AccountId: 011433970860
ContactId: 18236b39-66b2-4c9e-a965-84c6d8782a2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551690 ms
Total Talk Time (AGENT): 273442 ms
Total Talk Time (CUSTOMER): 195559 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/18236b39-66b2-4c9e-a965-84c6d8782a2b_20250513T22:39_UTC.wav
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[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good evening [PII]. Um, my name is [PII]. Um, I, uh, have a gap insurance with you guys through my employer.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And um it's covered, it's coverage for myself and my wife. Um, I just wanted to double check because we had a uh a claim filed through our primary insurance a couple weeks ago for her and we provided, um, the APL information as a secondary insurance. um, just not sure if uh there's anything that APL will cover just so that we can prepare for any potential bills that we'll have to pay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Um, and then, um, aside from that, I also was having issues registering to view these things online. I'm not sure if you'd be able to help me with that once we confirm all of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can help you with both um your claim and the online service center Mr. [PII]. Can I please get your call back number sir just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Absolutely that would be [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is your policy number, sir?
[CUSTOMER][NEUTRAL] Um, well, on my card I have a group number and I have a payer ID. I'm not sure which one of those two would be helpful for you.
[AGENT][NEUTRAL] Do you see an inpatient or an outpatient certification number?
[CUSTOMER][POSITIVE] Yes, I do, yes.
[AGENT][NEUTRAL] OK, can I have one of those numbers please?
[CUSTOMER][NEUTRAL] OK, so that'll be 01845855 M as in Michael, L as in Lima, 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] OK, [PII], I'll need for you to please verify your information for me for security reasons can you give me your date of birth?
[CUSTOMER][NEUTRAL] Yes, that's uh [PII].
[AGENT][NEUTRAL] Thank you sir and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, so my, uh, physical address should be [PII]. Um, email address if you have it should be [PII].
[AGENT][NEUTRAL] OK, looks like I have an uh a work email address.
[CUSTOMER][NEUTRAL] Oh, that could very well be it. It's like [PII].
[AGENT][NEUTRAL] Yes sir, and then the phone number that you gave me, sir, to verify if um the call gets disconnected, is that your cell phone number?
[CUSTOMER][NEUTRAL] Yes, yeah, my cell phone number is [PII]. I don't know if you needed me to verify a work phone number for you, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, sir. Just, um just your home and you've already done that. So we're gonna look and see if there's any claims that have been submitted for your wife, um, Ms. [PII], and I don't see any at this time that have been submitted for her, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the way that it works is you, as you know, your primary insurance will submit the explanation of benefits for their part that they paid um to us after they've paid their part and then the claims specialist will go through and uh review the claim once we receive it, it does take 7 to 10 business days to process. So if they have sent it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] At this time, um, I'm not showing that we have received it yet.
[CUSTOMER][NEUTRAL] Understandable. OK, well, let me ask a question. I mean this might, uh, might help me to better understand. In her case, um, she had an emergency room visit where, um, the primary insurance is covering the bulk of it, and then there's, um, there's like a $500 deductible, I think it is $500 copay on our part. Um, [PII]'s question would be is if APL would cover that $500 copay or if that's something that we would still need to cover ourselves.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull up your policy real quick to see if you have emergency room visits on it.
[AGENT][NEUTRAL] Um, it's gonna be just you're very welcome. It's gonna be just a moment while I pull it in.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] OK, let me check your benefits.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] I'm looking.
[AGENT][NEUTRAL] You do have emergency room benefits and it falls under your outpatient calendar year benefit max per calendar year um of $1000. So it helps with up to $1000 per calendar year. I do not show that you have any um emergency room deductible for accident or sickness, which is what this policy helps with, and this is just to verify your benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Your emergency room benefit is for accident or sickness. So if it falls under accident or sickness, then with your outpatient benefit, you have $1000 per calendar year to help with that.
[AGENT][NEUTRAL] Um, and, uh, all of that is based on what the primary pays. So in order for us to have a complete yes or no if you owe anything, it would have to, the claim would have to be filed and it would have to be processed.
[CUSTOMER][POSITIVE] You got it.
[CUSTOMER][NEUTRAL] OK, OK, perfect. So yeah, um, my, uh, thank you very much for clarifying all of that. I'm sure that, um, the primary is in the process of working with you guys for that, and, um, I'll just let it run its course kind of thing, um, um, if you bear with me a moment, my wife did have a question to ask.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh hello.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, I have a quick question about that $1000 calendar year. Is that per individual or is that just in total for the both of us?
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] OK, I just wanted to clarify that.
[AGENT][NEUTRAL] It's for individual.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you.
[AGENT][NEUTRAL] Yes. You're welcome, Ms. [PII]. um, and also Mr. [PII], to go over the online service center with you, um, when I verified your information, I did notice that your phone number was not added into the system, so I did add it in. So every little thing that we have in our system has to match in the online service center.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To tie it in together so that you have your portal, uh, I did add your phone number back in and if you want to try to go back in there and remember that we're using your uh work email address.
[AGENT][NEUTRAL] And try to sign up again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I wanna try one more time so as far um just to make sure because maybe this is where I was making the mistake when it's asking um for Social Security or member ID the member ID is that number I read off to you earlier, um, the cert number.
[AGENT][NEUTRAL] Right, that's the member ID number, but you're gonna want to put in your social.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Put in your social and use your work email address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you should be able to get in now that I've updated that phone number for you.
[CUSTOMER][POSITIVE] Oh yeah, now it's taking me through that process. OK, perfect, perfect.
[AGENT][POSITIVE] Awesome. OK. All right.
[CUSTOMER][POSITIVE] Well, you have been a wonderful help this evening. I greatly, well, we greatly appreciate your, uh, your assistance, and I wanna wish you a great day.
[AGENT][NEUTRAL] Well,
[AGENT][POSITIVE] Well, thank you and I appreciate you both calling in and I was, I'm glad I was able to help you. I hope you guys have a blessed night and thank you so much for calling APL.
[CUSTOMER][POSITIVE] Likewise to you, [PII]. Have a great one.
[AGENT][POSITIVE] Thank you bye bye.