AccountId: 011433970860
ContactId: 482da942-e3c5-4a68-a70a-9f141ca6ac0a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474839 ms
Total Talk Time (AGENT): 204394 ms
Total Talk Time (CUSTOMER): 236895 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/482da942-e3c5-4a68-a70a-9f141ca6ac0a_20250319T12:46_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I have a brief question. My name is [PII]. I have a
[CUSTOMER][NEUTRAL] I guess this is my secondary insurance, um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I wanted to know when I, I recently, well, in December I had a seizure and then last week I had another seizure and so I'm having to see specialists, um.
[CUSTOMER][NEUTRAL] Like, let's say for, for instance, the neurologist, um, I know my copayments are uh $80 so I'm having to pay it more frequently. American Public Life, what is this insurance? What does this insurance actually do? because I have my, my primary, but this is my secondary. Does this pick up co-payments or it does not?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so is this for office visit or outpatient or emergency room?
[CUSTOMER][NEUTRAL] Well, I did go to the emergency room. Uh, I, I always have to go to the emergency room. Um, but now like my neurologist, they charge every visit is $80. Like I just went, uh, Monday and they say that, um, American Public doesn't pick up co-payments.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Let's pull up your policy and we'll check if there's an office visit, and then, of course, we'll look at the outpatient benefit as as well for emergency room. Do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Uh, policy 025.
[CUSTOMER][NEUTRAL] 38094
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Verify your date of birth, mailing address and email address for me.
[CUSTOMER][NEUTRAL] Uh [PII], uh my address [PII].
[CUSTOMER][NEUTRAL] And um [PII].
[AGENT][NEUTRAL] Looks like this could be your work email address we have on file.
[CUSTOMER][NEUTRAL] Right, probably, yeah.
[AGENT][NEUTRAL] And is that what you just gave me?
[CUSTOMER][NEUTRAL] My work even, well, I moved here recently, uh, in August I moved here.
[AGENT][NEUTRAL] But your work email, what is your work email address?
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] OK, OK, that's the email address we have on file. Do you wanna leave it at the work email or change it to your personal?
[CUSTOMER][NEUTRAL] My personal time.
[AGENT][NEUTRAL] OK, can you give me that one more time, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] [PII] OK thank you let me get that updated real quick and then we will proceed.
[AGENT][NEUTRAL] What do you do there at the law firm?
[CUSTOMER][NEUTRAL] Pale.
[AGENT][POSITIVE] Oh, great.
[CUSTOMER][NEUTRAL] It's been years.
[AGENT][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm updating your email to [PII].
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] OK. That is done.
[CUSTOMER][NEUTRAL] are
[AGENT][NEUTRAL] Alright, so now I'm gonna go to your benefits section.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] So yes, the office visit, like if you report to like your primary care or specialist, which would be the neurologist, uh, the copay is not covered um actually service in a doctor's office is not covered, but of course you have the outpatient benefit under the policy which would the emergency room visit will fall under your outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's the only thing that covers emergency room?
[AGENT][NEUTRAL] Well you have an inpatient benefit too so if you were um.
[AGENT][NEUTRAL] Um, admitted to the hospital, um, and you're there 18 hours or greater, uh, that, that's an inpatient benefit for you. Let me pull up your policy. Um, urgent care is considered under the outpatient benefit as well, and let me see what other items fall under the outpatient benefit, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] this year.
[CUSTOMER][NEUTRAL] out there.
[CUSTOMER][NEUTRAL] here this morning
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Well as I look through your policy under the outpatient benefit, let's see.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Hospital emergency room, urgent care facility, outpatient surgery in a hospital facility, or freestanding outpatient surgery center, diagnostic testing in a hospital facility or MRI facility.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] And then outpatient treatment for a mental or emotional disorder in a hospital outpatient facility. Those are the items covered under that outpatient benefit under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK, alright, so like let's say I have to go for testing for neurology, um, things like that it wouldn't cover anything like that it's just basically hospital urgent care things like that.
[AGENT][NEUTRAL] If you're testing, if your diagnostic testing is in a hospital or a MRI or a diagnostic facility.
[AGENT][NEUTRAL] Those items can be considered under your outpatient benefit if they do testing in your neurologist's office, those items are not covered because it's in an office setting versus an outpatient hospital setting or a diagnostic facility setting.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. All right, so.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][NEUTRAL] Yes, yes, OK, so like let's say um.
[CUSTOMER][NEUTRAL] I do have to go outpatient actually I request uh diagnostic and uh I know I do have a test coming up for my brain that's gonna be in the doctor's office that would not be covered.
[AGENT][POSITIVE] Correct, because of the place of service where it's being done.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so any testing should always be outside of the actual office.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alrighty, so I just wanted to know that and then I guess for like women's care things like that like mammogram stuff like that, does that count as outpatient or inpatient?
[AGENT][NEUTRAL] So the meddling policy that you have it um considers services that are a result of an accident or sickness, which means wellness or routine uh services are not covered, which would be like your well woman checkups and things of that nature.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, alrighty, well, I just wanted to know because I have upcoming appointments. I just wanna know, I know definitely every time I go to the doctor and I was $80 for the special so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just didn't know, um, you know, like what was covered do I give them the card? Do I not give them the card, so, um.
[AGENT][NEUTRAL] You know, you always want to present your card, uh, present your identification card, and generally they'll contact us to verify your benefits.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright well thank you so much for your help.
[AGENT][POSITIVE] Alrighty, any other questions I can help out with today, [PII]? You too. Thank you for calling APL. Have a good day as well.
[CUSTOMER][POSITIVE] OK, have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.