AccountId: 011433970860
ContactId: fdccb88f-530a-4345-98e3-a8f18c405418
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398459 ms
Total Talk Time (AGENT): 218282 ms
Total Talk Time (CUSTOMER): 111538 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/fdccb88f-530a-4345-98e3-a8f18c405418_20250102T17:41_UTC.wav
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[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from Benefits in the card. I have a, a mutual member on online, um, [PII]. She has some questions that I do not have to answer regarding her benefits. Are you able to assist her?
[AGENT][POSITIVE] Yeah, I can absolutely do my best to help her out today.
[CUSTOMER][NEUTRAL] I, I do not have a policy number but I do have her social.
[AGENT][NEUTRAL] OK, perfect. Let me get that search screen up and we'll try to find her. Um, what is that social security number?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Um, OK. It's [PII].
[AGENT][NEUTRAL] All right, and.
[AGENT][NEUTRAL] Perfect and just her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, um, and yeah, I looks like she has a couple different policies with us and I can help her with whichever one she wants to look at.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me your name one more time? I'm sorry.
[AGENT][NEUTRAL] Oh, yes, it's [PII]
[CUSTOMER][POSITIVE] Alright, just bear with me. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi this is [PII] with APL.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling and I was calling uh.
[CUSTOMER][NEUTRAL] I'm here at the well 1st 1st Care and I was calling to see if I have a copay that I had to that I have to pay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, um, so let me pull up that policy you have with us, your hospital indemn indemnity policy. It looks like we want to look at. Um, while I'm getting that, that I cannot talk today, Ms. [PII]. I'm so sorry. While I'm getting that policy pulled up, would you be able to verify for me your mailing address on file?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and then just the email address as well, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] All right. Perfect. And then lastly is just your date of birth, if you will.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, thank you. All right. And so it looks like under that hospital indemnity policy, we do.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do have a benefit for you. I do wanna let you know any benefit information I give you is just a verification of coverage and not a guarantee of payment. Um, it looks like we have.
[AGENT][NEUTRAL] If for sickness, a maximum benefit of $75 per person, um, that would be eligible for coverage.
[AGENT][NEUTRAL] And it looks like
[CUSTOMER][NEUTRAL] So, so, so what, so what does that mean?
[AGENT][NEUTRAL] Um, so,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] If you file a claim with us or the facility that files a claim with us, um, your coverage options, it's up to $75 per visit for outpatient sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and so that's, that's the benefit that you'd have with us is up to $75.
[CUSTOMER][NEUTRAL] So it's so.
[CUSTOMER][NEUTRAL] So, uh, I guess my question is, so am I, am I gonna have to pay a $75 copay or what?
[AGENT][NEUTRAL] So this policy, this isn't a major medical plan, so there's no um like co-pay or deductible on it um it's a limited hospital indemnity policy, so it gives you supplemental benefits. I wouldn't be able to know how much you would be like I wouldn't be able to tell you how much.
[AGENT][NEUTRAL] You would end up paying out of pocket, but I can tell you that for outpatient sickness you have the benefit of up to $75. If you have any uh diagnostic testing, it looks like there's a benefit for up to $250 for diagnostic testing on here, um, but without seeing the claim form, I wouldn't be able to know.
[AGENT][NEUTRAL] Offhand like how much of what benefits um you'd be eligible for.
[AGENT][NEUTRAL] You just want to submit like a claim.
[CUSTOMER][NEUTRAL] Um, so I guess my question is.
[CUSTOMER][NEUTRAL] So should I, should I have um uh submit, submit, submit the uh submit a claim?
[AGENT][POSITIVE] Absolutely. I would, as much as you possibly can have the provider do it because they're gonna have access to all that paperwork and have them file the claim on your behalf.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK, so, uh, so do I need, so do I just need to show them this card that I have?
[AGENT][NEUTRAL] Yeah, I'd let them know that it's um like a supplemental hospital indemnity policy that you have outpatient benefits, um, and they can always, if they need to, they can always call us for verification of coverage and we'll do the same thing as where we tell them, you know, you have up to this much available per visit, um, and then.
[AGENT][NEUTRAL] They'll file the claim with us and then typically from there we don't like we would pay them if they file the claim or if you end up filing the claim with us the money would go to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty
[CUSTOMER][NEUTRAL] That's all I need to know.
[AGENT][NEUTRAL] Is there anything else I can do to help you, Miss [PII]?
[CUSTOMER][NEUTRAL] Mm, no, that was it cause like I said, um, not feeling too hot so I wanna go on and see what what's going on cause I know, uh, I saw some of that that COVID craps going around again.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yes, I wish you the best of luck and I really hope you get to feeling better. I know we have like a norovirus outbreak in my town just a couple of weeks ago, so I wish you the best and I hope you get feeling great.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I too.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure. You take care, Miss [PII] and happy New Year.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.