AccountId: 011433970860
ContactId: 3f9107cc-9513-4515-b21a-fd872b93bfb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1006320 ms
Total Talk Time (AGENT): 482094 ms
Total Talk Time (CUSTOMER): 458322 ms
Interruptions: 9
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/3f9107cc-9513-4515-b21a-fd872b93bfb2_20250318T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, um, I have a billing question. Um, I got a letter today from, uh, from a place for a bill. I was in an emergency on [PII] for a few hours. Um, I'm getting, um, a letter saying that my insurance applied these charges to my deductible, and as far as I know we're a group, a, a group plan thing that, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] APL is supposed to uh cover the deductible, so it's possible for you to check on this?
[AGENT][POSITIVE] It would be my pleasure to check on that for you, Ms. [PII]. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Yes, the API card is 02588457.
[CUSTOMER][POSITIVE] I also have a group number if that helps.
[AGENT][NEUTRAL] No, that's fine. I've got it. And I do need to verify your information. Can you verify your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Of course. Uh, [PII], and the address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And Ms. [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And I don't have an email on file. Would you like for me to add an email for you?
[CUSTOMER][NEUTRAL] Yes, please. Um, that would be um my first name [PII] and, and my second name altogether [PII], uh so it would be [PII]
[AGENT][NEUTRAL] And what is that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You will never guess. My birthday is on [PII] too.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEGATIVE] Oh, so cancer.
[AGENT][POSITIVE] How about that? When I, that's right. When I saw that, I was like, go [PII]. Best day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] I think that's amazing. That's awesome. Now, I'm a few years older than you are, but it's still on the same day.
[CUSTOMER][NEUTRAL] Yes, that's a coincidence, yes.
[CUSTOMER][NEUTRAL] Well, I'm gonna be [PII] this year, God willing, so.
[AGENT][NEUTRAL] Yeah, I'm gonna be [PII], so right we're.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yeah, we're almost there about the saving.
[AGENT][POSITIVE] Mom was right, the same. That's right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, you went to an emergency room and you were calling to see if it is covered under your plan?
[CUSTOMER][NEUTRAL] No, I got, I got it, uh, this letter from, I, I don't know if it's related to, I mean, to the, it has to be a, well, it says that it's related to this the charges incurred are for laboratory pathology services rendered to you while you were a patient at Memorial Regional Hospital.
[AGENT][POSITIVE] You got a feel.
[CUSTOMER][NEUTRAL] And that's uh, the date, uh [PII] that I was uh in Memorial Hospital at the emergency room for a few hours for a kidney stone.
[AGENT][NEGATIVE] Oh, bless your heart. I hear those are so painful.
[CUSTOMER][NEUTRAL] Yes it was.
[AGENT][POSITIVE] Oh, I hope you're feeling better.
[CUSTOMER][NEUTRAL] So, so I don't know.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, thank [PII], yes, yes. It was not a big one, by the way. They, they found that it was tiny, so it was not hard for me to pass, so thank [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh good, that's good. Well, it is covered or.
[CUSTOMER][NEUTRAL] By what they say
[AGENT][NEUTRAL] your policy does provide benefits for emergency room services.
[AGENT][NEUTRAL] Now your benefit amount is up to $500 per calendar day that we can pay towards your deductible, co-pay or co-insurance of your primary. When you went to the hospital, did you give them your APL card along with your primary insurance?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Because we don't have any claims on file for you yet.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] But if you're getting that bill, I would certainly call them and tell them, you know, to please file with APL as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I did call them before I call you. They're closed for lunch from [PII] uh Eastern time, my time, but they said in the letter, if you have any questions regarding your insurance company determination, please contact your insurance company directly. So that's why I was calling you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, well, it, it could be considered for benefits. Now I gave you those benefits now anytime that we do give benefits on the phone, it is a verification of coverage on your policy and not a guarantee of payments, meaning that we can't process the claim over the phone, but once they send that to us, then we'll get that processed.
[AGENT][NEUTRAL] And if it's payable we can send the benefit directly to them.
[CUSTOMER][NEUTRAL] OK, do you need their their information or their number or their address or?
[AGENT][NEUTRAL] So what should happen is they, if you give, gave them the APL information, they should file a claim with us. They will file with your primary insurance first.
[AGENT][NEUTRAL] And then once they get that response back from your primary insurance, then they should file a claim with APL with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so if, if I went to emergency and the and the uh bill is like I don't know, $5000 APA only covers $500.
[AGENT][NEUTRAL] That's correct, and that is a per calendar day benefit.
[AGENT][NEUTRAL] So it
[CUSTOMER][NEUTRAL] So that means that I'm responsible for whatever else is over $500 at emergency because as far as I know.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They said that the APM will cover 100%.
[AGENT][POSITIVE] It does cover 100% up to that $500 per calendar day benefit.
[CUSTOMER][NEUTRAL] So only $500 and of course if when I go to emergency, the, the, the, the thing has to be more than that.
[AGENT][NEUTRAL] Right, but your benefit amount is the $500 per calendar day. Now if it was if you were there over 18 hours, your inpatient benefit would kick in, and that is $7150 per calendar year.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The deductible.
[AGENT][NEUTRAL] That's what we pay towards your deductible of your primary if you were in the hospital more than 18 hours.
[CUSTOMER][NEUTRAL] Yeah, oh no, no, I was there for like uh 8 hours or 9 hours something.
[AGENT][NEUTRAL] 8 hours, yeah, so this is a $500 per calendar day benefit. So that means that like if you had to go back in 2 days, we could pay that $500 again or if you go to have diagnostic testing, we can pay up to $500. So there's no cap on it per calendar year, but it is a per calendar day benefit.
[CUSTOMER][NEUTRAL] So that
[AGENT][POSITIVE] So you can use that as many times.
[CUSTOMER][NEUTRAL] Yeah, but that well.
[AGENT][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] Yes, but I mean that doesn't, that doesn't help much because if you go to an emergency and, and you know, the bill is gonna be a lot more. I was, uh, you know, as far as I knew when they gave us the, the group policy they said that the job was to cover 100% and the only exceptions were the specialist medication and the.
[CUSTOMER][NEUTRAL] Primary physician, so if it's only 500 for emergency that will that work for the whole company and we are 50+ employees.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I have relay this to my HR controller.
[CUSTOMER][NEUTRAL] Uh hold on one second because this is really.
[CUSTOMER][NEUTRAL] Oh my God, outpatient benefits treatment in a hospital outpatient facility now resulting with a covered person's confidence as an inpatient treatment.
[CUSTOMER][NEUTRAL] So that was not clear. He says.
[CUSTOMER][NEUTRAL] Outpatient sickness 100%.
[AGENT][POSITIVE] Right, it's a 100, yeah, it's 100% of the benefit amount.
[CUSTOMER][NEUTRAL] In the plan that we have.
[CUSTOMER][NEUTRAL] Which is 500 a day.
[AGENT][NEUTRAL] That's right. Now we do have a portal if you're ever interested, you can create a login and password at [PII].
[AGENT][NEUTRAL] And when you see your policy number listed on that portal, you can click on that policy number and view the benefits that are covered under that $500 per calendar day benefit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Excuse me, I do apologize.
[CUSTOMER][NEGATIVE] This was not
[CUSTOMER][NEGATIVE] Wow, that this is not what they explained to us, and this is the APS plan one.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because that that's how we have it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Maximum 500 per call per person per car a day.
[CUSTOMER][NEUTRAL] For cover outpatient services.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. OK, well, let me have your notes.
[AGENT][NEUTRAL] And, and like I said,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Create that login and password so you can view all the services that are covered under that outpatient benefit.
[AGENT][NEUTRAL] And that way
[CUSTOMER][NEUTRAL] What was the um what was the website again?
[AGENT][NEUTRAL] Mhm. It's secured and that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And when you go to that website you'll choose that you're a new user.
[AGENT][NEUTRAL] And it'll ask you some questions and you're gonna choose the top question. I am an insured with an APL policy.
[AGENT][NEUTRAL] And then the next page will take you to enter your information and create a login and password.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the last time I, I think, I don't know if it was this website they were asking for our, uh, Social Security and we were not, um, you know, a comfortable doing that so but now we have the policy number so.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It does, yeah, it.
[AGENT][NEUTRAL] It does ask for the social to create that account.
[CUSTOMER][NEUTRAL] Mm, OK. So you said it was secured ended in [PII]?
[AGENT][NEUTRAL] Yes, ma'am. And if you would like, Ms. [PII], I can email you a copy of your policy.
[CUSTOMER][NEUTRAL] OK, please, please do that. Yeah.
[AGENT][POSITIVE] I can do that. You want me to do that for you? Yeah, let's do that and at least you'll have it on file now if you'll look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, in section 3.
[CUSTOMER][POSITIVE] Are you gonna do it now so I can, are you going to do it soon?
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] I'm doing it right now for you.
[AGENT][NEUTRAL] And if you wanna look at it, I'll show you where it is in the policy.
[CUSTOMER][NEUTRAL] I have my my.
[CUSTOMER][NEUTRAL] Yeah, could you hold on one second? Somebody's writing to me in here.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] Uh, no, it's not to me. It's just a share in conversation. OK, so, um, I'm here in my inbox. This is the [PII] account.
[AGENT][NEUTRAL] OK, bear with me just one second.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] And I'm, I'm just gonna put a quick thank you on this email so instead of taking time so so we can look at it together, how about that?
[CUSTOMER][POSITIVE] Yes, that sounds good.
[AGENT][NEUTRAL] All right. I just
[AGENT][NEUTRAL] Why is it not reckon? [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It's not recognizing.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And UPE
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm gonna try it again.
[AGENT][NEUTRAL] Because it's not recognized in that email.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's weird.
[CUSTOMER][POSITIVE] Correct, yeah.
[AGENT][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Let me check one more thing.
[CUSTOMER][NEUTRAL] I'm looking at it.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Let's try this one.
[AGENT][NEUTRAL] I think there was a space between the [PII] and the [PII].
[AGENT][NEUTRAL] An extra space, I think I did that. Let's see if this would work.
[AGENT][POSITIVE] Yep, I fixed it. I apologize for that.
[AGENT][POSITIVE] It's on the way for you. Glad I saw that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Cause that was really concerning me. I was like, I know that she's, I know that's what she said.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I, I got, yes, I got it, um, yes, I did get it.
[AGENT][NEUTRAL] See if you can open that attachment.
[CUSTOMER][NEUTRAL] Oh, the attachment.
[CUSTOMER][POSITIVE] OK, yes, I get it here. Yes, it's see it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once you open that
[CUSTOMER][NEUTRAL] So, uh, this is the.
[CUSTOMER][NEUTRAL] Uh-huh, yes, go ahead.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] And once you open that attachment, if you'll go to page 5.
[AGENT][NEUTRAL] In the documents under section 3 says benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it'll tell you what's covered under the inpatient and outpatient benefits.
[CUSTOMER][NEUTRAL] Section 36.
[CUSTOMER][NEUTRAL] OK, section 3. Well, the section 3 is on page 3 benefits. OK, so where, where, um, in outpatient you mean?
[AGENT][NEUTRAL] Mhm. So these are all the services that are covered under your outpatient benefit. You've got the outpatient facility, uh, hospital outpatient facility, treatment in an urgent care facility, treatment in emergency room, kidney dialysis.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Infusion therapy, physical therapy, so those are all the things listed that are covered.
[AGENT][NEUTRAL] Under that outpatient benefit.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yeah, but that, that all is up to 500.
[AGENT][NEUTRAL] That's right per calendar day.
[CUSTOMER][NEUTRAL] That's yeah that's OK.
[CUSTOMER][NEUTRAL] Oh well, I didn't know that. I thought uh the AP will cover uh the entire, uh, that we were told that we didn't have to pay any deductible, but I mean this one in particular is not a big deal. It's only $44 but the, the actual hospital.
[CUSTOMER][NEUTRAL] It's gonna be a lot more than that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and we have 7000.
[CUSTOMER][NEUTRAL] And, OK, um, let me.
[CUSTOMER][NEUTRAL] Uh, I don't see your name here. What was your name? I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII], thank you, [PII], for your help.
[AGENT][POSITIVE] Oh, it's been such a pleasure to assist you, my birthday, buddy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much for your help. I have this in my records now.
[AGENT][POSITIVE] All right. Well, Ms. [PII], thank you for calling the APL and I hope you have a wonderful day and I'm glad those kidney stones are better for you.
[CUSTOMER][POSITIVE] Yeah, you too. Yeah, yeah, thank you. Hope you have a good day. Bye-bye.
[AGENT][POSITIVE] Thank you. You have a wonderful day as well. Take care. Bye bye.
[CUSTOMER][NEUTRAL] But