AccountId: 011433970860
ContactId: 3617a754-c0e2-4498-b917-aacbd57c4fc0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419299 ms
Total Talk Time (AGENT): 172035 ms
Total Talk Time (CUSTOMER): 252873 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/3617a754-c0e2-4498-b917-aacbd57c4fc0_20250102T21:25_UTC.wav
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[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is new to me, um, this [PII] I just recently, um,
[CUSTOMER][NEUTRAL] Oh, I have new employment. I'm so sorry. I'm looking and I, I was, and I have, and they issued this card to me and I wasn't sure how this works. I was getting ready to go onto your website, but I said if you have any questions we can call. So I said let me call. Yeah, so I just wasn't sure how, so go ahead.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Yes, let's do it, um, do you?
[AGENT][NEUTRAL] Oh, I was gonna say, do you have that policy number handy and I can look at your individual policy.
[CUSTOMER][NEUTRAL] Yes, yes, I do have a policy. Let me see what do I have? Where's my policy? I have a.
[CUSTOMER][NEUTRAL] Um, my number, uh, a group, I have a group number, oh.
[CUSTOMER][NEUTRAL] I just have a group number I just.
[CUSTOMER][NEUTRAL] And I have a a certificate number that's outpatient cert.
[AGENT][NEUTRAL] Oh, it'll be that certificate number yep.
[CUSTOMER][NEUTRAL] OK, the certificate number is, would that be, where is it coverage and the group number certificate number, um.
[CUSTOMER][NEUTRAL] OK, they have two different ones in hospital and outpatient. Does it matter?
[AGENT][NEUTRAL] Um, the numbers in front of the letters should be the same, so I either one you give me should be fine.
[CUSTOMER][NEUTRAL] Oh, I see. Oh they are OK. 02571930.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your name, my friend?
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII]
[AGENT][NEUTRAL] Perfect and I'm just gonna have you verify some information for me starting with your date of birth if you will.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] Wonderful and then just a couple more pieces if you could verify the mailing address and email address on file.
[CUSTOMER][NEUTRAL] It's [PII] and then the email is and you wanted the email address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's [PII], then a [PII], then my last [PII], so it's [PII].
[AGENT][POSITIVE] Wonderful. Thank you. And then Ms. [PII], um,
[AGENT][NEUTRAL] Would you mind if I just got a good call back number from you in case we got disconnected?
[CUSTOMER][NEUTRAL] Yes, it's only one phone number it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Wonderful. Thank you, thank you. All right, and so I'm looking at this policy. So the basic overview on this policy just to give you like a little, I don't know, tidbit, um, is we are a supplemental insurance, um, we follow your major medical provider and what we do is we help pick up and pay on um anything that is applied to your co-insurance, co-pay or deductible for sickness, accident or injury. We don't cover anything routine.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, you do have benefits with us both inpatient and outpatient, um, in an office setting or an ER.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's kind of like a gap coverage, like to help cover the cost for major medical.
[CUSTOMER][NEUTRAL] Because I'm wondering.
[CUSTOMER][NEUTRAL] I've heard of that, yeah. And you know, it's so funny. I've never had that, so I'm not, I'm not familiar with it. That's why I was [PII]. OK, so I need to make an appointment at my dermatologist. Um, and that would not be a routine visit right now. I, I, because I'm, I'm, I'm, I'm having a problem. I have psoriasis and I'm the, anyway, it's this whole long convoluted story, but I gotta find it now I gotta find a new doctor and figure out what I'm gonna do about.
[CUSTOMER][NEUTRAL] I, I get, um, I get those monthly and um those monthly injections for my psoriasis.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um it's biologic and it's turned into this whole, this whole thing. I've got to just figure out what I'm gonna do because I was on a program and now the program I guess has changed. I don't know what's going on. I'm trying to figure it out. I talked to them and
[CUSTOMER][NEUTRAL] But I'm gonna have to make it now I'm gonna have to find a new dermatologist. And so it would not be a routine appointment. Uh, I'd have to go and say, OK, this is, I came from this dermatologist. This is what's going on with me now. So would that cover my deduct whatever I have my copay that I have to, because I had no idea what my co-pay is gonna be seeing these people.
[AGENT][NEUTRAL] Absolutely. So a lot of it's gonna depend, it's gonna depend on how your major medical processes, everything, and the claim form that comes in from your physician or your dermatologist's office. I do see that you have treatment in an office listed under your, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under your policy as something that's covered, so getting treatment in an office, it wouldn't cover like the consultation fees or like the administrative fees, but it could cover like the treatments, um.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] But some of it, OK, OK. Oh, I see the treatment. OK, some of the treatments, OK, mhm.
[AGENT][NEUTRAL] Yep and then.
[AGENT][NEUTRAL] And then with that being said um I'm just going to.
[AGENT][NEUTRAL] Take a peek a little closer at your policy, but
[AGENT][NEUTRAL] I'm so sorry. I think I lost my train of thought while I was scrolling to find the benefits.
[CUSTOMER][NEUTRAL] Oh, that's OK. No, you're trying to figure out, no, you're trying to figure out what I'm gonna have to pay so it wouldn't pay for the consultation, which is probably that, that would be something new for me with the new with the new doctor, and it wouldn't pay for it would pay for any treatment that I needed, but there's not gonna be really any treatment because it's gonna be basically a consultation because it's an ongoing situa Well, no, to be honest with you, I would, you know what my psoriasis is really not.
[CUSTOMER][NEUTRAL] The medicine, the medicine I'm using, it's, I've had a flare, I don't know if it's just a flare-up or what's going on. So I probably would have to have maybe some
[CUSTOMER][NEUTRAL] That would just be a consultation I guess I'd have to decide how they're gonna, how they're gonna organize that, yeah.
[AGENT][NEUTRAL] Yeah and so I can't, it's hard for me to guarantee like what's gonna happen without knowing exactly what that claim's gonna look at but it looks like you have benefits like so I would definitely recommend making sure you give your APL card to the office when you get there.
[CUSTOMER][NEUTRAL] Anyway,
[CUSTOMER][NEUTRAL] Oh, that's fine, yeah, sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I was gonna ask, OK, OK, good. OK, that's what I would.
[AGENT][NEUTRAL] And then letting them know that we are your gap coverage and what they'll do is they'll file the claim with major medical they'll get the information back from major medical and then they can file the claim with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that's what I do. So whenever I go to see a doctor or anything like that, do I not just normally give them my card also along with my insurance card? That's what I should be doing.
[AGENT][POSITIVE] Yes, you'll wanna give them both out at the same time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, fantastic. Yeah, I, I thank you so much. I was just curious about this. I was like, I think that's what it is, but I'm not sure, and I've never had it, so, OK, awesome sauce that's what I'll do.
[AGENT][POSITIVE] All right perfect is there anything else I can do to help you today, my friend?
[CUSTOMER][POSITIVE] Oh no thank you you've been a great help. Thank you so much for your, thank you so much.
[AGENT][POSITIVE] My pleasure, Ms. [PII]. Yes, thank you. Thanks for calling [PII]. I hope you have a fabulous day and a happy new year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, you do the same thanks bye.
[AGENT][POSITIVE] Thanks bye bye.