AccountId: 011433970860
ContactId: 24c5d236-c2b9-40bf-a9ab-57c5ac00beb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580809 ms
Total Talk Time (AGENT): 390403 ms
Total Talk Time (CUSTOMER): 153259 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/24c5d236-c2b9-40bf-a9ab-57c5ac00beb4_20250327T15:29_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] Hey [PII], my name is [PII], and I was wondering if you could help me out with some questions I have on a bill.
[AGENT][NEUTRAL] OK, [PII], are you the insured?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, and you have a question regarding
[AGENT][NEUTRAL] Either is it a claim or are you wanting? Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] Well, OK, so you're my gap plan provider.
[CUSTOMER][NEUTRAL] Maybe I, I need to find out if I submit a claim or how this works. It's my first time dealing with this.
[AGENT][NEUTRAL] Oh, sure. Yes, sir. I can help you with, um, how to file a claim or finding out about filing a claim. What is a good callback number for you?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Uh, can I give you some verification information to pull that up?
[AGENT][NEUTRAL] Uh, you can, if the, are you just subscriber? Is this for your employer that you have our coverage? OK, what is your full social please? Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Through my employer.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you one moment while I locate your information.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so first off, on any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first though for security purposes. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. The phone number that you gave me, the [PII], is that the best contact number that we should have on file for you?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, thank you and then lastly I do need to add an email address.
[CUSTOMER][POSITIVE] Sure, it's wonderful with [PII] and I can spell it for you.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Oops, one, I'm sorry. Hold on one second while my system wasn't ready. I, I thought I was ready, but I wasn't quite ready.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so let's start again. So
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] So it's wonderful, so like my name, so it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Uh, [PII] again. Wonderful [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] The old email but.
[AGENT][POSITIVE] That's creative though, with your name. That's perfect.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Yeah, little play there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so thank you for verifying all of your information. Now, you did not have your policy number, so do you have, have you received ID cards, one you should have?
[CUSTOMER][NEUTRAL] I don't think I have. No, I don't think I have. I mean, I have to go through my my mail, but last time I went through my mail I had not seen it.
[AGENT][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] Um, there's a possibly I got it, but.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Let me just
[AGENT][NEUTRAL] Because it looks like they were sent back in.
[CUSTOMER][NEUTRAL] And if there's a way we could set up another one to go out.
[AGENT][NEUTRAL] Yeah I can do that and I'm also going to email you our user guide for our portal called the online service center because once you set that up you can go ahead and have access to your ID cards, your policy information, the user guide will explain also how to upload uh claims information directly into your portal for our review if you're gonna be filing a claim.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can also add in direct deposit information so that if benefits are payable then we could electronically deposit them instead of having to issue, you know, and mail a paper check to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that sounds good.
[AGENT][NEUTRAL] OK, so I'll do that when we get off the phone. The email that you're.
[CUSTOMER][NEUTRAL] So I guess if you could just review what what how my coverage works and what's covered and what's not covered, I guess that's be a good starting point for this call.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, sure. So, on this policy, this is a supplemental policy to your primary health care insurance, and it is designed to help you with your co-pays, deductibles, and co-insurance amounts of coverage services. Now, on this plan,
[AGENT][NEUTRAL] Um, if you were to be admitted inpatient into the hospital, you're inpatient, and I, again, I'll be happy to give you all this information, but it's also, you'll see it in your portal as well. But you have an inpatient benefit maximum of $7150 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You have an outpatient benefit maximum that is $500 per covered person per calendar day for covered outpatient services for accident and sickness related.
[AGENT][NEUTRAL] Now, office visits though are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you were to have, you know, some type of procedure done in a physician's office, you know, or treatment in the office, that is something that could be reviewed, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] Got you. So I have a question maybe like an example I could use if that's OK. Um, so I have a, I have a bill for my CPAP supplies. I have like a mask that I wear and tubing and stuff, and I have a new bill, uh, for like $200. Um, do you know if something like that would be covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you do have um a a benefit for durable medical equipment. Now, for durable medical equipment though, the supplies.
[AGENT][NEGATIVE] would not be covered. Um.
[AGENT][NEUTRAL] The definition of durable medical equipment is that it can withstand repeated use, is not disposable or refillable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is used
[AGENT][NEUTRAL] To serve a medical purpose is not useful. To a person, the absence of sickness or injury is appropriate for use and primarily used within the home. It's not implantable within the body and is covered under the other medical plan.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] Reservoirs, cartridges, cannulas, things like that with the insulin, with insulin pumps and then like hoses, masks, water reservoirs.
[AGENT][NEUTRAL] would be things, you know, for the CPAP. Yes. So basically, if it's disposable, it would not be covered.
[CUSTOMER][NEUTRAL] Cushions
[AGENT][NEUTRAL] Disposable or refillable.
[CUSTOMER][NEUTRAL] Got you. So the machine is always sits in its place. If anything will go go wrong with it, maybe that would be the machine, but anything else that, that, uh, does not, that's what I needed to know.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Right. Now, what, and what I'm gonna recommend is, you know, you are always welcome to file your own claim, um, if your provider for some reason would not file your supplemental, whether it's whether you went and had some type of scan, you know, if they just said, hey, we don't file supplemental, you can do that and then you could call us at that point and we could tell you how to go about doing all that.
[CUSTOMER][NEUTRAL] That's why I needed to find from you guys.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] If you already know you have a claim that you're gonna need to be filing, I'll be glad to give you that information now. Um, but I always recommend that you just present your APL card along with your primary insurance card when you go for medical services because most providers will file both. And that just saves you a little um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, extra effort on having to get
[CUSTOMER][NEUTRAL] So having the card and showing it to him at the time.
[AGENT][NEUTRAL] Yeah, yeah, just present the APO card along with your primary insurance card.
[CUSTOMER][POSITIVE] OK, that's very helpful. And then I'll look for the email you sent me with the instructions, and I'll go to the website and take a look, you've answered all my questions in there.
[AGENT][POSITIVE] Absolutely. Yeah, I'm
[AGENT][NEUTRAL] OK, well, the, um, the email that I'm gonna send to you and again that's gonna be in just a couple of minutes it will come from care team at [PII] and I will put in your subject line APL online service center so that that's easy to recognize. It should not go to your spam or junk folder, but it might if we since we've, you know, never emailed you before, so if you haven't seen it within like 10 minutes.
[AGENT][NEUTRAL] Then check one of those folders.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that sounds good. I really appreciate all your help today.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Not at this point. You have a great day.
[AGENT][POSITIVE] Well, I hope you have a great day too, and thank you again for calling ATL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.