AccountId: 011433970860
ContactId: 1b6a1956-4e60-490b-b2a9-b68ce3e9e232
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384380 ms
Total Talk Time (AGENT): 201327 ms
Total Talk Time (CUSTOMER): 134980 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/1b6a1956-4e60-490b-b2a9-b68ce3e9e232_20250214T20:32_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] It was for
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I think they look like the sacramental. Yes, I'm calling about um
[CUSTOMER][NEUTRAL] Of, um, the information about my benefits? Mhm.
[AGENT][NEUTRAL] OK, like you want to go over your benefits?
[CUSTOMER][NEUTRAL] Yes, is this a supplement? I, I can't remember what this is for.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, well, I'll be more than happy to help you um with your benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you for that, Ms. [PII]. May I have your um policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Where would that be on this card?
[AGENT][NEUTRAL] Um, it should say in-hospital or outpatient policy certificate number?
[CUSTOMER][NEUTRAL] Oh, it's 02064160ML7.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] OK, this one is Place of Hope.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, that's the same thing as what you just said. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, that's the name, that's the name of my company. 00, you want the place, it's [PII]. I'm sorry.
[AGENT][NEUTRAL] Yes, it's OK. Um, and all the information provided is a verification of benefits, not a guarantee of payment. So your policy, um, this is a secondary policy. We're second to, let me see, Florida Blue.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we pay towards the copay, deductible and co-insurance of coverage charges after primary.
[AGENT][NEUTRAL] So your policy um has in-hospital and outpatient coverage. In hospital is when you're admitted to the hospital. Um, the policy will pay up to $6000 per calendar year towards any of those expenses while in the hospital. Um, for outpatient, the policy will pay up to $1500 per calendar year for your outpatient expenses, there's no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You also have the critical illness, um, writer for employee, spouse and child.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have the office treatment rider, so there's no in-office coverage like the doctor's office or a specialist's office, but any treatment done in the office as long as it's not cosmetic could be covered up to that $1500 per year per person.
[CUSTOMER][NEUTRAL] OK, so if I go to the doctor's office like a well visit, is this included? Do I have to put in a claim or that's something else?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, no, the treatment, yes, you, you, well, you don't have to put in the claim, you would give them your card, your APL card when you give the Florida Blue card because they're going to bill Florida Blue and then after Florida Blue responds, they're going to bill us automatically. If they don't have our information, they'll bill you, but we don't want you to get the bill.
[CUSTOMER][NEUTRAL] Uh, you know what, I forgot I even had this insurance so I was looking through my wallet.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So that's why I can't remember what it was for.
[AGENT][NEUTRAL] Well, you have had this policy since [PII], so you really, um, there's no timely filing limit. So if you had the documents, you really could um go back to [PII] and file claims.
[CUSTOMER][NEUTRAL] Yeah, I haven't been in the hospital or anything like that, but I didn't know what kind of claim, but I, what claims I would need.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've been like
[CUSTOMER][NEUTRAL] What, like, um, going to my primary physician or something like that?
[AGENT][NEUTRAL] Yes, that would be the office treatment rider.
[CUSTOMER][NEUTRAL] Oh, OK, well I can get some. I can get those because I've been, I go to him every 3 months. So what does that mean? Is that good or is that bad?
[AGENT][NEUTRAL] What? Did she go to the doctors?
[CUSTOMER][NEUTRAL] No, no, no, but I mean, what would be the disbursement?
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] I'm like, no, that's not bad.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, so, well, how would it be dispersed?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that would be under the office treatment writer, so it would be however many claims you send in, we would pay, you know, towards it up to, we just wouldn't go over that 1500, and you have that 1500 since [PII] to use.
[CUSTOMER][NEUTRAL] Cause I'm a
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK, alright, so I'll get the documents and just mail them. I mean, get back in touch with someone as far as like receipts or what do you, or you want what treatments were done.
[AGENT][NEUTRAL] So you'll need
[CUSTOMER][NEUTRAL] Like I'm gonna say, like yesterday, um, I went in there, he did a wellness check and he did an EKG and he drew blood.
[AGENT][NEUTRAL] So, um, you would just
[AGENT][NEUTRAL] Well, that would, anything that's done in the office, we're gonna look at the coding anyway. So you would just go ahead and send that into us and um it'll still come out of the office treatment rider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, but
[CUSTOMER][NEGATIVE] I, I will be reimbursed or I wouldn't be reimbursed. It just come off the, the treatment rider.
[AGENT][NEUTRAL] Well, it depends. If they, if it's something like a co-pay, because we only apply towards the copay, deductible and co-insurance. So if it's something to where you pay a co-pay and now you're filing the claim, yes, you could be reimbursed for that co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh OK alright I just wanna make sure I understand the policy. OK, I'll get the information, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye