AccountId: 011433970860
ContactId: 08e9cabb-1aab-4267-9865-8d35ac8ff87f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 799520 ms
Total Talk Time (AGENT): 356993 ms
Total Talk Time (CUSTOMER): 229398 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/08e9cabb-1aab-4267-9865-8d35ac8ff87f_20250606T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling with the ideal Company, and I was just calling for some assistance, um, logging in online.
[AGENT][NEUTRAL] OK, yes, ma'am. I can assist you with that. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, [PII], I'm sorry. And what is the uh group number, please?
[CUSTOMER][NEUTRAL] 13275
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment please.
[AGENT][NEUTRAL] OK, uh let's see, and Ms. [PII], uh, verify the group name, group num uh mailing address, your email address, and call number.
[CUSTOMER][NEUTRAL] Um, the ideal Company [PII] and my email is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Our number [PII].
[AGENT][NEUTRAL] OK, and did you try to create a new account and it gave you an error message?
[CUSTOMER][NEGATIVE] Um, I've had one, but it looks like something has changed, and whenever I go to log in, it doesn't take my credentials.
[AGENT][NEUTRAL] Uh, yes ma'am, they updated our online service, yeah, they updated the online service and I think last weekend, but um let me see.
[CUSTOMER][NEGATIVE] The like the page looks completely different.
[CUSTOMER][NEUTRAL] So do I need to create a new account?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So would I be considered group?
[AGENT][NEUTRAL] Group, yes, ma'am.
[CUSTOMER][NEUTRAL] For the role? OK.
[CUSTOMER][NEUTRAL] See if I can
[CUSTOMER][NEUTRAL] See if it'll take my information here.
[AGENT][NEUTRAL] It should. They're still working out the uh kinks in the site.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Yeah I didn't wanna make a new one if.
[CUSTOMER][NEUTRAL] And then mess things up, but let's see.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] After you've entered that information, uh, it's gonna give a
[AGENT][NEUTRAL] You have to check for a verification code that was emailed to you. Um, once you put that uh verification code in, verify that code and put in your password, then you'll be good to go.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or should be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, now it's asking for my email see if it'll send it.
[CUSTOMER][NEUTRAL] And then what is it's asking for display name given name and surname?
[AGENT][NEUTRAL] Yeah, I'm not exactly 100% sure for that, um.
[AGENT][NEUTRAL] Let me see if it's on any information we were given because.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Even sign on as an insured, I didn't understand that. um, let me double check and see.
[AGENT][NEUTRAL] And it doesn't say anything.
[CUSTOMER][NEUTRAL] Maybe just put my full name in the display name and leave the other two blank.
[AGENT][NEUTRAL] Maybe, well, I was thinking maybe to this life or.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][MIXED] It's OK, it's just kind of weird.
[AGENT][NEUTRAL] I should have asked about that, yeah, unless there's more than one.
[AGENT][NEUTRAL] Contact person that is added maybe just to kind of give their display name but their email address is there so I don't understand so I'm not sure.
[CUSTOMER][NEUTRAL] Well it doesn't act like it's like a required. I'm just gonna put my name in that top one and see if it'll let me continue.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Looks like it took it now it's.
[CUSTOMER][NEUTRAL] Let's see if it'll let me log in now oh.
[AGENT][NEUTRAL] And I will say each time you log in it's still gonna give a verification code as a like a.
[AGENT][NEUTRAL] Protection thing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It seems like
[CUSTOMER][POSITIVE] More and more people are doing that these days because it's safer.
[AGENT][NEUTRAL] I know it's that too, right, because, well, people are still in others' identities left and right, especially with companies too.
[CUSTOMER][NEUTRAL] I know. Yeah.
[CUSTOMER][MIXED] It's like it's kind of a pain sometimes, but to deal with the other, it's not quite that bad.
[AGENT][NEGATIVE] Yeah, I'd rather deal with it and get my identity stolen and someone.
[CUSTOMER][NEUTRAL] I know, right?
[AGENT][NEGATIVE] Takes my, going to my bank account or something, you know, well, any kind of identity. I mean, it's on the rise, unfortunately.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, so it looks like it's, I'm in there now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Axes, OK, alright, well I'll look in in there and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Look at the resource center is there like a user guide or something?
[AGENT][NEUTRAL] Uh, it should be. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also um I don't know if y'all pay like premiums through the online service center previously, but they said once you start um once you set up a new account you may have to reenter that information. If you look at the top right corner, uh, it should be a little blue box, probably have your initials in it to where you can change your profile.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, where I ask for like the banking information if needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll, um, I, I look at the bills. I'm not the one that pays it, but I'll, I'll look into that and see so that's that's good to know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I do have another question like as an employee who has this coverage.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any kind of um resources like to understand like how the coverage works like when to.
[CUSTOMER][NEUTRAL] Like have my doctor bill the secondary insurance and understand like what's covered and that kind of stuff. I mean, I've got like the policy.
[CUSTOMER][NEUTRAL] All of those documents but like kind of just like a simple.
[CUSTOMER][NEUTRAL] Is there any kind of resources for that?
[AGENT][NEUTRAL] Uh, usually in the policy, there is, um, the schedule page that kind of breaks down what is considered outpatient or in hospitals or what's covered for each.
[AGENT][NEUTRAL] Um, let's see, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Trying to see what's your last name, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Like for example, I had like 5 X-rays. There was just a little tiny bit that was covered, um, and then I have like a couple of MRIs that have been billed and just curious like to what might be covered or just trying to understand that and then also so I can understand at least to help some employees that might have some simple questions.
[AGENT][NEUTRAL] Oh, no, I understand. Um, I will say with the secondary policy, it is very, um, places service-driven. Like if it's not a covered outpatient facility, it wouldn't be covered under the plan.
[AGENT][NEUTRAL] Like for this policy outpatient is like ER urgent care.
[AGENT][NEUTRAL] Ambulatory surgery center, MRI or imaging center. So any office physics or procedures in the office wouldn't be covered.
[AGENT][NEUTRAL] And inpatient as if they're confined um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Over 18 hours in the hospital.
[AGENT][NEUTRAL] But uh yes, ma'am, if you look in the policy under a schedule of benefits, it kind of gives a breakdown of each benefit of how much is covered for inpatient, outpatient, and what is considered outpatient.
[CUSTOMER][NEUTRAL] Oh what about like as far as like imaging centers like that's where my stuff would be like how, how, how would, how would have it been determined like how much they cover on like the X-rays?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, uh secondary, we only pick up what primary applies towards deductible, co-pay or co-insurance up to your benefit max.
[AGENT][NEUTRAL] Um, and it looks like you have, uh, it picks up what primary applies towards the deductible, co-pay, or co-insurance up to the benefit max.
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] And looks like, I'm looking at specifically your policy, looks like there's a deductible of $100. So how that works is,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the explanation of benefits from the primary, it will show deductible co-pay or co-insurance amounts and any benefit that could be payable will go towards that deductible first.
[AGENT][NEUTRAL] So that's why it looks like part of one of your claims were paid a portion of it and the others it looks like it was applied towards the deductible.
[AGENT][NEUTRAL] But, um, imaging center or MRI facility is considered outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Does come under the coverage, right?
[AGENT][NEUTRAL] Yes, ma'am. It is considered outpatient under the plan.
[CUSTOMER][NEUTRAL] OK, do you see like the billing for the MRI's yet?
[AGENT][NEUTRAL] Um, do you have the data service or around what time? Because I see the most recent one.
[CUSTOMER][NEUTRAL] Or the claim.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] Yeah, it would have been.
[AGENT][NEUTRAL] It's like pro scan imaging of Troy.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Of this year? Well, yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I don't show anything for that data service.
[CUSTOMER][NEUTRAL] OK, so maybe it just hasn't gone through.
[AGENT][NEUTRAL] More than likely, they have to get from your primary insurance first before they submit it to our company.
[CUSTOMER][NEUTRAL] Oh, OK. That's no.
[AGENT][NEUTRAL] And that could be a delay in processing until we receive that information, um.
[AGENT][NEUTRAL] I know some people it's like, well they I gave them the information why I haven't received it. Well, they have to wait for the primary to process first and then they, uh, submit the EOB and the billing to us to process so it can take a while unfortunately.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I think the X-rayss took a while.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, I appreciate your help.
[AGENT][POSITIVE] Yes, ma'am, and I thank you.
[CUSTOMER][POSITIVE] I think that was all I needed for today.
[AGENT][POSITIVE] Well, good deal. If you have any other questions uh just give us a call back we're try to help navigate through the online service center.
[CUSTOMER][POSITIVE] Yeah, well, I appreciate your help. That was, that was helpful.
[AGENT][POSITIVE] Yes ma'am, you're welcome and thank you for calling APL. You have a great weekend, Ms. [PII].
[CUSTOMER][NEUTRAL] Uh you too bye bye.
[AGENT][NEUTRAL] Bye.