and anesthesia benefits as well.
[CUSTOMER][NEUTRAL] OK. What about like annual physicals that, that's not in there?
[AGENT][NEUTRAL] I don't see a wellness benefit for this policy. Let me see.
[CUSTOMER][NEUTRAL] OK, but that might be part of my monthly plan or so.
[AGENT][NEUTRAL] Well, now, hang on just a moment. Let's see.
[AGENT][NEGATIVE] Sorry, it's um a bit slow this morning. I think cold is kinda slowing everybody down.
[CUSTOMER][NEUTRAL] Oh no, you're fine.
[AGENT][NEUTRAL] OK. So yes, there's a wellness and diagnostic test benefit rider. Um, so, diagnostic testing is going to be things like um MRI, uh, CT scan, colonoscopy, and then there's the wellness exam.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Here we are, OK, so that benefit is it would pay $75 per test or per per wellness exam, excuse me.
[CUSTOMER][NEUTRAL] OK, oh, just $75.
[AGENT][NEUTRAL] Yeah, um, and so the same is with the outpatient sickness as well it would essentially be $75 per visit and that's going to be regardless of what happens there I mean if it's strictly a consultation or if there are tests or anything like that it pays that set amount.
[CUSTOMER][NEUTRAL] OK, OK. Um, OK, that's interesting. uh.
[AGENT][NEUTRAL] It is a different kind of policy, yes.
[CUSTOMER][NEUTRAL] Yeah, um, and this is this the same for my spouse or is this, is it different?
[AGENT][NEUTRAL] Oh yes, um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII], yes, so she's covered under this policy as well.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, OK, she's
[CUSTOMER][NEUTRAL] Ah, cool. OK, so we have the same thing.
[AGENT][NEUTRAL] Yes, absolutely, and I will get this sent to you. Um, I'll send you the accident policy as well. That one doesn't have an ID card. um, obviously that's going to be more if, you know, either one of you were involved in an accident, um, and then you needed to go and receive care, then you could file claims for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Car
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it's, uh, I, I'm curious if, if we've been using this because, uh, I don't know if you have the ability to just, you know, don't have to go into the details of the past claims, but you know, I know in the past we've been married for 4 years, so, uh, at least since [PII] I think, uh, we've had a couple of claims. I don't know if they've gone through APL because I've been, we've been, I have this card, but it doesn't have APL listed on there. It has multipla listed on there, but I guess that's a different.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Yes, and then this is where it gets even more confusing, um, but so I do see this this plan has been active since [PII]. So looking at you I see that we've received 4 claims for you. We were and they were all through positions.
[CUSTOMER][POSITIVE] Sounds great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we were only able to pay on one and that could be that we were missing information. Um, I will say this to you, [PII], that sometimes it really does depend on the provider whether they, you know, quote, choose to accept this coverage or not. That basically means whether or not they would follow the claims for you if you ever run into that they're more than welcome to give us a call first of all and we can explain the plan to them if there's confusion.
[AGENT][NEUTRAL] Or if you know it's kind of one of those things that's too late, um, or you don't wanna go anywhere else, you can absolutely file those claims yourself. So if they don't do it for you, don't think that you're just completely sunk.
[CUSTOMER][POSITIVE] I got you. OK, so I can, I can just call you guys and get it submitted that way, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course, uh they can too you can give us this phone number or you can give them this phone number just again it'd be less for you to have to worry about, um, so we've received four claims for [PII] as well dating from [PII]. The last one we received was in [PII] and we paid on three of those.
[CUSTOMER][NEUTRAL] OK, was that just the $75 or is that?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] That one that was 75.
[AGENT][NEUTRAL] Another one. Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so for each of those that paid $75.
[CUSTOMER][NEUTRAL] I got you. OK, so it's not like a deductible or anything like that. It's more.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Right, that's what that limited indemnity is again it's specific yet very broad if that makes sense and you'll kind of see that in your policy, um, where it's since it pays that just that set dollar amount it's not like, you know, Blue Cross or Aetna where you have to reach a deductible, make those co-pays where it and then it pays a percentage. This one just pays that set dollar amount.
[CUSTOMER][NEUTRAL] Yeah, OK
[CUSTOMER][NEUTRAL] I got you. OK. Is there a way to, to upgrade or is there other options or is that just how AP?
[AGENT][NEUTRAL] That would be it would be through your employer if they offered different options it would be through your employer, yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] Got you, got you, OK, well I think our, well, I think our enrollment was already.
[CUSTOMER][NEUTRAL] It's already gone through so.
[AGENT][NEUTRAL] I think it well I don't know I mean I know sometimes there's the open enrollment, but then at the start of the [PII] they might have options as well.
[CUSTOMER][NEUTRAL] Yeah, but I think that ended already.
[AGENT][NEUTRAL] Oh, really? Well, I don't know. It might be worth uh worth to ask.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] OK, yeah, OK, maybe I can, I can at least ask, yeah, you're right, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Are you guys, what number did I call her because I do have they do have a number, but I don't think that's the one I called you but regardless of.
[AGENT][NEUTRAL] Ours is the um
[AGENT][NEUTRAL] It's [PII]. That's our direct number to our customer service.
[CUSTOMER][NEUTRAL] OK, OK, OK, um, OK, interesting, yeah, so I'll, uh, yeah, I'll, I'll try to give them a call to see, um, to see if I can upgrade or whatever they, whatever they offer, um, so on and so forth, but no, that sounds good.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, yeah, did you have any other questions for me? Trust me, I know it's confusing.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, oh, yeah, I know. I, I, it's funny. I work in the medical industry too, and but I don't do the insurance so it's too confusing. I'm just a simple IT guy.
[AGENT][NEUTRAL] I, yeah.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] That would be me, yes.
[CUSTOMER][POSITIVE] Yeah, so, uh, oh, now I think I got the card or the information here, so great.
[AGENT][NEUTRAL] Um, I did just send one of the policies. I'm sorry, they are all going to be separate. Um, I'm getting your ID card sent now and then I'll get your, yeah.
[CUSTOMER][NEUTRAL] Oh cash.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, OK, well I'll call, I'll call on my employer and see uh what I can do on the, on the enrollment stuff, but.
[AGENT][POSITIVE] All right sounds good if you have any other questions feel free to give us a call back and I hope you have a great rest of your day, [PII].
[CUSTOMER][NEUTRAL] Hold on
[CUSTOMER][POSITIVE] Yes you too thank you very much.
[AGENT][POSITIVE] All right thank you bye bye.