AccountId: 011433970860
ContactId: 1a5934e0-61ab-4bef-ae18-80ab271a2c55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574659 ms
Total Talk Time (AGENT): 391338 ms
Total Talk Time (CUSTOMER): 144091 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/1a5934e0-61ab-4bef-ae18-80ab271a2c55_20250313T13:58_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] OK.
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I just got a card from this company, and I don't know what this is about. It's just like an insurance?
[AGENT][NEUTRAL] OK, [PII], so you've received an ID card from APL and you're wanting to find out what type of coverage that is for, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and I'm so sorry, what was your last name?
[CUSTOMER][NEUTRAL] [PII], I can give you the ID card, ID number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, just a moment. And what is a good callback number for you, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And now the policy number, please.
[CUSTOMER][NEUTRAL] Uh, OK. Policy, policy number is 02552938.
[AGENT][NEUTRAL] OK, thank you. Give me one moment to get your policy information pulled up and then [PII], I will need to verify several things with you first for security purposes, OK? And any information provided would be a verification of benefits and not a guarantee of payment. So first off, if you would please verify your date of birth.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, also your home mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK thank you and then lastly I do need to add an email address on file for you um what is.
[CUSTOMER][NEUTRAL] It, it would be my name, first and then my name [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And so that's [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][POSITIVE] OK, thank you very much. So one moment please.
[AGENT][NEUTRAL] OK, so Ms. I love, this, um, coverage that you have with APL. This is a supplemental policy that goes along with your primary health care insurance. It's through your employer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy helps you with your co-pays, deductibles and co-insurance amounts of covered services. So whenever you go to the doctor, you should always present your APL ID card along with your primary health care insurance card because most providers would call us to verify your eligibility and get your benefit information for the type of service you're having rendered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then take care of filing the claims with APL once they have processed them with your primary insurance. Now if for any reason you were to ever have to file your own claim with APL.
[AGENT][NEUTRAL] So you can also do that and you could call us back at that point and we could give you all of the information on how to go about doing that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the reason that I added your email address is because we have a portal that is called the online service center and it should have talked about that on the document that or ID cards were attached to at the top.
[CUSTOMER][NEUTRAL] Mhm. Mhm. OK.
[AGENT][NEUTRAL] But I have a user guide, Ms. [PII] that I can email you and I'm going to do that that explains how to set up your profile and then also the different things that you can do within our portal once that has been set up.
[CUSTOMER][NEUTRAL] OK. Thank you. And so, so you say it was, this insurance will helps me with medical bills?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am, this policy will help you with your deductibles, co-pays, and co-insurance amounts of covered services.
[CUSTOMER][POSITIVE] OK, because I have, it's funny they have this, um, I, uh, have a whole bunch of uh co-pay.
[AGENT][NEUTRAL] So, for example, uh-huh.
[CUSTOMER][NEUTRAL] Go ahead. Is, is that, does it have a qualify like last year I had a lot, a lot of medical bills.
[CUSTOMER][NEUTRAL] So, um, how can I, uh, like have, I mean, I have so many bills to pay now? How can I get some benefits from this insurance? How can I do the claim?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I guess I can go online.
[AGENT][NEUTRAL] Uh yes ma'am, once you have set up your profile, you can submit the claims. Now I can go ahead and include uh the type of claim form that you would need to use when submitting a claim because it has instructions on it for not only how to complete the claim form but also the additional documentation that you would need to provide.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When for us to review a claim. Now, on this policy, office visits are not a covered service under your policy. This is more um directed towards like if you had to go to an urgent care or you were admitted as an inpatient into the hospital. Give me just one moment, [PII], to pull up some additional information on your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so again, this hos this benefit, this plan rather, would help you if you, you know, were admitted as an inpatient into the hospital. You, you know, you have benefits for that. Also, if you were to have to go to the emergency room or if you had went to the urgent care, this would help you with a maximum of 3 urgent care visits for covered person per calendar year.
[AGENT][NEUTRAL] Um, or if you had to have some type of outpatient surgery or diagnostic testing at a hospital or freestanding facility, those are the types of things that this plan would help with. But treatment that's done, you know, in the doctor's office, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, treatment in the office.
[AGENT][NEUTRAL] Let me double check one thing.
[AGENT][NEUTRAL] But office visits themselves, just an office visit would not be covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, like last year I went, I had to go, I went to the emergency room. Um, they've been doing a lot of tests. Like next week on Tuesday, I'm having um a a procedure and inpatient, outpatient thing. They let me go the same day. Um, so that, that will help me with that. Uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am. Now, uh, for this upcoming procedure, I would try and like again like I stated before, give the facility your primary insurance card along with your APL card because most of them will file it for you which makes it a little easier for you as far as you know getting the documentation that's required for us to review a claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you have a maximum outpatient benefit of $250 for covered person per occurrence for covered outpatient services and there's no deductible and what per occurrence means and what again once you set up your profile in our portal you're gonna have access to this information that I'm giving you as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But the definition of per occurrence means treatment for the same or related condition unless separated by a period of 90 days. Treatment for the same or related conditions separated by 90 days or an unrelated condition will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and you say uh $200. What about the, the emergency?
[AGENT][NEUTRAL] $250.
[CUSTOMER][NEUTRAL] The emergency that I had last year, can I still, that was back in I think it was in December or November. It's still on time to claim.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes ma'am, because we do not have a timely filing limit with APL like some insurance companies do, so yes ma'am, absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the paperwork that you're going to email me it to have the form that I have to fill out for that, correct?
[AGENT][NEUTRAL] Yes ma'am, you so you could just make, you know, multiple copies if you had more than one claim, but I'm gonna include the claim form along with the portal user guide for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else, Miss [PII], that I can help you with this morning?
[CUSTOMER][POSITIVE] No, thank you. You were very helpful. Thank you for your help.
[AGENT][POSITIVE] Well, yes ma'am, that was my pleasure and thank you for calling APO. I hope that you have a very nice day and again give me just a couple of minutes to send this email to you and it will come from care team at [PII].
[AGENT][POSITIVE] Um, and it will have those two attachments and I did put [PII] in your subject line. OK, well, you're welcome. Have a wonderful day.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[CUSTOMER][POSITIVE] OK. Thank you. You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.