AccountId: 011433970860
ContactId: 2024319c-14cd-430e-929a-f75666930096
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515289 ms
Total Talk Time (AGENT): 240988 ms
Total Talk Time (CUSTOMER): 199387 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/2024319c-14cd-430e-929a-f75666930096_20250117T20:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I have a, I guess it's a policy with you guys. I'm scheduled for a colonoscopy on the [PII], but for some reason, the doctor ordered two additional tests, and I, he didn't tell me why.
[CUSTOMER][NEUTRAL] So I wanna know is only can be a free standing place for me to be covered?
[CUSTOMER][NEUTRAL] Cause it's gonna be at Saint Joseph's Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], so you have a policy with APL and you're wanting to find out.
[CUSTOMER][NEUTRAL] It's uh
[AGENT][NEUTRAL] About a benefit for an upcoming procedure?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, ma'am. I can take a look and help you with this. What is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the policy number for you?
[CUSTOMER][NEUTRAL] Oh, let me get that out. Hold on.
[CUSTOMER][POSITIVE] Thank you for holding. OK, let me.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] I don't know. I think the doctors just overcharging me for stuff just to see, and he didn't tell me about it because I would have told him no at the time. OK, let me get this here, um.
[CUSTOMER][NEUTRAL] My um
[CUSTOMER][NEUTRAL] Policy number is 0127.
[CUSTOMER][NEUTRAL] 711566
[AGENT][NEUTRAL] OK. So let's say that number one more time because that's too, too many numbers. I, I may have just misheard what you said, Ms [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, no problem. Let me, maybe I just need to put my glasses on. Hold on for a second.
[CUSTOMER][NEGATIVE] They're driving me right out of my mind. I'm like.
[AGENT][NEUTRAL] Oh, well, don't let anybody do that to you.
[CUSTOMER][NEUTRAL] I know, because I'm like, because my doctor, my PCP, he does this to me all the time, just to see. And I'm like, and then usually I'm fine. OK, you ready?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] 01271566
[AGENT][POSITIVE] OK, thank you, so one moment please.
[AGENT][NEUTRAL] OK, Ms. [PII]. So I will need to verify several things with you first for security and then also any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, thank you. And the last piece of information to verify is your email address.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you so much. All right. And so you're wanting to find out about your outpatient benefits, is that correct?
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So just a moment.
[AGENT][NEUTRAL] And you said this is going to be done at a, an outpatient facility. Is that correct?
[CUSTOMER][POSITIVE] Yeah, exactly.
[AGENT][NEUTRAL] OK, so on your outpatient benefits on this supplemental policy, you have a $1250 calendar year maximum benefit for covered outpatient services and there's no outpatient deductible per covered person per calendar year on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you just need to make sure to present your APL card to your provider along with your primary insurance card.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Most providers will file both insurances for you, Ms. [PII], but if for any reason your doctor doesn't file your supplemental coverage, then you can file policy, excuse me, claims with APL yourself, and I can see you've already set up your profile in our portal online on the online service center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you were to have to do that instead of me giving you information overload, you could call us back to find out how to file a claim if you have to do that, but most, again, most providers will file both of your insurances.
[CUSTOMER][NEUTRAL] OK, because
[CUSTOMER][NEUTRAL] OK. All right. Well, I'm going to get him. I got a call into him and he's supposed to be calling me back, because he's, I guess he said that, my family, there was a history of colon cancer. It was a half brother that had it, you know, and
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] But I'm just like, I just wish when I was in his office, he would have told me what he was ordering, and he didn't do that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I was OK with the colonoscopy because I haven't had one in 14 years. But all that other stuff, 2 extra procedures.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And I'm like, what? And then I just paid them a deposit today for the, uh, another procedure I'm getting on the [PII]. So it's like, huh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] I care about my health, but if I don't have the money, they're not gonna do it for free.
[AGENT][POSITIVE] I, I can totally respect and understand everything that you just said. Yes, ma'am.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] So this policy again, we, this policy for covered outpatient services, of course, we would have to receive the claim to determine if their benefits payable, obviously, but the maximum again that your maximum outpatient benefit for covered outpatient services is $1250 with no deductible.
[CUSTOMER][NEUTRAL] But OK, what
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright that sounds good thank you so much for the information and I appreciate your time.
[AGENT][NEUTRAL] We
[AGENT][POSITIVE] Absolutely. Well, I.
[CUSTOMER][POSITIVE] And I'm gonna hook
[CUSTOMER][NEGATIVE] Hopefully Doctor [PII] will call me and tell me why he did that and why didn't he tell me he was gonna do that.
[AGENT][POSITIVE] Oh goodness. Well, I hope they do call you back as well. We all like to have answers to our questions. I know I do anyway, Ms. [PII].
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][POSITIVE] Oh, I do too because it's only me. And I got a mortgage and everything. I can't just say, OK, here, take, take the money, take the money. But OK, then, well thank you again and I'm gonna be soon as he calls me back, I'll get back in touch with you guys. How long are you open today?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, we're open till [PII]
[AGENT][NEUTRAL] And again you will just need to make sure to have um to give them your APL information and let them know you have a supplemental insurance because most of the providers they will also call to verify your benefits and again we can't guarantee payment until the claim, you know, we have to receive the claim and review it but the important thing is to make sure they have your information for us as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, that sounds good. Thank you again. I really appreciate you.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome and I hope everything goes very well for you, Ms. [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes, ma'am. And do you, can I help you with anything else?
[CUSTOMER][POSITIVE] No, you've been very helpful you have a wonderful day.
[AGENT][POSITIVE] Well, thank you so much. I hope you do too and a nice weekend and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome, bye bye.