AccountId: 011433970860
ContactId: 010564f1-5119-4386-990d-309bb33aa425
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455480 ms
Total Talk Time (AGENT): 283253 ms
Total Talk Time (CUSTOMER): 125547 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/010564f1-5119-4386-990d-309bb33aa425_20250312T15:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just uh had a question about my, the service that I got with you guys. I called the other day and they had advised me that I was able to use it for.
[CUSTOMER][NEUTRAL] Dental, but I didn't have any luck. So I just wanted to make sure maybe I misunderstood.
[AGENT][NEUTRAL] OK, so you're wanting to do you have a dental policy with APL?
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Well, I don't, that's just it. I wanna know what the all it covers. I wanna make sure cause when I called they told me what all I had, but when I went to the dentist yesterday, they said no.
[AGENT][NEUTRAL] You're not sure?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, ma'am. Well, I can check your benefits or see what type of policy you actually have with APL. Uh, who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hey Ms. [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Thank you and what is your full social, Ms. [PII], so I can look up all of your information?
[CUSTOMER][NEUTRAL] Can I give you the policy number?
[AGENT][NEUTRAL] If it's for your dental policy, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I don't have a dental. I only have one card and it has a policy number on it.
[AGENT][NEUTRAL] You can give me that and I can try and cross reference it, but I will have to verify several things with you for security purposes.
[CUSTOMER][NEUTRAL] That's fine. I'm just not quick to give out my social. I'm sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hey Miss [PII], any information that I do provide would be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So the policy, the only policy, Ms. [PII], that you have with APL is this supplemental policy. This is a supplemental policy to your medical, your primary health care insurance that helps with your co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this policy does not have dental benefits. This is for medical only.
[CUSTOMER][NEUTRAL] Does it help with the hospital indemnities or like the additional hospital stays and after a hospital?
[AGENT][POSITIVE] This helps with
[AGENT][NEUTRAL] Well this helps with co-pays, deductibles and co-insurance amounts of covered services. So on this policy you do have benefits for outpatient and inpatient. Outpatient benefit maximum per calendar year for covered outpatient services is $1000 with no deductible and your inpatient hospital benefits per calendar year is $3000 also with no deductible.
[AGENT][NEUTRAL] So always present your APL card along with your primary insurance card when you go for medical services because most providers will follow your primary and the supplemental as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then, so maybe that's.
[AGENT][NEUTRAL] Now if you believe that you should have dental coverage with another carrier, um, Ms. [PII], I would just recommend talking with your HR department to see if you are enrolled for a dental plan with another company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then. I, I spoke with somebody when I was in the hospital to see exactly how that works. And um I don't know, the way she made it sound was that I was covered, but maybe I misunderstood.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I wanted to make sure cause I did go to the dentist yesterday. Yeah, she was just kind of telling me what all I had and I asked her about the hospital stay, and she said that I would, I would be able to receive.
[AGENT][NEUTRAL] Covered for dental?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You know, whatever, but that's fine. No baby.
[AGENT][NEUTRAL] You were admitted inpatient for dental?
[CUSTOMER][NEUTRAL] No, no, no, no, no. I was actually in hospital. I just got released on Monday.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, but this was not related to anything dental is what I'm asking.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] Oh, OK. So yes, ma'am, a claim can be filed once it has been processed by the primary insurance. It can then be filed with APL because we will always have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, all right then, thank you. And then once my um once the hospital sends out for the billing, um, if they don't send it to you guys, I'm able to do it online?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Absolutely, yes ma'am. You can obtain our claim form. This policy is a medlink which should be on your ID card, and you can go to our public website, Ms. [PII] at [PII].
[AGENT][NEUTRAL] And when that page pulls up at the top you will see a tab that says or link that says claims and forms.
[AGENT][NEUTRAL] Click there.
[AGENT][NEUTRAL] And you would scroll down the page you're gonna see a small box that says filter by product and it has a green drop down arrow in it and if you will click on the green arrow, it gives you a list of forms you'll see the word medlink.
[AGENT][NEUTRAL] And you would just click on that.
[AGENT][NEUTRAL] And once you do that you should see a blue button out to the right.
[AGENT][NEUTRAL] That says um download form and if you click on that it will open up the claim form.
[AGENT][POSITIVE] And the claim form and the top section, Ms. [PII] has the instructions for completing the form and what additional documentation you will need to submit if you were, you know, gonna be submitting it, but you could call us back if that does come up, if you need any help, and we'll be glad to assist you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's probably what I'll just do.
[AGENT][NEUTRAL] It's a lot easier if they will do it because of the forms, you know, you will have to get information from the hospital.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So if they will file it that is easier but you are welcome to file it if you so choose to.
[CUSTOMER][NEUTRAL] You know, uh, if they don't do it, I'll do it, but I gave it to them when I left the hospital, so hopefully they'll do it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK. Well, yes, ma'am. I hope so for you too because I do know it's a lot easier that way.
[CUSTOMER][NEUTRAL] Alright then.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] OK, well then, thank you very much for calling APO and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.