AccountId: 011433970860
ContactId: 0d05a3f9-f70d-4233-b03d-5d00b300b27a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358279 ms
Total Talk Time (AGENT): 192089 ms
Total Talk Time (CUSTOMER): 174043 ms
Interruptions: 3
Overall Sentiment: AGENT=1.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/0d05a3f9-f70d-4233-b03d-5d00b300b27a_20250107T13:33_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, [PII]. My name is [PII] as well, and
[AGENT][NEUTRAL] How do you name.
[CUSTOMER][NEUTRAL] I, I know. What are the chances, right?
[AGENT][NEUTRAL] Right. And how do you spell your name, [PII]?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][NEUTRAL] Me too.
[CUSTOMER][NEUTRAL] Oh, that's really weird. OK, well, there you go, maybe.
[AGENT][POSITIVE] Gonna be a good day. That's right.
[CUSTOMER][NEUTRAL] That's what I was gonna say, um.
[CUSTOMER][NEUTRAL] I have a question. I have um this um APL program through my work, and I have never used it. I'm not really sure how to use this. Can you, um, it's it like a sup I said, I'm really not sure what, how it's used.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, I would be happy to assist you, [PII], and I can help you with that. Do you have your APL policy number available?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, it's um 02545364.
[AGENT][NEUTRAL] And what is your last name and date of birth, please?
[CUSTOMER][NEUTRAL] Last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] I'm [PII]. My birthday is [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] That is so weird.
[CUSTOMER][POSITIVE] Wow.
[AGENT][POSITIVE] Well, that's just, that's a great way to start the day.
[CUSTOMER][POSITIVE] Yeah, that's funny. Oh my [PII].
[AGENT][POSITIVE] What is a good callback number in case we get disconnected? I can get right back to you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And do you mind verifying your current mailing address and email?
[CUSTOMER][NEUTRAL] It's [PII], and then the email is [PII].
[AGENT][POSITIVE] Perfect. Thank you.
[AGENT][NEUTRAL] OK, so yes, ma'am, this is like a supplemental policy. It is secondary to your major medical.
[AGENT][NEUTRAL] And you have benefits um for inpatient hospitalization and outpatient hospital facilities as well as treatment in a doctor's office. The um doctor's office co-pay is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would always show this APL card with your primary insurance when you go for medical attention.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK. Now, if the phy uh
[CUSTOMER][NEGATIVE] So I have had an issue. My primary insurance denied.
[CUSTOMER][NEUTRAL] An MRI and I have paid for the MRI. I already paid for it and had it, and I have a fracture in my pelvis and the primary insurance denied the MRI. Yes, yes, that's not surprising. But in that sense, could I have used APL for the, for the cost of the MRI?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh my goodness, they denied it.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] If your primary insurance covered it and applied something to your deductible copay or co-insurance, then we could uh consider benefits. So we pay towards your deductible, co-pay, or co-insurance of your major medical.
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if they denied it, then there would be nothing applied to that deductible copay or co-insurance, therefore no benefits would be payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, and then when I submit, when I show this with my primary insurance, is there paperwork I need to submit after or?
[AGENT][NEUTRAL] So normally the providers will file the claims for you and we pay them direct that way there's no um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know we can cover up to the benefit amount but that way you don't have to pay out of pocket up to the benefit amount. Now we do have a website and you can actually create a login and password on our [PII] and you can click on your policy number and view the benefits on your policy. It'll download your document, your policy document.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it'll tell you what's covered, but I always show your APL card with your primary insurance and then just a little, uh, side note, I just wanna make sure you know you have a right to an appeal, an insurance decision, so you may wanna check with your primary insurance and check on the appeal.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yes, but
[AGENT][NEUTRAL] Information
[CUSTOMER][NEUTRAL] 3 months. It was 3 months, the appeal, yeah. So by that time, I really would have hurt my body, so, no. I just went ahead and paid for it, so.
[AGENT][NEUTRAL] 3 months.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah. Well, they, you know, you can appeal it afterwards and, you know, if there's any money, then it would come to you. Just, just, just kind of a side note, I just wanna help you.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, I already, uh, yeah, I'm, I'm, I'm not gonna let it go just out of principle.
[AGENT][NEUTRAL] Yeah, I mean, that's crazy. If it's medical necessity, anyway.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Yeah, the way the world runs in healthcare here, but whatever. All right.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] But any.
[CUSTOMER][POSITIVE] All right, [PII]. Well, thank you very much.
[AGENT][POSITIVE] Well, it's been so nice to help you, [PII], and it's so weird saying my name cause I never get to.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] That's funny. Well, you have a great day.
[AGENT][POSITIVE] I hope you do too, [PII]. Thank you for calling APL and I hope you and your family have the happiest of [PII]'s.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye. Bye-bye.
[AGENT][POSITIVE] Thank you and thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.