AccountId: 011433970860
ContactId: 2f4922b9-5bff-4c14-b085-3d8bab7db9a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541440 ms
Total Talk Time (AGENT): 297062 ms
Total Talk Time (CUSTOMER): 224882 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/2f4922b9-5bff-4c14-b085-3d8bab7db9a9_20250402T20:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm trying to find out um on my APL what y'all actually cover.
[AGENT][POSITIVE] OK. I can help you.
[CUSTOMER][NEUTRAL] Or what do y'all help us to?
[AGENT][NEUTRAL] Right, Miss, Miss. [PII], I can help you with your benefits. Can I please get your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK and then what is your policy number?
[CUSTOMER][NEUTRAL] It is let me find it on here 146297.
[CUSTOMER][NEUTRAL] 29 hold on 1462947.
[AGENT][NEUTRAL] 2947. OK, let me look that up real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] It's [PII], that's in [PII].
[CUSTOMER][NEUTRAL] Um, I forgot what else you said, phone number?
[AGENT][NEUTRAL] Uh, yes, ma'am, that we have on the policy for you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, it should be the [PII] and then the email OK.
[AGENT][NEUTRAL] OK, and then one last
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, it looks like I have your uh work email address.
[CUSTOMER][NEUTRAL] OK, and I don't know it off the top of my head.
[AGENT][NEUTRAL] That's OK. Yes, ma'am. That's OK. All right. So let's look at your policy real quick. Um,
[CUSTOMER][NEGATIVE] Broke down at work.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what you have, and this is just to verify your benefits, it's not a guarantee of payment, you have a supplemental insurance policy, it's billed secondary to the primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It has deductible co-pay and co-insurance in coverilities so uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Here.
[AGENT][POSITIVE] And I'm having a little bit of phone trouble, Miss [PII], so if this call disconnects, I will definitely call you back. I just know that because the phone's going.
[CUSTOMER][NEUTRAL] OK, yeah, I can tell that it's cut out, yeah.
[AGENT][NEUTRAL] Terrible weather right now. Yes, we're having bad weather and I apologize. OK, so if you go inpatient, you have a $1000 benefit per calendar year to help with your deductible co-pay or a co-insurance, and that's for 18 hours or more and then you also have an outpatient calendar year benefit amount of $1000.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] OK, that's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That helps for outpatient benefits and covered facilities uh per your policy.
[AGENT][NEUTRAL] Um, let's look, um, and it's gonna be just a second, my computer decided to spend. It's gonna be just one moment. I'll get it going again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I apologize. I know.
[CUSTOMER][NEUTRAL] And this might help you. That's OK. You're fine.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And this might help you too because what I was calling about is I'm supposed to have an ultrasound at my GYN office well she was supposed to call and verify would they cover it and.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] My Blue Cross Blue Shield is weird. I don't know what I'm supposed to pay when I go to the office because I don't have a set deductible, I mean a set copay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But she was telling me that the APL will cover the copays and I'm like, no, they don't. They, they always told me they didn't cover copays. So I was confused, so she told me to call and find out.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Right. And it does help with deductible, co-pay or co-insurance. It does look like on your policy that office visits are not covered. So that might be where the confusion's coming in. Um,
[CUSTOMER][NEUTRAL] Yeah she's saying that y'all are telling her that the copay is covered.
[AGENT][NEUTRAL] And, and
[AGENT][NEUTRAL] Right, the office
[CUSTOMER][NEGATIVE] And I'm like, no.
[AGENT][NEUTRAL] Yeah, office visits are not covered under your policy. So with that, in order to be able to get it done, you'll need to go to an ER urgent care center, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if the hospital has like an ambulatory center that's attached to it that does ultrasounds. Um, and you can write that down so you can let the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Well, if they do.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, if they do it in the office, so it won't cover that at all?
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Um, now, let me.
[CUSTOMER][NEUTRAL] If they're in their office because they do ultrasounds.
[AGENT][NEUTRAL] Let me look and see as far as um your policy if it has a, uh,
[AGENT][NEUTRAL] Office treatment.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Right. The treatment in the office is covered, but the physician's fee is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, that's what I was trying to find because I knew that I know like I've had the APL for a while and in the beginning I thought that we was told that the copays, so I wasn't paying the co-pays and then I get all these bills in and I'm like, what do you mean they're not cover so I that's how I know because I had called and talk to you about that.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh bless your heart.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then a lot of these doctors try to, oh yeah, I, and I'm like no it doesn't pay the copay.
[AGENT][NEUTRAL] No, it has to be.
[CUSTOMER][NEUTRAL] It's more the, like the
[CUSTOMER][NEUTRAL] Like the labs and stuff like that, right? X-rays.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Right. It it has to be for covered procedures per your policy. So, do you have a copy of your policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, I don't think so.
[AGENT][NEUTRAL] Let me, uh, tell you about our online service center.
[AGENT][POSITIVE] Uh, I'm gonna give you that address. It's secured, [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. So that AM is like [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] [PII] if you go sign up for the online service center it is a really neat, uh it's a direct portal to.
[AGENT][NEUTRAL] Um, policy certificate.
[CUSTOMER][NEUTRAL] Uh, at least, oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You can, you can file claims on there you can check your claim status on there it's really neat.
[CUSTOMER][NEUTRAL] OK, so I don't have to have any like passwords or anything from y'all to to start it up or?
[AGENT][NEUTRAL] No, not from us.
[CUSTOMER][NEUTRAL] Or it does all that when I'm gonna.
[AGENT][NEUTRAL] Right, you'll figure out what you want your username and password to be and um once you get in the first screen you're gonna check that you're a new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the second screen, you're gonna say you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I tell you that just because on the drop down, there's several different things to choose from, so I wanted to make sure you got the right one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, individual with the APL policy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then you just figure out what you want your username and password to be and like I said it's a direct portal to your policy so you can see all kinds of stuff on there it's pretty cool.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. I'll do that then. I just want to make sure that I knew what I was talking about.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, you do.
[CUSTOMER][NEGATIVE] And this is, this, this Blue Blue Cross one is just throwing me for a loop this year. I'm just like I don't, you can't get it. You can't get a direct answer from Blue Cross Blue Shield. You can't get it from the doctor's offices.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh no. So it's
[CUSTOMER][NEGATIVE] And you don't know what you're supposed to pay when you're going in for an office visit. You have no idea.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Right. Oh, I hate that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're kind of just winging it.
[CUSTOMER][NEUTRAL] So that's what I was trying to find out. Yeah, yeah.
[CUSTOMER][POSITIVE] OK. Well, I do appreciate your help.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] I think that'd be it. Be safe.
[AGENT][POSITIVE] You too, thank you. I appreciate that, Ms. [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Yes ma'am you too bye bye.
[AGENT][NEUTRAL] Bye-bye.