AccountId: 011433970860
ContactId: 2121cea0-d4c0-43fb-ab62-ad4464ddc9b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1109359 ms
Total Talk Time (AGENT): 514374 ms
Total Talk Time (CUSTOMER): 292924 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/2121cea0-d4c0-43fb-ab62-ad4464ddc9b2_20250619T18:46_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, [PII]. Um, I don't have my card with me, but I have a note of my policy number. I wanted to know if you could tell me if there are any claims recently. My husband's having um an outpatient procedure tomorrow. Well, I think it's actually maybe inpatient, I'm not sure. Um, and I just wanted to know if there are any benefits available for him.
[AGENT][NEUTRAL] OK, so you're the policy holder and you're wanting to get your policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And find out if any benefits.
[CUSTOMER][NEUTRAL] I have the policy number. Yeah, I, I think I have the policy number. I just wanted to see what benefits we have available.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can try and help you with this. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII], did you say [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][POSITIVE] OK, thank you. And Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] 02304224.
[AGENT][NEUTRAL] OK, thank you one moment while I get your information pulled up.
[AGENT][NEUTRAL] OK, and Miss [PII], I will have to verify several things with you first for security and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth and your husband's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII] and my husband is [PII] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address, please?
[CUSTOMER][NEUTRAL] [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] Mhm.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Thank you. And lastly your email address, please.
[CUSTOMER][NEUTRAL] Uh, personal is [PII].
[AGENT][NEUTRAL] OK, so we do have something different on file for you?
[CUSTOMER][NEUTRAL] Unless it's
[CUSTOMER][NEUTRAL] OK, that'll be [PII].
[AGENT][NEUTRAL] OK, thank you. All right. So, first off, on your, um, excuse me.
[AGENT][NEUTRAL] We have a portal, Ms. [PII], in which you can set up your profile to be able to have access to your ID cards, policy information, and claims information online. Has anyone ever told you about our portal?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Well, I just tried to log in the APL OSC OS yeah OSC and it said it didn't re it didn't, yeah, didn't recognize my email.
[AGENT][NEUTRAL] Uh-huh. That's it. Oh, I see. Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, if you were trying to use your personal email, that would be wise.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me try to log in. Maybe I haven't, maybe I haven't created an account. Would that be the case?
[AGENT][NEUTRAL] Yes, ma'am, and I was gonna say that I would email you a couple of guides, but you're welcome to set it up and I can still email these to you for just, you know, tips on how to use the portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you, yeah absolutely try and set it up if you have time with me on the phone just to make sure that you can and don't get another error message.
[CUSTOMER][NEUTRAL] Yeah, so we can't find your account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I have a password, so I'm looking at the notes in my phone, so it looks like I.
[AGENT][NEUTRAL] OK, so now
[AGENT][NEUTRAL] Right, but you're gonna have to set up a new profile because there was an update to the portal.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So everyone is having to create new new profiles for security.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on that very first screen below below the log in.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Or you should see where it says create OSC account.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Wonderful
[CUSTOMER][NEUTRAL] Group, which role best describes you?
[AGENT][NEUTRAL] And then you're going to select insured.
[AGENT][NEUTRAL] You're the insured. Uh-huh.
[CUSTOMER][NEUTRAL] In short, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And that was my member ID number, right?
[AGENT][NEUTRAL] OK. The only 3 boxes you need to fill in are the ones that have the red asterisks beside them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, I sent you that email that I was talking about, so you should get that in a couple of minutes, um, and it's gonna come from [PII], Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, once it tells you that it's going to, it's sending you a, your security code via email, that may take a couple of minutes for that to come through.
[CUSTOMER][NEUTRAL] You
[AGENT][POSITIVE] So just be patient with it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, well let me put my date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK, got it.
[AGENT][NEUTRAL] Did it let you down?
[CUSTOMER][NEUTRAL] Next email.
[CUSTOMER][NEUTRAL] Complete your account set u[PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um hold on one second.
[CUSTOMER][NEUTRAL] Yes, it's saying now I'm gonna set it up password and everything, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now it should be, yeah it would email you.
[AGENT][NEUTRAL] Has it, have you received your code yet?
[AGENT][NEUTRAL] Via email, OK, so you'll have to do that first and verify that code before you'll be able to create a password.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It says send verification code. Do I need to hit that?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh, click there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like I said, it's, that may take a minute or two. Sometimes it comes pretty quickly, sometimes it takes a few minutes to get that in your email.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, we have something with our email so it goes to the filter first and then we get emails but.
[AGENT][NEUTRAL] Yeah, everything has a lot of filters and all that these days, but unfortunately, we have to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, you need that the that's my time.
[AGENT][NEUTRAL] And once you do get, do receive your code, you're just gonna copy and paste that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I know I can create.
[AGENT][NEUTRAL] And then once you, right, once you click verify code, then you can, so you entered your code and clicked verify code. Is that correct?
[CUSTOMER][NEUTRAL] New password.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is display name? just something that's gonna be.
[AGENT][NEUTRAL] Right. That can be your name, just your
[AGENT][NEUTRAL] Your name it's fine there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once you do that and click continue.
[AGENT][NEUTRAL] No, it should ask you about, uh, gives you some terms of use and policy, privacy policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To accept and then you'll do that and click continue.
[AGENT][POSITIVE] And it's gonna send you another bear yeah I was gonna say it's.
[CUSTOMER][NEUTRAL] I'm trying to log in now.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Should get, so that's like a two-factor or multi-factor authentication.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I get the code.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] All right, continue.
[CUSTOMER][NEUTRAL] Alright, I'm here dashboard. Welcome to our online next, um, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So it sounds like you are signed in.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I guess this now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Text messages, OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. And then that way you can opt in for text alerts when we process the claim.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] For anyone covered on your policy?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. So where do I find the information about claims or available funds or whatever?
[AGENT][NEUTRAL] OK, so I can provide you that information, but your policy information, you're on your dashboard you should see where it says my policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you click there, uh, one of the options should be blue with a pair of hands and a heart in the center that says view your policy details.
[CUSTOMER][NEUTRAL] What does it say my policy and then it says we go where?
[AGENT][NEUTRAL] OK, when you click my policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You should see two different icons. One's blue, one says, would you like to review the coverage details of your policy, and the other one says, do you need to access your ID cards?
[CUSTOMER][NEUTRAL] Oh, on the dashboard, yeah.
[AGENT][NEUTRAL] So to view your policy documents, your policy information, you would click the policy details.
[AGENT][NEUTRAL] And that will take you, uh huh, and that will, you can download the policy information from there it should say downloading.
[CUSTOMER][NEUTRAL] My details, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm this is my detail and claims.
[AGENT][NEUTRAL] OK, did you click on my policy?
[AGENT][NEUTRAL] Or the policy details, did you click on that? OK.
[CUSTOMER][NEUTRAL] Yeah, my plan.
[CUSTOMER][NEUTRAL] Yeah, my policy, my details.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then I've got policy details here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you should be able to click on that.
[CUSTOMER][NEGATIVE] But it's downloading something. It's just circle spinning, it's not doing anything.
[AGENT][NEUTRAL] Yes, that's gonna be
[AGENT][NEUTRAL] Right, right, it's thinking, it's downloading your policy information.
[AGENT][NEUTRAL] Now on this policy again, any information that I provide for you Ms. [PII] regarding benefits will be a verification of benefits and not a guarantee of payment on this supplemental policy for out excuse me, covered outpatient services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said your husband was having a procedure, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum.
[AGENT][NEUTRAL] On this policy per calendar year per covered person is $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEGATIVE] As of now, no benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just make sure that when you all go for the procedure to present the facility with your APL card along with your primary health care insurance card because most providers will file both insurances for you in the event that they tell you they do not file a secondary or supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you can file your claim, you can actually upload all the necessary documents directly into your portal for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you could call us back if that need arises and we can explain how to go about doing all that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But again, most providers will take care of that for you and if they will it's, you know, it does make it easier.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so there's no claims as of yet, you said.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEGATIVE] As of now no benefits have been used, no outpatient benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] OK, cause my husband was in hospital last year, last week, last month.
[CUSTOMER][NEUTRAL] I guess they're not doing anything about it then either.
[AGENT][NEUTRAL] Well, the, the way this plan works is, you know, it just, it, it was that recent. I mean, uh, and you presented them with your APO information then?
[CUSTOMER][NEUTRAL] Maybe they won't
[CUSTOMER][NEUTRAL] Yeah, yeah, I, I, yeah, I, I stated this is primary and this is secondary. Don't forget to put the secondary down there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] So, I see, let's.
[CUSTOMER][NEUTRAL] OK, so they haven't.
[AGENT][NEUTRAL] So they have to file it with your primary insurance first and then with APL because whether they file it or you file it, we have to receive a copy of your primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Go ahead, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So they may just not have had enough time yet, but as of now we have not processed any type of claims.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] For this calendar year.
[CUSTOMER][NEUTRAL] This year, OK, all right, so the
[CUSTOMER][NEUTRAL] OK, so, so for the outpatient, which she's having, it must, yeah, it's uh I think it's an outpatient procedure tomorrow, um.
[CUSTOMER][NEUTRAL] There's $1500 per person, right?
[AGENT][NEUTRAL] For covered outpatient services again, I cannot guarantee payment. I can only verify what the benefit or benefits are.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and what about, what are the benefits for inpatient?
[AGENT][NEUTRAL] For an inpatient admission to the hospital on this plan, the inpatient benefit is the same amount per calendar year.
[AGENT][NEUTRAL] And there is no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and they're two different pots, right? They're like two different buckets as an outpatient and an inpatient amount.
[AGENT][POSITIVE] That is correct. Mhm. Yes, ma'am, it is. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so maybe when he stayed in hospital, the outpatient, they'll try and claim it from the outpatient and the inpatient, they'll they'll claim it from there, OK.
[CUSTOMER][POSITIVE] Alright, I got it. I got it, I got it, I got it.
[AGENT][NEUTRAL] Yeah, it's depends on how his stay is classified, correct.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alright, perfect. Alright, thank you. I appreciate your help, [PII]. I really do thank you.
[AGENT][POSITIVE] Well, uh, absolutely. Oh, you're very welcome. Is there anything else that I can help you with or try to answer for you today?
[CUSTOMER][POSITIVE] No, I think you've done a great job. Thank you. I appreciate it.
[AGENT][POSITIVE] Oh, well, you're welcome, Mrs. [PII]. It was my pleasure in speaking to you and thank you again for calling APL. I hope that you have a very nice rest of your day and I hope that everything goes well with your husband.
[CUSTOMER][POSITIVE] Thank you. I appreciate that. You take care as well. Thanks.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.