AccountId: 011433970860
ContactId: 2a0fd19f-6a21-487e-b34e-9eac941ed71b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 702309 ms
Total Talk Time (AGENT): 448298 ms
Total Talk Time (CUSTOMER): 205440 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/2a0fd19f-6a21-487e-b34e-9eac941ed71b_20250605T17:45_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] Hi, good afternoon. My name is [PII]. I was at the doctor's office this morning. They tried to put a claim through and they said as of [PII] that my policy was expired. Um, I'm not sure exactly what's going on, so I just wanted to see if I can get checked.
[AGENT][NEUTRAL] OK. So Miss [PII], you're the insured and you said that you went to the doctor this morning, but when they verified your benefits or eligibility, they were told that your policy had termed as of [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Is that correct? OK, yes ma'am I can help you with this. I can check that for you. Um, first off, what is a good call back number for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Policy number is, is that going to be the
[AGENT][NEUTRAL] It it depends on.
[CUSTOMER][NEUTRAL] Like I'm, I'm looking on my card.
[AGENT][NEUTRAL] Yeah, I was gonna say it depends on the type of policy you have with APL Miss [PII], as to how it would be worded. So if it doesn't have a policy or policy certificate, you may have an in-hospital or outpatient number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you see one of those? OK, so, and if you'll notice then on those two numbers, the first part of each number prior to the letters ML, the numbers are identical. So that's actually your policy number. So just give me the first part of that number, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK perfect so it's 0260.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 831 9
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, and give me a couple of moments to get your information pulled up. Then once I do, I will have to verify several things with you for security and also Miss [PII], 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.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. 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][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, thank you and lastly your email address and this appears to be your work email.
[CUSTOMER][NEUTRAL] Uh yes, so it's um [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so now on this supplemental policy, um, now.
[AGENT][NEUTRAL] You, you said that they told you they called us this morning?
[AGENT][NEUTRAL] And we told them that.
[CUSTOMER][NEUTRAL] No, they just, no, that, so I, I had an appointment this morning. Um, they were trying to charge me the co-pay, and I told them that, you know, through this policy, um, that there shouldn't be a co-pay for an ultrasound visit. Um, they said that they, that a claim tried to go through as of [PII].
[CUSTOMER][NEGATIVE] And that they, when the, the information that they received back was that it was expired as of [PII]. So I don't think that they spoke to anybody. I think it was just through.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so first off, we have not processed a claim for you. I see that we have a couple of things in line for review for you on file, Ms. [PII], but none of them have, have been reviewed. Your policy with us is active.
[CUSTOMER][NEUTRAL] Submitting the, the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You, there is no termination date on your coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I don't know if maybe that was something they checked because they wouldn't have even on like a portal, they wouldn't have been able to access anything. I mean, I don't know if they were referring to your primary healthcare insurance, but with your APL they wouldn't have been able to see anything online. We haven't.
[AGENT][NEUTRAL] We haven't reviewed a claim that an explanation of benefits would have been sent out on yet.
[AGENT][NEUTRAL] Stating that and I don't see that we've received any type of call from a provider since April of this year.
[AGENT][NEUTRAL] For you about any inquiring on any benefit information or anything like that. There's not been anyone reach out to us since April.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm, OK, so mm, what do you recommend to do then? Because I just wanna make sure that.
[AGENT][NEUTRAL] OK, so you can call back and speak to your doctor's office and I mean, tell the person that you spoke with regarding that, that gave you that information. You know, that your, your supplemental policy is active.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Give them our phone number, give them your policy number, they can call and verify that themselves if necessary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but again, you know, we haven't received anything in order to send anything out saying that your policy is not active with us.
[CUSTOMER][NEUTRAL] OK, and then you said that there are a few things that are pending. Are they um like in the process of being, you know, verified and and reviewed or is there an issue with them? I just wanna make sure that that's being handled.
[AGENT][NEUTRAL] We just, we just received the claims on [PII], so I mean the information so I can't even tell what it is at this point. I just see that you have two things in line for review and processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that, yeah, that's the same date that she gave me [PII], so I'm wondering if maybe because those are processing that the, that my that the doctor's office thinks.
[CUSTOMER][NEUTRAL] That I don't know, that I'm just trying to think of why they would, they would have been told the plan was expired.
[AGENT][NEGATIVE] Well, I don't know who would have told them that because they haven't called us.
[CUSTOMER][NEUTRAL] Um, that's just odd.
[AGENT][NEUTRAL] There's not been any.
[CUSTOMER][NEUTRAL] Yeah, I mean, the.
[AGENT][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] The lady who told me at the front desk, I mean, she, she just showed me like on the computer, so I don't know where that information came from. Like I said, I don't, I don't think obviously that they called you guys at all.
[AGENT][NEUTRAL] Mm, no, no, I mean, you know, unless she was referring to maybe something with your primary health care insurance, but it couldn't have been with us because she wouldn't have been able to see anything like that online anyway, until we've processed a claim and it's been reviewed and then, you know, a claim number has been issued. Our portal, you can't check your eligibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Providers can't check eligibility or like they can with major medical insurance, our portal isn't like that.
[CUSTOMER][NEUTRAL] Got you. OK, so just next time I go in, I will, um.
[CUSTOMER][POSITIVE] I guess just tell them that I spoke to you guys and that it's effective and that.
[CUSTOMER][NEUTRAL] If they have any issues just to call directly.
[AGENT][POSITIVE] Yes, that's what I would, I mean, I really would recommend you doing that now I'm going to also send you a user guide for our portal so because it doesn't appear that you've set yours up before and we just had an upgrade to it, so everyone is that even had set it up is having to create a new profile so I'm gonna send you that email so that you can do that because that's gonna give you access Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To your ID cards, your policy information with your benefits in there, and also you will be able to see claims that we have received for you and the status on those and if in the event that you were to ever need to file your own claim with us, you can do that and you could actually if that need arises, you can call us and we would explain how to go about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it's uh, it is easier for you if you, the providers will do it and most providers will file both of your insurances, so I just recommend that you always present.
[AGENT][NEUTRAL] Your primary insurance card and your APL card together.
[AGENT][NEUTRAL] And then then once again in the event that they don't follow your supplemental policy call us we'll give you all the information you need how to do that because you can upload your information directly into this portal and the user guide that I'm going to send to you the email is coming from [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did put APL in your subject line.
[AGENT][NEUTRAL] So that you should easily recognize that. You should have that email now.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] But in the event you don't see it in your inbox, check your junk or spam folder if, if we've not emailed you before.
[CUSTOMER][NEUTRAL] Yeah, that's
[AGENT][NEUTRAL] And it might, it might would go there. You might have to refresh your email, but I did send it to your work email.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. I'm checking.
[AGENT][NEUTRAL] And just so you know, that is also the email to Miss [PII] that you'll need to use to set up your profile.
[AGENT][NEUTRAL] Is your work.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because for security purposes if you try to enter your personal email it's gonna reject you and tell you you can't be failed.
[CUSTOMER][NEGATIVE] Gotcha. OK. Yeah, I still haven't received anything yet. Nothing in my junk.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's AL, let me, OK, it was sent to [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so that is where it was sent to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, and with your, that being you.
[CUSTOMER][NEGATIVE] It might just be delayed.
[AGENT][NEUTRAL] And it could, yeah, I mean, it could be seeing as how that's your work email. I mean, I know that with work emails, a lot of times it has to go through a few of the firewall checks or, you know, for security.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, if you don't receive it,
[CUSTOMER][POSITIVE] And, uh, I just got it. Just got it.
[AGENT][POSITIVE] You did get it? OK, good deal.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, so if you have any questions though or need any assistance when you go to set it up, um, just call us back and we'll be more than happy to help you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help today.
[AGENT][POSITIVE] OK. Oh, well, you're very welcome. And is there anything else at the moment I can help you with?
[CUSTOMER][POSITIVE] That is all. Thank you again.
[AGENT][POSITIVE] OK. You're welcome, Ms. [PII], and thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You as well. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.