AccountId: 011433970860
ContactId: 45369cf7-ac82-415a-bbde-4c6950a00a86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553340 ms
Total Talk Time (AGENT): 293903 ms
Total Talk Time (CUSTOMER): 249049 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/45369cf7-ac82-415a-bbde-4c6950a00a86_20250115T17:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I need sir.
[CUSTOMER][NEUTRAL] Um, I have this insurance, APL, and I, I understand it's like an extra coverage if I have a medical emergency, but I'm not, I'm not exactly sure what exactly does it cover.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. I can help you with that.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's through my employer. I have the group number. I have the payer I need ID number. Which one will be that one?
[AGENT][NEUTRAL] Well, let me ask you, do you have your ID card because it could be at the bottom of the card under the outpatient benefit cert number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, this, uh, the in a hospital benefits certified number and it's an outpatient benefits certified number. There's two of them.
[AGENT][NEUTRAL] OK. Either one of those, that is your policy number at the bottom of the card.
[CUSTOMER][NEUTRAL] Oh great, OK, uh, that one. OK, you want, you want the number?
[AGENT][NEUTRAL] Yes, ma'am, please.
[CUSTOMER][NEUTRAL] Sure. It's 02538099 M as in mother, L as in Louis, number 7.
[AGENT][NEUTRAL] All right, thank you. And can you verify your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] My name is [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Ms. [PII], can you verify your current mailing address, email, and phone number, please?
[CUSTOMER][NEUTRAL] OK, email. OK, email address, oh gosh, I don't know which one I have on file.
[AGENT][NEUTRAL] Well, actually we don't have an email on file for you so whichever one you would prefer.
[CUSTOMER][NEUTRAL] OK, it will be, so you're gonna add it right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It will be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to verify that I have [PII].
[CUSTOMER][POSITIVE] Perfect, yes.
[AGENT][NEUTRAL] Alright, and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And then finally, do you mind verifying your current mailing address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] All right, Ms. [PII]. Yes, ma'am. This is your secondary gap policy.
[AGENT][NEUTRAL] You have had this policy since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it covers services for inpatient hospitalization and outpatient facilities such as emergency room visit or urgent care facility, outpatient surgery, diagnostic testing in an outpatient facility or diagnostic center.
[AGENT][NEUTRAL] Um, you have an independent laboratory benefit, means if, you know, if you go to the doctor and they send it to Labor, Quest Diagnostics, then the services for the laboratory facility could be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, really?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because I've been paying my lab work because uh I'm getting a co-pay actually, the co-pay won't cover it, right? It won't be covered. I don't know if it's a co-pay, but it.
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] Yeah, if it's fine
[CUSTOMER][NEUTRAL] But they say my
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead, sorry.
[CUSTOMER][NEGATIVE] It they always send me a bill. It's $5.07 dollars, $8 so you know, but it get it add up through the year.
[AGENT][NEUTRAL] It does add up, that's for sure. And that's a quick then. Well, if you've had any of those services that you have not paid for since [PII], you can give them your APL policy information and they can file a claim for you and we can provide, we can pay the benefits directly to the lab facility.
[CUSTOMER][NEUTRAL] Mhm mhm yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. How about uh medical doctor's visit because I always, my insurance they get bill and I ended up with the big bill, 94 $100 sometimes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh my goodness, yeah.
[CUSTOMER][NEUTRAL] And, and I, yeah, it goes.
[CUSTOMER][NEGATIVE] And I noticed that, you know, it's like, well, what my insurance paying, so they are paying $400 for insurance and then I get another bill from the from the clinic saying you owe $75.95 dollars here in the itemize all the service they need. I don't understand why they have to double, I think they're double billing. I don't know.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah. So with your APL policy, the only thing that would be covered in a doctor's office is for cancer treatment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Like just going because you're not feeling well and they, you know, do testing, that is not covered in a doctor's office. But you do have the urgent care and emergency room benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, one question. I'm sorry. One question.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] Uh, if I'm, when you say hospital treatment, it's just ER treatment or just in hospital hospital, hospital, you know, to be, yeah, I guess I mean if hospitals it's a long work I can't even say.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I got you, yes ma'am.
[AGENT][NEUTRAL] It is OK, so.
[CUSTOMER][NEUTRAL] A hospitalization.
[AGENT][POSITIVE] Right, you got it.
[AGENT][NEUTRAL] It's a hard word to say. So it, it does cover hospitalization, um.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] It did.
[AGENT][NEUTRAL] If you were admitted into a hospital more than 18 hours, that would be covered under your inpatient hospital benefit.
[AGENT][NEUTRAL] If you go to say to a hospital for say an outpatient surgery.
[AGENT][NEUTRAL] That would be covered under your outpatient benefit certificate number. Under the outpatient benefit, that does include your emergency room visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, your urgent care visit, your outpatient surgery.
[AGENT][NEUTRAL] And you also have a physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Benefit as well under the outpatient. Mhm.
[CUSTOMER][POSITIVE] Oh, really? Oh wow.
[CUSTOMER][NEUTRAL] I didn't know that. OK.
[AGENT][NEUTRAL] So, what I would suggest, Ms. [PII] is always show your APL card with your primary insurance when you're going for medical services outside of a doctor's office.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, OK. I see, um, OK. And it's covered nationwide or, or if I travel like anywhere in the [PII], it will be covered?
[AGENT][NEUTRAL] Yes, ma'am, as long as your primary insurance provides benefits, as long as they apply something to your deductible or co-insurance.
[CUSTOMER][NEUTRAL] OK. Uh, I'm talking about the deductible, my deductible is $3000. The, uh, this insurance won't pick up my deductible, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It will for the covered services and we also have a portal and.
[AGENT][NEUTRAL] Online service center, you can actually create a login and password, and you can click on your policy number and it will download your documents and you can view exactly what is covered under your plan.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK. I'm gonna check it out. OK. OK, thank you for your help. I appreciate it.
[AGENT][NEUTRAL] I actually
[AGENT][NEUTRAL] I am checking on that and you already have an account on our portal.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't know that, but I don't know my is it show my username and password, no.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I can give you your username. You may have to reset your password if you don't remember, but your username is all lower case and it is [PII], maybe.
[CUSTOMER][NEUTRAL] OK, what are you
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes, yes it did. You just do that right. You're perfect.
[AGENT][NEUTRAL] I'm learning to speak Spanish, so.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Oh [PII], that's good, that was perfect.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, OK. So I'm gonna check into it and see, you know, what I can find because, yeah, I always had it. I said, what is, and then I heard dental, how about dental?
[AGENT][NEUTRAL] Dental is not covered through APL that's gonna be with a different company.
[CUSTOMER][POSITIVE] Oh, OK. No problem. No, I just wondering. No problem. Thank you for your help. I appreciate it. Have a wonderful day.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Ms. [PII]. If you have any further questions or concerns, don't hesitate to give us a call, and I hope you have a wonderful day also. Take care.
[CUSTOMER][NEUTRAL] OK. OK. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.