AccountId: 011433970860
ContactId: 3f64da1e-b0b4-48db-bb0d-64678ddd66b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387820 ms
Total Talk Time (AGENT): 197419 ms
Total Talk Time (CUSTOMER): 137485 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/3f64da1e-b0b4-48db-bb0d-64678ddd66b3_20250327T20:32_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] Yes, um, good afternoon. Um, I wanted to know, um, if, uh, I have the gap insurance and I wanted to know if it covers, um, a co-payment if I'm gonna do a cataract surgery.
[CUSTOMER][NEGATIVE] And they, they charged me, uh, like $1800 out of pocket. Do you guys cover that or no?
[AGENT][NEUTRAL] OK, so you're the insured and you have a question on your outpatient benefits on your policy. Is that correct?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] OK. Uh, my name is [PII].
[AGENT][POSITIVE] OK. Thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] 01863860.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your information pulled up.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Hi Miss [PII], I will need to verify several things with you first, for security purposes and also any information that I do provide for you 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] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided to me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And lastly, your email address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. Alright, so just one moment.
[AGENT][NEUTRAL] OK. And will you be having this procedure done in like an outpatient facility?
[CUSTOMER][NEUTRAL] Well, um, actually, I believe it's a hospital, Baptist hospital, because
[CUSTOMER][NEUTRAL] Um, that's what they informed me. I don't think it's an outpatient. I'm not sure. I think they told me the hospital.
[AGENT][NEUTRAL] OK, so you have under your outpatient surgical, I mean your outpatient benefits, you have a $7900 per covered person per calendar year benefit for covered outpatient services with no outpatient deductible per covered person per calendar year. So you would just need to present your APL ID card, Ms. [PII], along with your primary insurance card.
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To your provider, most providers would file both of your insurances for you, your primary and the supplemental policy in the event that they don't file the supplement, you could also file it, but I can see that as of now you have not used any of your benefits for this calendar year at this time.
[CUSTOMER][NEUTRAL] Right, right. So, so then it's, um, so it will cover it then, the the the deductible, the co-pay.
[AGENT][NEUTRAL] Again, I I cannot guar excuse me, I cannot guarantee payment of it. I can only provide you, you know, with what the benefits are on this policy. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, yeah, you
[CUSTOMER][NEUTRAL] With the information.
[CUSTOMER][NEUTRAL] Right, yeah, yeah. OK, OK, that's.
[AGENT][NEUTRAL] We would just have to receive the claim for review.
[CUSTOMER][NEUTRAL] Sounds good. I just didn't know whether, you know, it, um, you know, the eye surgery would be covered under that or not. You see what I'm saying? That's why I called. OK, all right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you, thank you so much. I appreciate it.
[AGENT][POSITIVE] Well, you are very welcome. Absolutely. And is there anything else I could help you with this afternoon?
[CUSTOMER][NEUTRAL] You know what, um, if you could please give me the, the website to filing a claim.
[CUSTOMER][NEUTRAL] Uh, I had it and I can't remember now. I, I need to file a couple of claims, uh, that I've gone to the doctor, you know, the.
[AGENT][NEUTRAL] Uh yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so to log you're wanting the website to log in to your portal?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, so you would go to [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII], perfect. Yeah, I've, I've been there before but I couldn't remember.
[AGENT][NEUTRAL] Yes, ma'am. And then.
[AGENT][NEUTRAL] Now you can also Miss [PII], if you're gonna be filing the claims yourself and we'll need the Medin claim form you can also go to our main website so that you can get your claim form and also you can there's a link that says sign in and if you click the sign in, it will take you to the online service center login page and our main website is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. OK, thank you so much. I appreciate it.
[AGENT][POSITIVE] Well you, yes, ma'am, you're certainly welcome. So again, if that is all I can help you with, thank you for calling APL and I hope you have a very nice evening.
[CUSTOMER][POSITIVE] Alright you too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.