AccountId: 011433970860
ContactId: ef992f37-ad89-49b1-a2b8-64557c56f3b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497720 ms
Total Talk Time (AGENT): 309142 ms
Total Talk Time (CUSTOMER): 172167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/ef992f37-ad89-49b1-a2b8-64557c56f3b7_20250218T23:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] Doing well thank you how are you?
[CUSTOMER][NEUTRAL] Doing all right, thank you. You got a minute left and I'm sorry to hand this to you but um I've got an insured on the line um she has a few questions about the policy. Um, one of them is mental health, which frankly I'm not quite sure. I don't see anything explicitly stating, and that's such a broad thing to me, so I'm, I'm not quite sure. I know some people would consider that a sickness, so I'm just not sure if that's going to be anything covered under her policy.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] It is 2571784.
[AGENT][NEUTRAL] OK, and that's the insured calling?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[AGENT][NEUTRAL] The [PII]. OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then is that her callback number or do you have a call back?
[CUSTOMER][NEUTRAL] I do. Let's see if that's the same one, the [PII], yeah.
[AGENT][NEUTRAL] And she's asking specifically you said about mental health benefits, right?
[CUSTOMER][NEUTRAL] Yes, um, she also asked of course what networks were affiliated with, but I did kind of explain how this policy works in short, um, but I don't know if that might be something she asked you as well.
[AGENT][NEUTRAL] OK, and everything's been verified correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, I appreciate you thank you.
[AGENT][POSITIVE] You're welcome have a good evening.
[CUSTOMER][NEUTRAL] Alright. You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, good evening. My name is [PII]. I, um, uh, in the claims department, is this Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] I'm doing well thank you how are you?
[CUSTOMER][POSITIVE] I'm good.
[AGENT][NEUTRAL] So Ms. [PII] transferred you over to me. I have some specific questions about your policy benefits, um, and she's, I think she said you were asking about mental health benefits, is that right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, like, do you guys, um, help cover for mental health, um, services like counseling and going to get evaluations and things like that.
[AGENT][NEUTRAL] OK, um, uh, so let me just start with let me pull up your policy here and this would be outpatient services, is that right?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, no be patient like I'm not going to get like, um, admitted or anything. Just gonna do a little, yeah, you know, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so let me just pull up your policy benefits and we can go over the benefits just to let you know it is a verification of your coverage only and not a guarantee of payment. Um, now, um, this policy is a limited uh medical hospital indemnity plan so it does pay uh limited medical benefits. Now this policy doesn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much does it pay?
[AGENT][NEUTRAL] Well, it would
[CUSTOMER][NEUTRAL] Does it, how much, what percentage of the bill does it pay like?
[CUSTOMER][NEUTRAL] You know, like,
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Is it just a set of from each um
[CUSTOMER][NEUTRAL] Like if I was to pay $150 out of pocket, like how much would this insurance cover?
[AGENT][NEUTRAL] OK, so that's gonna depend on the, on the service, uh, the services rendered, so there is a schedule of benefits um here that I can go over those benefits with you. Now of course there um in this policy there is hospital admission and consignment for there if you were uh in inpatient. There is also a surgery benefit um and diagnostic testing as well as uh prescription drug and ambulance benefit.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, as far as the treatment um for this policy, so let me just give you kind of, for instance, so the outpatient accident and sickness treatment benefit, um, it's kind of broke down into a couple different categories. You have an emergency room, you have an urgent care, and you have the physician's office. So more than likely if you were going to see a counselor, um, that would be uh.
[AGENT][NEUTRAL] More than likely those services are rendered in the physician's office or some sort of clinic, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So you are allowed for that physician's office benefit um you're allowed up to 4 days per covered person per calendar year and we would pay a benefit of $50 and that, um, so and like you were asking if you paid that co-payment or you paid um the amount out of pocket and we would reimburse up to $50 per day and again that's 4 days per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so, so if I went to to this counselor and I did end up paying out of pocket, you guys would still be able to reimburse me $50 back like with this $250 like or what? I don't know.
[AGENT][NEUTRAL] Yeah, it would be that $50 benefit that's the maximum payable per day and again you have 4 visits, basically 4 days per covered, uh, per calendar year. So we weverse you that $50 for that office visit, um, and again that that maximum benefit would be $50 and it's up to 4 days. Now, um, can you tell me, Miss [PII], do you know when you signed up, did you sign up for the
[CUSTOMER][NEUTRAL] How.
[AGENT][NEUTRAL] Um, MEC Wellness, in addition to this policy, do you know if you have the wellness?
[CUSTOMER][NEUTRAL] Uh, I, I for sure I was gonna get whatever I could get that was kind of affordable and that was stilling with the money on my check, like, you know, so, um, I'm not quite sure, but, um, I do have an OBGYN appointment tomorrow for a follow up check up that they're charging me $80 out of pocket tomorrow. Can I provide them with this insurance information?
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can, um, you, yes, you have a a copy of your card?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so yeah, you would go ahead and present that card um to that um physician's office. Um, a lot of times they'll call and get your benefits, um, now you have 22, scenarios that you can use. You can either present the card to them and then they usually have you sign an assignment of benefits over and what that does is give them permission to bill to send us a bill, a claim on your behalf, um, or you can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Out of pocket and then send the claim in yourself for reimbursement. A lot of times it's easier if you just give that assignment over to the physician's office, um.
[CUSTOMER][NEUTRAL] Right, right, what I'm gonna do, and then, so then I know.
[AGENT][NEUTRAL] And also,
[AGENT][NEUTRAL] Um, just so you're aware, um, ask them if, uh, ask that provider or that doctor's office if they participate with multi-plan.
[AGENT][NEUTRAL] And um because this is because this is limited medical benefits, um, it, you know, some providers or doctors will actually be participating with multi-plan and they may be able to offer you um some sort of discount for the amount that's charged.
[CUSTOMER][NEUTRAL] Multi
[AGENT][NEUTRAL] Um, between the amount that's charged and the amount that this, um, policy pays because it is limited coverage and it doesn't work like a major medical. Now that information is also on your ID card. It tells you like at the bottom there to locate a provider, uh.
[AGENT][NEUTRAL] Use that website or that phone number, um, but that will help remind you to ask them um and when you present that card they should see it as well um that providers of the doctor's office and they should know whether they participate with multi plan.
[CUSTOMER][NEUTRAL] OK, OK, so I will ask tomorrow morning if they participate with multi plan. That sounds good.
[CUSTOMER][POSITIVE] Um, I thank you for your time and explaining and breaking it down to me and telling me like the way I can do it, like just provide them the card and give them permission to.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Did you have any other questions Miss [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, that's about it for now. If I do, I'll just call back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Tomorrow
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you have a good
[AGENT][POSITIVE] You too, thank you for calling APL. I hope you have a great evening bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.
[CUSTOMER][NEUTRAL] Bye bye.