AccountId: 011433970860
ContactId: 46f0ad35-dbfd-48d2-b0e7-6c8bc289e87a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507230 ms
Total Talk Time (AGENT): 301832 ms
Total Talk Time (CUSTOMER): 198149 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/46f0ad35-dbfd-48d2-b0e7-6c8bc289e87a_20250121T17:04_UTC.wav
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[CUSTOMER][NEUTRAL] I thought OK grandejeo.
[AGENT][POSITIVE] Hi, thank you for calling.
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, hi, um, I wanna know how the APL works.
[AGENT][POSITIVE] OK, yeah, um, I'd love to help you with that. Do you have like a particular policy you're wanting to look at?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have Cigna, yeah, I have Cigna.
[AGENT][NEUTRAL] OK, um, do you have, I guess, we offer a bunch of different types of plans and policies. Do you have like a particular APL policy number I can go over with you?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Well it says group.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that 17675.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the name of your employer?
[CUSTOMER][NEUTRAL] Uh, Jetstream Federal Credit Union.
[AGENT][NEUTRAL] Perfect. Alright, so it looks like um Jetstream has the Medin policy with us. Um, so how that policy works is it's really similar to a gap insurance. Um, you might have like heard of like Aflac, they offer a gap. I know they have commercials on it, but the way it works is it um
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] It's like your medical supplemental plan, so they pick up and pay on things that are applied to your co-pay, your co-insurance or deductible, um, typically for sickness or injury, not typically routine things, so like your well checks, um, but if you have to go to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Um, in urgent care because you're sick or you end up in the hospital, um, that money that your, your major medical uses for you to pick up on that co-pay, the co-insurance or the deductible, um, you could have benefits there. And again, like without knowing the particular policy, I can't tell you exactly that benefit amount. Um, it varies, but
[AGENT][NEUTRAL] You'd have benefits.
[CUSTOMER][NEUTRAL] Well, it tell it it already tell me $750 but my question is yes yesterday I went to do an MRI. They wanted to charge me $360 because I don't have my deductible.
[CUSTOMER][NEUTRAL] So does that can I.
[AGENT][NEUTRAL] OK. Do you, so you have an APL policy with us right now?
[CUSTOMER][NEUTRAL] Uh, well, I got the card here in front of me, uh.
[AGENT][NEUTRAL] OK, yeah, do you have something on there that says maybe like a certificate number, um, or an inpatient outpatient number?
[CUSTOMER][NEUTRAL] Yeah, it says in hospitals, outpatient, uh-huh, I do.
[AGENT][NEUTRAL] OK, can I have that number and I can pull up your particular policy?
[CUSTOMER][NEUTRAL] OK, 0246.
[CUSTOMER][NEUTRAL] 4742 ML 8.
[AGENT][POSITIVE] Perfect. And would you be able to verify for me, please, your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. Would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful, and I do just have like two other things to quickly verify with you if you could verify just your mailing and email address.
[CUSTOMER][NEUTRAL] My email address is my work or my personal?
[AGENT][NEUTRAL] Uh, it's your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh, I'm so sorry. It's your professional email and your personal mailing is what I meant. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's my work. OK, it's um [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then that mailing address please.
[CUSTOMER][NEUTRAL] My job mailing address?
[AGENT][NEUTRAL] Your personal mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you very much. Um, yeah, so then when you were at the doctor's, so I would go ahead and I would give them your, your
[AGENT][NEUTRAL] APL card so they can bill a secondary um.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Don't, you said you want to go get an MRI?
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Yeah, so I see that you have like.
[AGENT][NEUTRAL] I mean, outpatient benefits that that $750 per calendar year. So I would go ahead and I'd ask them to bill a secondary um after your major medical to see if we could pick up and pay on any of that, um.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] To bring that cost down for you.
[CUSTOMER][NEUTRAL] So then I give
[CUSTOMER][NEUTRAL] So then I need to give him the signa plus this.
[AGENT][NEGATIVE] Yeah, I would give out both of them every time you go.
[CUSTOMER][NEGATIVE] Yeah, but you see, I went yesterday and when they told me $360 I go, no, I, I didn't have it with me, so.
[CUSTOMER][NEUTRAL] I had to leave and then talking to a friend of mine here at work, she goes, do you, do you know if you have the APL? And I go, I don't know.
[CUSTOMER][NEUTRAL] So, so I guess um that's the way it works.
[AGENT][POSITIVE] Yeah, typically like when you go into your provider, I'd always recommend because you can submit a claim with us, but it's so much easier to have the doctor's office do it because they have all that paperwork right there and you don't have to wait forever for them to like give it to you, which seems to take a while um is any time you go, I would recommend just having them um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] To to hold off on paying until they bill a secondary, um, because that's that's our goal is to help cover some of those out of pocket costs. So I certainly would like call back and say like, hey, you know, let's reset up an appointment. Here's my secondary insurance. Can you please bill them?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect perfect and I do give him the one I gave you which is the outpatient because there's one for in hospital and outpatient OK perfect I'll do that.
[AGENT][NEUTRAL] Yeah, you betcha. So actually the numbers before the ML should be the same and so that number before the ML is really what's gonna matter, um.
[CUSTOMER][NEUTRAL] Yeah, 7 and 8, right, right, right, I see it here, yeah.
[AGENT][NEUTRAL] Mhm, yup, yep.
[AGENT][NEUTRAL] So, um, giving them that number and they'll be able to, we'll be able to verify with them when they call for eligibility.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][POSITIVE] But yeah, have them bill us first. I'd absolutely highly recommend it um we wanna save you some money you know that's what we're here for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. OK, thank you.
[AGENT][POSITIVE] Hey, it's my pleasure, [PII]. Thank you so much. And what else can I help? Mhm.
[CUSTOMER][NEUTRAL] Uh, now, quick question, quick question that, yeah, quick question, the girl that works here with me, does this also cover like when you go to the doctor for your, for your office visit?
[AGENT][NEUTRAL] So for a wellness visit, probably not because we don't cover routine, so like you're just your well check um and I can't speak on your friend's policy. I can tell you on your policy um that you have an additional office treatment rider. So if you go to the doctor and you need.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To get treatment in a doctor's office. So like, I don't know, maybe it's a splint, like you sprained your finger and you go to your doctor and they give you a splint. I'm just guessing here. But if you get treatment in an office, that treatment could be covered. Um, but the consultation fees are just a well check are typically not covered on this policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, right, I see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect perfect got it.
[CUSTOMER][NEUTRAL] OK, great, great. Yes I lost my, I was sitting there like for a half hour and once they called me up.
[CUSTOMER][NEUTRAL] I, and I just had to leave.
[AGENT][POSITIVE] No, I know, and those, they're, I mean, it's really expensive, so I definitely understand that. So yeah, definitely give them our card, try to get some use out of us. We want to, um, I mean, I don't hope you're ever in a situation where you need to be impatient, but you pay for this policy, and I hope you get some benefits out of it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, yeah, I didn't even know. I'm glad that I spoke to a friend of mine I'm telling her yesterday I went and I couldn't do it because of the money. She goes, but wait a minute, don't you have this because I have it? And we discovered this.
[AGENT][POSITIVE] Good. Well, I'm really glad you mentioned it to her and I'm glad we were able to take a look at your policy today.
[CUSTOMER][POSITIVE] Perfect, perfect. OK, great, thank you very much.
[AGENT][POSITIVE] Hey, it's my pleasure. If you need anything else just give us a call and we'll take care of you, OK?
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] My pleasure. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.