AccountId: 011433970860
ContactId: 1c245f72-a5e1-4bf2-9104-edf066bd4d9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442410 ms
Total Talk Time (AGENT): 190892 ms
Total Talk Time (CUSTOMER): 134036 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/1c245f72-a5e1-4bf2-9104-edf066bd4d9a_20250324T12:21_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling AP how can I help you?
[CUSTOMER][NEUTRAL] Hey, yeah, how you doing? Good morning, um, uh, uh, so we're members with um.
[CUSTOMER][NEUTRAL] If you, I just had a couple of questions.
[CUSTOMER][NEUTRAL] Um, for secondary insurance, how does it work exactly? Um, do you cover?
[CUSTOMER][NEUTRAL] Um, the deductible, like if I were, if, if I were to go to a doctor and I had to meet my deductible, so therefore the primary insurance would, uh, force me to pay out of pocket mostly for the deductible to, to pay towards deductible, do you cover that?
[AGENT][NEUTRAL] OK, so you have some general.
[AGENT][NEUTRAL] Questions on how the supplemental policy works is that.
[CUSTOMER][NEUTRAL] Yeah, yeah, I have to.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's, yeah.
[AGENT][POSITIVE] Yes, sir. Well, I can help you with those.
[AGENT][NEUTRAL] OK, sure. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] I'm sorry, [PII], what was the last name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh [PII]. OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please, Mr. [PII].
[CUSTOMER][NEUTRAL] Um, 02.
[CUSTOMER][NEUTRAL] 519
[CUSTOMER][NEUTRAL] 567.
[AGENT][NEUTRAL] OK, thank you. So if you give me a moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Mr. [PII], I will need to verify several things with you first for security and also any information that's provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And the last thing to verify is going to be the email address for you.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Actually I believe this may be your work email Mr. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and I can see that you all have already you've set up your profile on our online service center where you can have access to your information also online so this supplemental policy that you have with us, it does help with coverage services as far as your co-pays and deductibles. Now office visits are not.
[AGENT][NEUTRAL] Covered under this policy.
[CUSTOMER][NEUTRAL] 00, is the offices that are not covered under this policy.
[AGENT][POSITIVE] If you're specifically asking, that is correct.
[AGENT][NEUTRAL] Now, if you were to have some type of procedure done in the office, that is something that could be reviewed, but the office visit itself is not.
[CUSTOMER][NEUTRAL] Uh-huh, so
[CUSTOMER][NEUTRAL] Uh-huh, um.
[CUSTOMER][NEUTRAL] OK. Oh, so, oh, so you're saying the procedure. OK, so couple, OK, so let me just a couple of follow-up questions. So I actually had um a sleep study done.
[CUSTOMER][NEUTRAL] Would that be covered? It wasn't an office procedure. I mean, it wasn't, uh, I mean, it was actually at home.
[CUSTOMER][NEUTRAL] Sleep study like they mail me something.
[CUSTOMER][NEUTRAL] I don't know if you got the invoice um from the uh because I told them to send it to you guys.
[CUSTOMER][NEUTRAL] That's the first question I had.
[AGENT][NEUTRAL] What was the date that you had that done, Mister?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] February something I don't.
[AGENT][NEUTRAL] We uh
[AGENT][NEUTRAL] Cause we, as of now.
[CUSTOMER][NEUTRAL] February something I don't know they might they.
[AGENT][NEUTRAL] Uh-huh. Go ahead. No, no, no, I was gonna say as of now.
[CUSTOMER][POSITIVE] Yeah, I'm sorry.
[CUSTOMER][NEUTRAL] They might it might.
[AGENT][NEUTRAL] We haven't received a claim for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] At this time. Now, they do have to file, if your doctor's office is handling everything, they would file with your primary insurance company first because we do have to have a
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, they already did
[AGENT][NEUTRAL] And then once they have filed.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] With the primary, they would fall with APL because we do have of the primary healthcare insurance explanation of benefits along with each claim.
[AGENT][NEUTRAL] That we review
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But as of now, we just haven't we have not read that.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK, I'm just wondering would that be covered?
[AGENT][NEUTRAL] That will be something that is just going to have to be reviewed once we receive the information, depending on the, you know, several different things once the claim has been reviewed since that was done at home. Give me just a moment.
[AGENT][NEUTRAL] To look at just a few things on here.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So again, these are, it is something that could possibly be covered.
[AGENT][NEUTRAL] Under this policy, but again, we will have just to receive the claim in order to review that. It is possible that could be reviewed under your outpatient benefits.
[CUSTOMER][NEUTRAL] OK, alright, I guess I'll let the, I'll let the process go and we'll see what happens, OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, no, so you said uh just, just to, uh, review, so you said the office visit itself is not covered but uh possibly a procedure.
[AGENT][NEUTRAL] No, sir.
[AGENT][POSITIVE] That is correct. Yes, sir, that is correct. Uh-huh.
[CUSTOMER][NEUTRAL] Might be covered.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] OK. Well, you, I hope you have a great day too, and if that's all I can help you with, thank you again for calling APL Mr. [PII].
[CUSTOMER][POSITIVE] Thank you so much have a great day.
[CUSTOMER][NEUTRAL] Alright bye bye.