AccountId: 011433970860
ContactId: ff07f551-28dc-45cb-9fe2-5cb5e7b5920d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397630 ms
Total Talk Time (AGENT): 189132 ms
Total Talk Time (CUSTOMER): 109803 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/ff07f551-28dc-45cb-9fe2-5cb5e7b5920d_20250328T19:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], my name is [PII]. I'm calling because I'm trying to see if I'm covered. I use today I have my exam and I have my car here, but I don't know if the expenses that I had are covered if, if they are how to submit it and all that.
[AGENT][NEUTRAL] OK. Do you have a policy number on that card?
[CUSTOMER][NEUTRAL] A policy number, yeah, it's 02.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 1902.
[AGENT][NEUTRAL] OK, let me pull that up. Hold on one moment.
[AGENT][NEUTRAL] And what was your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your first name was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Uh, and let's see, um.
[AGENT][NEUTRAL] So it looks like for this policy,
[AGENT][NEUTRAL] This is like a uh supplemental medical policy.
[AGENT][NEUTRAL] So it'll pick up, it'll pick up like outpatient and inpatient hospital charges.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Um, or is it.
[CUSTOMER][NEUTRAL] So like eye exam or related to eye exam is not covered.
[AGENT][NEGATIVE] Correct, yeah, [PII] would not be covered.
[CUSTOMER][NEUTRAL] OK, so when it's outpatient or um.
[CUSTOMER][NEUTRAL] Whatever you were saying exactly what it is. When we go to check up with a regular doctor or what?
[AGENT][NEUTRAL] So let me pull up exactly what's covered on your policy. So it's
[AGENT][NEUTRAL] And this is not a guarantee of payment, it's just a basic outline of your policy, so it's gonna be for if you're inpatient in the hospital, it'll pay up to $2000 after your primary insurance pays so that could be paid towards your like deductible or co-insurance and then if you had outpatient hospital services, it would pay up to $2000 as well. So after your primary.
[CUSTOMER][NEUTRAL] If if
[CUSTOMER][NEUTRAL] But when you say outpatient, outpatient hospital services, what does that mean? Like
[CUSTOMER][NEUTRAL] Because if I go to see a doctor, is that is that considered outpatient hospital or what exact, I don't, I'm trying to understand that part.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So it would be for let me see.
[AGENT][NEUTRAL] It would only be for if you went to like the physician's office and had like treatments or procedures, the actual office visit is not covered under this policy, or say you went to the hospital and had surgery um and had to stay inpatient or had like an outpatient surgery, um, so it'd be like things of that nature.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Mm, I just, I, I don't understand what outpatient because outpatient means that it wasn't done in the hospital. I, I, I'm just trying to understand what that means.
[AGENT][NEUTRAL] It, it'd be basically anything that you had rendered like if you went to the outpatient hospital, so I went to like um I don't, uh.
[AGENT][NEUTRAL] I'm not sure what's a big hospital that's close to you?
[CUSTOMER][NEUTRAL] I don't know that my, I guess um.
[CUSTOMER][NEUTRAL] Oh my God, I can't remember the name. Um, let's say [PII], yeah, what.
[AGENT][NEUTRAL] Whatever
[AGENT][NEUTRAL] OK, yeah, [PII]. So if you went to Mercy and you had to have surgery, um, say like you had to have knee surgery or something like that, for example, this policy would pay after your primary insurance paid. It could pay up to $2000 for, for a knee surgery, for example.
[CUSTOMER][NEUTRAL] Yeah, but then you surgery will be done in the hospital.
[AGENT][POSITIVE] But I'm sorry?
[CUSTOMER][NEUTRAL] Is that a patient that's an inpatient thing.
[AGENT][NEUTRAL] Right, so it'd be outpatient too. Say you had to have like your gallbladder removed, which is typically an outpatient procedure, or you had to have like some diagnostic.
[CUSTOMER][NEUTRAL] Of is that is that that I don't stay overnight, is that what I mean?
[AGENT][NEUTRAL] You, you don't have to stay overnight. There's two separate benefits. There's a benefit for if you stay more than 1 night, and then there's a benefit if you just go during the day and then you're released to go home.
[AGENT][NEUTRAL] For services that are written.
[CUSTOMER][NEUTRAL] Is that called
[CUSTOMER][NEUTRAL] And what, what a pension means?
[AGENT][NEUTRAL] Yeah, so, so if again, if you have, if you go to a hospital, an outpatient hospital or a doctor's office and have any type of treatment or procedure where you don't have to stay overnight.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I was trying to understand, OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So if I go for a colonoscopy that is a day thing, that's cover.
[AGENT][NEUTRAL] Right, if it, as long as it's not like a routine colonoscopy because those typically pay 100%, so there wouldn't be anything left to pay. But if you were having symptoms and you went to go get a colonoscopy, then it could pay up to 2000.
[CUSTOMER][NEUTRAL] No, it's it.
[CUSTOMER][NEUTRAL] It's like for a first checkup, like just a regular first time doing it.
[AGENT][NEUTRAL] Yeah, if it's your first time.
[CUSTOMER][NEUTRAL] Just to get it done
[AGENT][NEUTRAL] Yeah, if it's your first time doing it, that would not be covered because that's preventative. It's like routine and that like your primary, yeah, your primary insurance would cover 100% of that typically, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, OK, perfect.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][POSITIVE] Sounds good. OK, thank you. Yeah, yeah, now I understand better. Thank you.
[AGENT][NEUTRAL] OK, anything else I can help with?
[CUSTOMER][NEUTRAL] Uh no, that's it.
[AGENT][POSITIVE] OK, well thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye.