AccountId: 011433970860
ContactId: 15140683-6162-4b0a-81c8-4512a39b0e65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543619 ms
Total Talk Time (AGENT): 322047 ms
Total Talk Time (CUSTOMER): 150766 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/15140683-6162-4b0a-81c8-4512a39b0e65_20250313T13:25_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, good morning, [PII]. My name is uh [PII].
[AGENT][POSITIVE] Yes sir, Mr. [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, I have a, I have a uh test tomorrow, uh, an echo Doppler test.
[CUSTOMER][NEUTRAL] Um, that my cardiologist sent, um, I got a call yesterday and they told me that my insurance would cover a certain amount, um, but that I would have to pay my co-pay of around $1000. Uh, I told them that if, um, I asked them if my gap had covered anything, and they told me they didn't, they didn't have any, any information regarding my, my gap insurance, so I gave them, um, my APL, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, number and yeah, the PO box and I just wanted to know if you had if you had received any requests uh from them, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, so you're having a test that you're wanting to see if we've received a call from your provider to find out about any benefit information or eligibility for you. Is that correct?
[CUSTOMER][POSITIVE] That's correct, ma'am.
[AGENT][POSITIVE] Yes, so I can help you with that. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I have a group number. Uh, it's 2003.
[AGENT][NEUTRAL] There's another num, yes, so there's another number on the front of your card though, not your group number. It may say, depending on the type of coverage you have, Mr. [PII], as to how it would be worded. You may see an in the hospital or an outpatient.
[AGENT][NEUTRAL] Number, you may see a policy certificate. Yes, sir. I need one of those numbers.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have the uh I have an outpatient number.
[AGENT][NEUTRAL] OK. What is that?
[CUSTOMER][NEUTRAL] Uh, it's
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 04
[CUSTOMER][NEUTRAL] 82
[CUSTOMER][NEUTRAL] M as in Mary
[CUSTOMER][NEUTRAL] L as in Larry
[CUSTOMER][NEUTRAL] And the number 8.
[AGENT][NEUTRAL] OK, thank you. So give me just one moment please to get your information pulled up, then I will have to verify several things with you first for security and also Mr. [PII], any information that I provide for you today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that you gave me, the [PII], is that the best number that we should have on file for you?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you and lastly I do need to add an email address for you so that you can set up your profile in our portal where you can also have access to your ID cards policy information.
[AGENT][NEUTRAL] And claims.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] Yes, are you ready?
[AGENT][NEUTRAL] Yes sir, I am.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Now Mr. [PII], I am also going to email you this user guide for our portal that I was just referencing, um, because it gives you the instructions on how to set up the profile as well as the different things that you can do in there so give me just one moment so I can go ahead and send that to you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the email that you will receive from this from me will come from [PII] and I did put APL in the subject line for you so that that'll be easy to recognize. OK now, um, I do not see where we have received a call from a provider to check your benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On this, now are you going to be having your procedure? Most OK and most providers will file both claims because the claim will have to be submitted to your primary insurance company first and then with APL because one of the documents that we have to have when reviewing a claim is your primary insurance company's explanation of benefits, but um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As of now, no, so they have not called.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] What right now that I get to work and I and I and I open my email and all this and I set up my my my account um if if they call or.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or contact you in any way will that appear um on on the on the.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] No sir, the portal is only going to give you access to like your policy certificate which has all your benefit information, also your ID cards, it will show you claims that we have received for you on this policy and also if you were to ever have to file your own claim because a provider, you know, didn't do it or you had forgotten to give them your APL information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can also submit claims to us via the portal and if that need ever arises you can call us back we could get you, you know, direct you as far as getting the claim form which has the instructions of all the necessary documents you would need to include.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] But yes, so you may want to follow up with them um and always present your APL card along with your primary insurance card when you go for medical services because again, most providers will call to verify your policy is active, to get your eligibility information and then request, you know, benefit information related to the type of service that you will be having rendered.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][POSITIVE] Correct. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll, I'll I'll show up tomorrow and see.
[CUSTOMER][NEUTRAL] And see what's up.
[AGENT][NEUTRAL] Uh, well, hopefully, you can, uh, so that your test is tomorrow?
[CUSTOMER][NEUTRAL] It's not already scheduled.
[CUSTOMER][NEUTRAL] Yeah, tomorrow morning at [PII].
[AGENT][NEUTRAL] OK. So again, um, they may call us later on today, you know, they may not call us until in the morning. Um, that's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's hard to say, but are you having this done at an outpatient facility or are you having it done at your doctor's office at the clinic?
[CUSTOMER][NEUTRAL] It's an outpatient.
[AGENT][NEUTRAL] OK, so I mean you do have outpatient benefits as you're well aware on this policy, your maximum outpatient benefit per calendar year for covered outpatient services is $7900.
[AGENT][NEUTRAL] And no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, I can um give me just one moment to look at one other thing.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] And and as of now we have not received any claims for you for this calendar year, so at this time your full benefit is still available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's good news
[AGENT][POSITIVE] Yes sir, that is good news.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] So is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] Uh, no, no, I think that's it. Um, if anything, uh.
[CUSTOMER][POSITIVE] We'll be in contact.
[AGENT][POSITIVE] Yes, absolutely. If you have any other questions come up, please give us a call and we'll be more than happy to help you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I appreciate your help today.
[AGENT][POSITIVE] Well, you're certainly welcome. Yes, sir. It was my pleasure and if that is all that I can help you with at the moment, thank you again for calling APL. I hope you have a very nice day and I hope everything goes very well for you tomorrow with your test.
[CUSTOMER][POSITIVE] Thank you very much, ma'am. Have a good one.
[AGENT][POSITIVE] Yes, sir. You too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.