AccountId: 011433970860
ContactId: 02d38d65-9ed0-4eeb-abfc-edce7b0bc7f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540099 ms
Total Talk Time (AGENT): 148780 ms
Total Talk Time (CUSTOMER): 310625 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/02d38d65-9ed0-4eeb-abfc-edce7b0bc7f8_20250418T19:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name is [PII] and I'm calling because I have um cap insurance with you guys and I have a doctor's appointment on Monday. Um, it is with a specialist and I wanted to see how, how does that work in regards to my deductible and and such things like that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I'll also be needing um.
[CUSTOMER][NEUTRAL] Uh a surgery soon, so I would also like to know like how would that work in regards to the coverage like.
[CUSTOMER][NEGATIVE] Whatever my insurance doesn't cover, how can I go about the claiming that through you guys?
[AGENT][NEUTRAL] OK, uh, do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, I have it says a group number. Would that be it?
[AGENT][NEUTRAL] Um, there should be a policy certificate number.
[CUSTOMER][NEUTRAL] Um, let's try this number 16846. If not, I also have an in-hospital benefit certificate number and an outpatient benefit certificate number.
[AGENT][NEUTRAL] OK, um, what's the outpatient number?
[CUSTOMER][NEUTRAL] OK, that one's 1281266 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and do you have your, uh, just need to verify a few pieces of information. Do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my phone number is [PII]. That's my cell phone number.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII]. No problem, no problem.
[AGENT][NEUTRAL] And the address?
[CUSTOMER][NEUTRAL] The address is um I'll tell you right now what's your address [PII].
[CUSTOMER][NEUTRAL] Sorry about that, and that's [PII].
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I don't show that address.
[AGENT][NEUTRAL] Or another address that might be under.
[CUSTOMER][NEUTRAL] The problem is that I moved um I can give you my old address perhaps that's the one that you guys have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like this is an old policy. Let me see if there's something more recent.
[CUSTOMER][NEUTRAL] OK, yeah, I don't have like a recent card that's the only card that I have but um I'm, you know, we're still with the same people and it's still with like the I'm with the same company.
[CUSTOMER][NEGATIVE] I never got a new one. Is there any way that perhaps you guys can mail me a new one?
[AGENT][NEUTRAL] Uh, yes, we can do that. Um, let's see, let me make sure that that's an option.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull up the um.
[AGENT][NEUTRAL] In a
[CUSTOMER][NEUTRAL] OK, if, if, if, if there is a new cert, yeah, if there is a new certificate number, are you able to provide that for me in the meantime in case that I have to call back before I get my card?
[AGENT][NEUTRAL] And you said it's for outpatient.
[CUSTOMER][NEUTRAL] Yeah, he should be because he's under UN and.
[AGENT][NEUTRAL] Um, it's it's 2583622.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you, I appreciate that.
[AGENT][NEUTRAL] pull up your information.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy.
[CUSTOMER][NEUTRAL] You help I think
[AGENT][NEUTRAL] OK, so for
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So office visits are not covered under the policy, the actual office visit.
[AGENT][NEUTRAL] Um, it will cover for
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So the deductible either like, like I understand the office visit which would be which would be what the the co-payment.
[CUSTOMER][NEUTRAL] I was there.
[AGENT][NEUTRAL] Correct, so the off anything related to the office visit charge, the actual office visit charge itself is not covered, but let me check, uh, treatment and procedure is. Hold on one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so $55.
[CUSTOMER][NEGATIVE] OK maybe the the whoever I was speaking to didn't know what the heck they were doing.
[CUSTOMER][NEUTRAL] Is that your co-payment? I'm sorry, is that your co-payment? OK, aside from your co-payment, are you responsible for anything else for that visit?
[CUSTOMER][NEUTRAL] And a quick question and then because I'm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, yeah, so this plan specifies what's covered under that 1250 is it would be for like outpatient um hospital emergency room, urgent care facility, surgery in the hospital outpatient facility, uh, surgery center.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I, I, I will.
[AGENT][NEUTRAL] Um, diagnostic testing and how.
[CUSTOMER][NEUTRAL] Yeah, um, I will be needing surgery, um, um, the, the appointment will be on Monday with the surgeon, um, that would be the first, um, that would be the first, uh, visit. So after that I'm not quite sure exactly, you know, when we be scheduled and whatnot, but I wanted to know exactly what would cover that. So outpatient, um, surgeries is covered.
[AGENT][NEUTRAL] Yes, it just has to be.
[CUSTOMER][NEUTRAL] Or even if I have to stay and that would also be covered?
[AGENT][NEUTRAL] Yes, so that, that's covered if, if it's done in the hospital, and this pays after your primary insurance processes the claim. So they have to process it first and then whatever is left over, we pay up to 1250.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For your inpatient hospital benefits, it's up to $5000 if you stay in the hospital overnight, so like more than 18 hours.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hang on, inpatient benefit would be instead of 1250 would be up to 5000 if I stay overnight.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Over 18 hours. OK. And then, so first, the primary insurance will have to process the claim?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then whatever's left then um I would have to file a claim with you guys or the insurance will do that or how would that work?
[AGENT][NEUTRAL] So it, it's, you can ask that the provider do it for you. Um, sometimes they will, um, but the most important thing is that you need the claim and then we need your primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So need claim.
[CUSTOMER][NEUTRAL] And explanation of benefits from my primary insurance.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] That's what you guys would need to process the claim?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, not a problem, thank you so much.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, no, no, if you can just, um, um, um, update or my my mailing address and if I can have a new card sent to me please.
[CUSTOMER][NEUTRAL] So then I can have, you know, like my.
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Hold on one moment, let me make sure I've got that.
[CUSTOMER][NEUTRAL] No, that makes a lot.
[AGENT][NEUTRAL] What was the uh updated address?
[CUSTOMER][NEUTRAL] The updated address is [PII].
[CUSTOMER][NEUTRAL] I am I am.
[AGENT][NEUTRAL] OK, I've got that on file and we will get that mailed out to you.
[CUSTOMER][POSITIVE] It's gonna come via via via mail? OK, thank you so much.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you I really appreciate it you too bye bye.
[AGENT][POSITIVE] Thank you.