AccountId: 011433970860
ContactId: 1c851132-a768-4817-90d0-b281fd565b52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 731630 ms
Total Talk Time (AGENT): 306441 ms
Total Talk Time (CUSTOMER): 229945 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/1c851132-a768-4817-90d0-b281fd565b52_20250520T13:46_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, my name is [PII], and I have um coverage with you. I would like to know because I went a few months ago to the foot doctor and I had to pay a copay. Um, do you reimburse that money?
[AGENT][NEUTRAL] OK, so you have a question regarding your benefits on your policy. Is that correct for an office visit?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that and I'm so sorry, but what is your name again? I wasn't able to understand you the first time.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you, Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is um your policy number, please?
[CUSTOMER][NEUTRAL] Let me get that for you right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says group. Could it be the group number?
[AGENT][NEUTRAL] No, ma'am. There will be some other.
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Could it be the um benefit cer certification number?
[AGENT][NEUTRAL] Yes, ma'am. That would.
[CUSTOMER][NEUTRAL] In hospital outpatient? Yeah.
[AGENT][NEUTRAL] This would be outpatient.
[CUSTOMER][NEUTRAL] OK. 02.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Outpatient. 02505670 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, Miss [PII], thank you. Give me a moment please to get your information pulled up, and once I do, I will have to verify several things with you first for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. So just one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so first off, Miss [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and 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][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you and lastly your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And your last name is [PII], correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you. Alright, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so Mages on this supplemental policy, um, for an office visit, the office visit benefit on here, was this for a specialist or a primary care?
[CUSTOMER][NEUTRAL] Special
[AGENT][NEUTRAL] OK, so the specialist office visit benefit is up to $50 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So when you went to your doctor's appointment, did you present them your APL card along with your primary insurance card?
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] OK, so yes, ma'am, that is something that we can review for benefits for under your policy.
[CUSTOMER][NEUTRAL] OK, but they still charge me a 60%. I don't know if they even considered billing the APL or I, I'm sorry, I think I just gave you the, can you check?
[AGENT][NEUTRAL] I can check.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] I can see if we've received the claim for you. One moment.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when did you go? What date was your doctor's appointment, Ms. [PII]?
[CUSTOMER][NEGATIVE] No, I cannot tell you exactly because I forgot. It was a few months ago, but I did call APL and they were supposed to send me, uh, the claim forms and I never received them.
[AGENT][NEUTRAL] OK, so miss as far as the
[CUSTOMER][NEUTRAL] It was the same month.
[AGENT][NEUTRAL] OK. So you don't know when your doctor's appointment was so that I could check to see if we've received a claim for you?
[CUSTOMER][NEUTRAL] No, it was a few months ago. I mean, I didn't even write, uh, I went to my doctor's appointment, but I didn't write it down. I didn't think I was gonna have this issue.
[AGENT][NEUTRAL] OK, so we haven't received a claim for you for a data service in [PII].
[CUSTOMER][NEUTRAL] OK, good. Can you send me 2 or 3 forms so I can, because today I'm gonna go to um Baptist Health, Baptist Cancer Institute, and I'm gonna have to pay a co-payment there too. So,
[CUSTOMER][NEUTRAL] Unless I give them my card and they accept it, but if they do charge me the co-pay, I would like to file a claim.
[AGENT][POSITIVE] OK, so I'll be happy. I'm going to email you the user guide for our portal messages so that you can set up your profile online and be able to have access to your policy information. Now I'm I can also include the Medli claim form in this email that I'll send to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you could, you know, print it as many times as you need to for your claims because you can upload your claims information directly into your portal for our review if you're going to be submitting the claims and that user guide will explain how to do that as well.
[AGENT][NEUTRAL] OK, and the claim form does have the instructions for what other documentation you will also need to provide if you're going to be submitting the claim.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] OK, let me ask you a question. How about for people that don't have emails?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean, they don't have printers. Do you, uh, send it through mail like a long time ago, you guys did?
[AGENT][NEUTRAL] It can be sent through the mail. It will take up to 10 business days for that to be received in the mail.
[CUSTOMER][NEUTRAL] It doesn't matter. I've waited. I, this was months ago, so it doesn't matter. It was 10 days.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK, so give me just a moment to get that information pulled up to order that for you.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][POSITIVE] Thank you. If you can mail me 2 or 3, I would appreciate it.
[CUSTOMER][POSITIVE] For one, it's OK because I can make a copy. I can go and make that and I can make a copy for.
[CUSTOMER][NEUTRAL] If you do accept the copies.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I have requested the forms be mailed to you in the mail. I'm going to email you that information and that I, that I would, and if your daughter, you said your daughter could possibly print or make copies or for you, is that correct? Oh, daughter-in-law, OK. So, yes, ma'am. So I have sent that, so the email that you should be receiving from me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My daughter-in-law.
[CUSTOMER][NEUTRAL] Yeah, I done.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] will come from [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And I did put APL in the subject line and again it will have two attachments on that email.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEGATIVE] I see. Let me see. I'm clicking on that now, but it's not letting me open. Suspicious attachment. Oh, how weird. How can I can I cannot open it.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] It shouldn't be a
[CUSTOMER][NEGATIVE] It's not letting me open the account.
[AGENT][NEUTRAL] OK. Are you on a work computer?
[CUSTOMER][NEUTRAL] No, no. I'm in my phone.
[AGENT][NEUTRAL] No, personal.
[AGENT][NEUTRAL] Oh, on your phone, that could possibly be why you're not able to open it. I would think that you should still be able to open it. I'm not sure why you're getting that suspicious email because I've sent.
[CUSTOMER][NEUTRAL] Yeah, my phone.
[CUSTOMER][NEUTRAL] Oh, OK, so
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] I've actually sent the same two documents, um, a couple of times this morning and they were able to open it without getting an error message like that.
[CUSTOMER][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll get it to my laptop.
[CUSTOMER][NEUTRAL] I'll get
[CUSTOMER][NEUTRAL] That's, that's weird, but I'll open it through my laptop in a little bit. I have a laptop and I'll just open it there.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and then maybe because we've not ever emailed you, you know, maybe before. I'm not sure, but you are the first person.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Messages that has told me it has given them that message. So again, I'm not quite sure about that, but it is just a user guide and a blank claim form.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it says, to keep your information safe, downloading attachments has been disabled. Oh my God, that's crazy.
[AGENT][NEUTRAL] I said that sounds like something on your phone. Yes, and that sounds like that's something on your.
[CUSTOMER][NEUTRAL] That is crazy.
[CUSTOMER][NEUTRAL] I guess
[AGENT][NEUTRAL] On your phone.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][POSITIVE] Yeah, no, but I have uh the laptop like I said, and I'll do that from there. Don't worry. I appreciate you very much.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. So again, is there anything else that I could help you with this morning?
[CUSTOMER][NEUTRAL] No, I think that's about, that's about it.
[AGENT][POSITIVE] OK. Well, you are very welcome and thank you again, Miss [PII], for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] That's about it. Thank you, ma'am.
[CUSTOMER][POSITIVE] You too, ma'am. Thank you. Bye bye.
[AGENT][POSITIVE] Uh-huh. Thank you too. Bye-bye.
[CUSTOMER][NEUTRAL] Welcome. Bye-bye.