AccountId: 011433970860
ContactId: 108e4ab3-16be-4c96-9396-f83f945c87a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699479 ms
Total Talk Time (AGENT): 319257 ms
Total Talk Time (CUSTOMER): 228604 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/108e4ab3-16be-4c96-9396-f83f945c87a6_20250604T19:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], um, my name is [PII]. I am trying to get information. Um, I'm very new to this American Public Life Insurance. It's the first year I've had it.
[CUSTOMER][NEUTRAL] Um, with my company, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just trying to understand what it covers.
[CUSTOMER][NEUTRAL] Because I was explaining that it covers, you know, like all deductibles. I don't know, it doesn't seem to be the case.
[AGENT][NEUTRAL] OK, um, I can help you with benefits. Um, [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, you know, let me give you my cell [PII].
[CUSTOMER][NEUTRAL] [PII] um and the reason I'm calling because it looks like I had something with the the emergency room and you know I looked it looks like you guys covered like 500 of of it um Blue Cross covered, but I mean they they just charge so much it's crazy what they charge.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, anyway, so I have, there's a claim that was just paid 500 and I was just trying to understand.
[CUSTOMER][NEUTRAL] Why and what it, what you guys do cover.
[AGENT][NEUTRAL] What we cover, OK. Um, what's the policy number that you have with us?
[CUSTOMER][NEUTRAL] Let's see, so just I have a group number in hospital benefits certification number and outpatient certification number. What do you, what do you want?
[AGENT][NEUTRAL] Uh, either of the certificate numbers.
[CUSTOMER][NEUTRAL] So let's see in the hospital, 0256.
[CUSTOMER][NEUTRAL] 9492.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 7.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can I get you to verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] And the address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the phone number that we have on file?
[CUSTOMER][NEUTRAL] For me,
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, I guess, I guess it's my cell [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Yes, this is a meddling policy, so it's secondary gap insurance. Um, let me pull up one of the claims.
[AGENT][NEUTRAL] Yeah, it looks like we paid $500 because that check met the maximum benefit payable for that date of service.
[AGENT][NEUTRAL] Let me go ahead and pull up.
[AGENT][NEUTRAL] Your policy
[AGENT][NEUTRAL] And I can tell you what it's covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have an online portal, um, an online portal account with us?
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK, um, if you would like, you can also go to [PII] and you'll register an account using the email address that we have on file and then um you'll be able to see all of the documents and the policy certificate, which is what I'm gonna go with uh through with you today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh what was it secure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah let me write it down just so I can save it secured.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII] OK.
[AGENT][NEUTRAL] And uh can you verify the email address that we have on file? because that's the one that you're going to need to register the account.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't know, is it [PII] or?
[CUSTOMER][NEUTRAL] Um, do you have a personal, I get so many email addresses.
[AGENT][NEUTRAL] Um, I've got, I get to or [PII], but it's not, that's not the end of it.
[CUSTOMER][NEUTRAL] [PII] you have?
[AGENT][NEUTRAL] Um, no, I have a different one.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You have dug at CTC custom furniture?
[AGENT][NEUTRAL] Yes, so that's the one that you're gonna wanna use um whenever you log in.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] OK, so sign in your email address, it says password. I don't.
[AGENT][NEUTRAL] No, you'll want to create a new account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Let's see, create your OSC account, OK.
[CUSTOMER][NEUTRAL] Um, so just say insured.
[AGENT][POSITIVE] Yes, you would be insured.
[CUSTOMER][NEUTRAL] Next
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you only need to fill out.
[CUSTOMER][NEUTRAL] Just the member ID I.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Do I put the SSN or member ID?
[AGENT][NEUTRAL] It's either or um I will say if it doesn't have an asterisk next to it it's not required so if you don't want to enter your Social Security or member ID you don't have to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it gets the answerword let's see, OK, then I just put in a new password, OK.
[AGENT][NEUTRAL] And um don't forget to click the verify email. It will send you a uh verification code. You should get that pretty soon after you um apply for it and then um and if you don't see it, check your spam.
[CUSTOMER][NEUTRAL] So do I.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh send new. OK, OK, let me see.
[AGENT][NEUTRAL] Yeah, you'll need to verify your email before you can continue.
[CUSTOMER][NEUTRAL] Alright, let me just see if it went to spam. Oh here it is OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I guess I'll just do this.
[AGENT][NEUTRAL] And if you don't see the code, um, check your spam.
[CUSTOMER][POSITIVE] Yeah, it goes, yeah, OK, account has been created successfully.
[AGENT][NEUTRAL] OK and then so from now on every time you log in you'll use that email we know um and then it will verify your email every time.
[AGENT][NEUTRAL] Uh, because of all the information that we have in there and all of the, the private health information, uh, we added an extra barrier of support, so you will get a verification code every time.
[CUSTOMER][NEUTRAL] OK, you can't verify by cell phone?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, once you create the account, the account, you should be able to include, um, there should be an option in there somewhere to um opt for text messaging.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Um, but I don't believe so for the first time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, so I'm good to go here.
[CUSTOMER][NEUTRAL] Oh hell, you can receive claim status for text. OK, I see that.
[AGENT][NEUTRAL] And um I do have your policy pulled up right now and I do want, and I can go over this with you um just briefly. If you'd like, you'll be able to see the rest of the information on there, um.
[AGENT][NEUTRAL] So whenever you pull up your policy documents, you'll go to a policy certificate, and typically the the easiest way to look for what's covered is to scroll down to your schedule of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and you had mentioned that we only paid $500 and what I'm stating now is just a verification of benefits and not a guarantee of payment, um, but your outpatient benefit maximum is $500 per calendar day, so that's why we only paid $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, is because that's the maximum allowed for an outpatient benefit, um, per day.
[AGENT][NEUTRAL] So should you go back another time for any reason, uh, we will pay another $500 if it's a covered service.
[AGENT][NEUTRAL] Um, but that's what you get for your outpatient benefit. Mhm.
[CUSTOMER][NEUTRAL] So what is the
[CUSTOMER][NEUTRAL] What is the outpatient then versus like what uh.
[CUSTOMER][NEUTRAL] That's anything um like.
[AGENT][NEUTRAL] Like an inpatient?
[CUSTOMER][NEUTRAL] What's impatient and what is that?
[AGENT][NEUTRAL] So outpatient is typically going to be your surgeries, your um your urgent care visits, um if you need to go into a hospital for whatever reason.
[CUSTOMER][NEUTRAL] What is
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Inpatient is a little bit different, uh, inpatient, you're going to be there for a while.
[AGENT][NEUTRAL] Typically, you'll sometimes see something called a confinement. Um, inpatient is when you're, you're admitted into a hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and is there a limit there?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, and so you have an in hospitals benefit maximum of up to $6600 per calendar year.
[AGENT][NEUTRAL] Um, and since you have a family plan, you have a maximum of $13,200 for all covered persons combined.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this also includes an ambulance benefit?
[AGENT][NEUTRAL] And uh treatment for mental or emotional disorders for the ambulance benefit and the disorder benefit, it is subject to a maximum of 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right, I guess, yeah, they didn't really explain this to me correctly, um.
[CUSTOMER][NEUTRAL] But it's OK. I, I, it seemed like it didn't make sense to me actually what they said, um, but anyway, I understand. I get it now.
[AGENT][POSITIVE] Yeah. Feel free, and once you look at your schedule of benefits, um, it also has a bunch of definitions in there as well, and you have some riders in there like a dependent child maternity rider, um, any of those things, it, it will be in the schedule of benefits and that's a nice little breakdown of benefits for you and there are definitions as well. um, but if you're ever confused on anything on what's covered, uh, go ahead and give us a call back and we can look into that for you.
[AGENT][NEUTRAL] If you're unsure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, I appreciate your help.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's OK, thank you.
[AGENT][POSITIVE] Alright, thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Right bye.