AccountId: 011433970860
ContactId: 3d205fee-5e22-4ec2-b1a8-2293e562b547
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440630 ms
Total Talk Time (AGENT): 200527 ms
Total Talk Time (CUSTOMER): 233769 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/3d205fee-5e22-4ec2-b1a8-2293e562b547_20250225T13:40_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, uh, good morning. Um, my name is [PII], and I have APL as a secondary insurance. I have Blue Cross Blue Shield, and I'm going in for an MRI tomorrow. I just want to confirm that, um, I will be covered for the, the excess payment.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you this morning. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Uh, I'm looking for it as I'm talking to you.
[AGENT][NEUTRAL] Do you have your APL ID card?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That's right. Uh, I'm actually looking for the APL ID card but uh.
[CUSTOMER][NEUTRAL] Maybe I should put that away, uh, maybe I should find that first before I called you. I'm so sorry.
[AGENT][NEUTRAL] No, you are fine. I can look up your policy by your social if that would be easier.
[CUSTOMER][NEUTRAL] Uh, do you need, can I give you my last four digits of my social, or do you need the whole thing?
[AGENT][NEUTRAL] It would be the complete number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Um, otherwise, I need to give you, I, I'm with the university, so, um,
[AGENT][NEUTRAL] You know what, you can spell your last name.
[CUSTOMER][NEUTRAL] Well, I found the card. I found the card. OK. OK. All right, so it's the group number. Do you need the group number? 23143?
[AGENT][POSITIVE] Yay, look at you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And at the bottom of the card, do you see the outpatient benefit certificate number? That's what I need.
[CUSTOMER][NEUTRAL] And then it
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. OK. 0247.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3070 M as in Mary, L as in Lamp 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. And can you verify your date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And you say your is your first name [PII]? Is that how you say it? All right, good, good.
[CUSTOMER][POSITIVE] That's right. Yes.
[CUSTOMER][NEUTRAL] You said it right. You didn't say [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, well, I have an odd name. It's [PII] and a lot of people say it different ways, so I, I try to get names correct.
[CUSTOMER][POSITIVE] Thank you. Mm.
[CUSTOMER][POSITIVE] Oh, that's pretty. I think [PII]'s so pretty.
[AGENT][POSITIVE] Oh, thank you. I think
[AGENT][NEUTRAL] I think your name is [PII] too, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let's see, and can we go ahead and verify your current mailing address, email, and phone number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. And your phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I can add an email for you. We don't have one on file. Can I add one?
[CUSTOMER][NEUTRAL] Of course. Uh please do. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's the.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] that's right, and then [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Got it. Thank you so much. All right, so you're going in for an MRI tomorrow. You do have diagnostic testing benefit under your policy. Now that benefit amount is $300 per calendar day that we can pay towards your deductible or co-insurance or co-pay of your major medical for that MRI.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, mm.
[AGENT][NEUTRAL] And again, that benefit amount is a per calendar day benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK. I think then I, they, then, um, they said they will bill you when, when they, uh,
[CUSTOMER][NEUTRAL] Um, after the, after the, um,
[AGENT][NEUTRAL] The primary
[CUSTOMER][NEUTRAL] After I do the MRI tomorrow.
[AGENT][NEUTRAL] Yeah, so normally, normally what they'll do is they'll um submit the claim to your primary insurance, and once that has been processed, then they'll send the claim to us for additional benefits.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So, um, I have 300 will be covered. OK, then I think.
[AGENT][POSITIVE] Yes, ma'am, that is your outpatient benefit.
[AGENT][NEUTRAL] And then I will need to also advise that when we give benefits over the phone, it's not a guarantee of payment, it is a guarantee of coverage on your policy. So it just means we can't, we can't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Process claims over the phone.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Of course, I understand.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um, I guess I need to, uh, find, since you're secondary, you will just cover the 300, right? So I need to find out from my primary whether there is a difference. I am in network, but if there is any other, uh, because I'm, they, they said that the excess is 500, so if you pay 300, I will still have to pay the $200 for it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right. And of course that does depend on your primary insurance and what they apply to your deductible or co-pay or co-insurance. And so they're saying that your primary insurance um is applying a $500 deductible.
[CUSTOMER][NEUTRAL] No, uh, the MRI, the excess, after my, uh, primary covers it, the excess is 500. So if, if APL covers 300, then I'm still responsible for another 200.
[AGENT][NEUTRAL] Oh, got you.
[AGENT][NEUTRAL] 300.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Isn't it?
[AGENT][NEUTRAL] And we can process and pay that claim as long as that amount is applied to your deductible, co-pay, or co-insurance of your major medical.
[CUSTOMER][NEUTRAL] Mhm. OK. Mm.
[CUSTOMER][NEUTRAL] Mm, yeah.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I will, uh, uh, go ahead and give them my primary a call and see whether there are any adoptions.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] And you know, anytime you need anything as funny as said, don't never hesitate to give us a call. We are here to help you any way we can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Thank you so much. I appreciate it.
[AGENT][POSITIVE] It has been such a pleasure to assist you this morning. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, not at all. Thanks, [PII].
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.