AccountId: 011433970860
ContactId: 415ad68c-61f1-4ca7-b1e6-d1bd09a38dde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 810640 ms
Total Talk Time (AGENT): 326815 ms
Total Talk Time (CUSTOMER): 103071 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/415ad68c-61f1-4ca7-b1e6-d1bd09a38dde_20250513T22:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. How can I find out what kind of coverage I have?
[AGENT][POSITIVE] Sure, I can help you with coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I get your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell that last name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Did you say
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] No, I do not.
[AGENT][NEUTRAL] OK, and do you spell your name [PII] or [PII]?
[CUSTOMER][NEUTRAL] With the [PII]
[AGENT][NEUTRAL] Alright, give me one moment to look you up.
[CUSTOMER][NEUTRAL] I have my so if if you could use that.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I should be able to look.
[AGENT][NEUTRAL] You, uh, by your social, and what is your social security number, ma'am, if I may?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, [PII], can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your mailing address?
[AGENT][NEUTRAL] And your phone number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get an email num an email address for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right. Thank you so much for verifying that with me.
[AGENT][NEUTRAL] Alright, [PII], if you have a pen and paper I can give you that policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just let me know whenever you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, it's 02.
[AGENT][NEUTRAL] 55.
[AGENT][NEUTRAL] 51.
[AGENT][NEUTRAL] 28.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like this policy, let me double check, it looks like it is no longer active. Let me see if there's any other policies.
[CUSTOMER][NEUTRAL] It's an active undercover.
[CUSTOMER][NEUTRAL] It's active under COR.
[AGENT][NEUTRAL] One moment while I check on that for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we will need to wait for the cover to be updated on our end, but I can go ahead and give you what policy you did have and hope and it might be the same. I just want to let you know that this is a verification of benefits and not necessarily a guarantee of payment.
[AGENT][NEUTRAL] It looks like you have a medlink policy which is our secondary gap policy, so you will need to have major medical if you want to um.
[AGENT][NEUTRAL] Put any claims under this policy because it will need, uh, we will need to have the major medical in order to process a claim through this particular policy since it is a secondary gap.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I guess I'm not understanding what you're saying. This is what now?
[AGENT][NEUTRAL] This policy through us is a secondary policy.
[AGENT][NEUTRAL] Meaning it is not your major medical. So for example, if you go somewhere.
[CUSTOMER][POSITIVE] OK, so as long as I have a, so long as I have medical insurance, this works.
[AGENT][NEUTRAL] It will work, but we will need to have the major medical explanation of benefits first before proceeding with a claim through this particular policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you want, I can check and see what exactly you have on this policy.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Give me just a moment while I pull that up for you, just so I can give you everything that you might need.
[AGENT][NEUTRAL] Right, and again this is a verification of benefits and not a guarantee of payment. Under this policy after it gets approved through COBR, you will have an inhospital deductible of $1000 per covered person per confinement.
[AGENT][NEUTRAL] You will have an outpatient.
[CUSTOMER][NEUTRAL] OK, wait a minute 10, can you slow down just a little bit please?
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You said the inhospital deductible?
[AGENT][NEUTRAL] Yes ma'am, of up to $1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is per confinement.
[AGENT][NEUTRAL] And let me check to make sure what your confinement would be for this particular policy.
[AGENT][NEUTRAL] So for that, the confinement will be for at least 18 consecutive hours is what your policy considers as confinement.
[AGENT][NEUTRAL] So for that in-hospital deductible of $1000 per confinement, it must be at least 18 hours.
[CUSTOMER][NEUTRAL] OK, 18 consecutive hours, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, that is a benefit, not a deductible. I apologize for that.
[AGENT][NEUTRAL] So you have in hospital benefits of up to $1000 not the deductible, just per person per confinement. So for that 18 hours, I misspoke, it is not a deductible.
[AGENT][NEUTRAL] It is just a payment of up to $1000 per hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your outpatient benefit is up to $500 per person, per covered person per occurrence. That means each time you come in for a specific reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You also have urgent care coverage of a maximum of 3 urgent care visits per covered person per calendar year.
[AGENT][NEUTRAL] You also have outpatient surgery benefits, diagnostic testing benefits, and an outpatient facility or MRI facility. Mhm.
[CUSTOMER][NEUTRAL] OK. I'll put
[AGENT][NEUTRAL] So for diagnostic testing.
[CUSTOMER][NEUTRAL] You said, OK, the first.
[CUSTOMER][NEUTRAL] The first one was the outpatient.
[AGENT][NEUTRAL] Surgery.
[CUSTOMER][NEUTRAL] Outpatient surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient surgery, then what?
[AGENT][NEUTRAL] Then you also have a diagnostic testing.
[AGENT][NEUTRAL] Benefit
[AGENT][NEUTRAL] At a hospital outpatient facility or an MRI facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you also have an outpatient treatment for mental or emotional disorders at an outpatient facility.
[AGENT][NEUTRAL] With a maximum of 30 days per treatment per calendar year.
[AGENT][NEUTRAL] And if you would like I can email this policy certificate to you if that would be easier so you would also have it in front of you.
[CUSTOMER][NEUTRAL] Yes please, what can I ask you about the urgent care does that?
[CUSTOMER][NEUTRAL] Urgent care, does that go for like the emergency room as well?
[AGENT][NEUTRAL] OK, let me check and make sure.
[AGENT][NEUTRAL] I believe your urgent care will be its own separate.
[AGENT][NEUTRAL] So let me double check so that I don't give you the wrong information.
[AGENT][NEUTRAL] So this would be an urgent care facility, meaning that it's a medical, medical facility or a clinic where patients can be treated in on a walk-in basis without an appointment. So this would not be for emergency room visits and it also does not include physician office benefits under the urgent care facility.
[AGENT][NEUTRAL] You would need to go to an actual urgent care facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And does the email you gave me earlier is that a good email to send this to you?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I will get this emailed out to you.
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome and have a great day.
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.