AccountId: 011433970860
ContactId: 48580346-ce06-44ce-8399-44a381ef6e33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 746590 ms
Total Talk Time (AGENT): 362879 ms
Total Talk Time (CUSTOMER): 213554 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/48580346-ce06-44ce-8399-44a381ef6e33_20250624T17:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need some help, uh, a couple of things. I'm gonna need a new card, but the reason for my, uh, call is I'm trying to, I had my doctor order a, uh, a diagnostic, uh, CT, uh, of my lumbar spine, and I checked with my primary and, and it, it has a $75 copay, um, and I want to see if my APL covers that.
[CUSTOMER][NEUTRAL] And the reason I know I need a new card is I'm looking for outpatient uh certification number here and it's I can hardly see it. I can see the.
[CUSTOMER][NEUTRAL] In hospital out out of hospital is kinda well I think the numbers the same except for the last digit so I'll I'll I'll be able to get it to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so you're needing to find out about an ID card and then also you have a question on a benefit for a CT, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, sir. I can help you with those things. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII]. That's [PII] Last name [PII]
[AGENT][POSITIVE] OK, thank you and Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is, um, that policy number on your ID card?
[CUSTOMER][NEUTRAL] OK 0184.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 797.
[CUSTOMER][NEUTRAL] 7 Mike Lima 7 actually for outpatient would be Mike Mike Lima 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine. Thank you. Give me just one moment please.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], I will need to verify several things with you for security and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address.
[CUSTOMER][NEUTRAL] Well, I hope you have it. I hope it's updated, but my home mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is also on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright thank you and then the last piece of information to verify will be your email address.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, thank you. Now Mr. [PII], are you familiar with our portal called the online service center?
[AGENT][NEUTRAL] Has anyone ever told you about that? OK, so the online service center is our.
[CUSTOMER][NEUTRAL] Not really.
[CUSTOMER][NEUTRAL] They may have.
[AGENT][NEUTRAL] OK, well, do you use the internet very much?
[CUSTOMER][NEUTRAL] No, I mean, not often. I'm on the road a bunch, I mean, but, uh, but please tell me. I'm listening.
[AGENT][NEUTRAL] OK, so the portal once you set up your profile, it gives you access to your ID cards, your policy information, and also claims information. If you were to ever have to file your own claim with APL, you can actually upload your information into that portal and you can have access to your explanation of benefits from claims that we have processed.
[AGENT][POSITIVE] So if you think that that is something that you would be interested in setting up, I do have a couple of user guides that I would be very happy to email you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Please, please do so and I, and I'll try and do that.
[AGENT][NEUTRAL] Explain
[AGENT][NEUTRAL] OK, alright, so give me just a second and I'm gonna go ahead and send you that right quick while we're on, on the phone, so just one moment.
[CUSTOMER][POSITIVE] Yeah, I mean, I have something similar set up with my Aetna, my primary, uh, there's an app, you know, that it, it's on my phone and I access everything through there, uh, I rarely have to call them.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right, so this would be.
[AGENT][POSITIVE] Yeah, so this would be very similar to that but obviously if you ever have any questions, you know, don't hesitate to call us and we'd be happy to assist you. So I'm sending you that now one of them again is about creating and logging in the other one is about using the portal, OK? And that email that you're gonna receive will come from care team.
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] And I did put APL in your subject line for you.
[AGENT][NEUTRAL] And then Mr. [PII], I also need to give you a new policy number because that ID number that you gave me is an older policy that's no longer active.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, well, um, you know, unfortunately I can't write it down now.
[AGENT][NEUTRAL] Are you able to
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm driving. Uh, can, can it make, can we possibly put it on the email you're sending me?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Well, I, I just, I can send you another email. I actually have already sent that other one, but I can, so give me, give me just a second. What I'll do is I will, I've ordered some ID cards.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Be mailed to you?
[AGENT][NEUTRAL] But I will also just go ahead and pull up your ID card and I can attach it and send that in another email.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, you're welcome. So just a moment please for me to do that. You're welcome.
[CUSTOMER][POSITIVE] Thank you ma'am.
[AGENT][NEUTRAL] OK, just a moment, Mr. [PII], for that to load up.
[AGENT][NEUTRAL] It typically takes Mr. [PII] about 7 to 10 business days to receive those cards, your ID cards in the mail, so you can kind of be, you know, looking for them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I have just sent you the other email with your ID card, Mr. [PII], that one will also come to you from [PII].
[CUSTOMER][NEUTRAL] OK, so I
[AGENT][NEUTRAL] I don't think they will go to your, yes, sir. I don't think they're gonna go to your junk or spam folder, but if you don't see those two emails from care team in your inbox, you might want to check.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One of those other folders. OK, so on this supplemental policy as far as benefits related to a CT scan, you do have an outpatient benefit maximum per calendar year for covered outpatient services of $2500.
[CUSTOMER][NEUTRAL] OK, I'll find it.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year on this policy.
[AGENT][NEUTRAL] So just make sure to present your APL ID card along with your primary insurance card to your provider because most providers will file both of your insurances.
[AGENT][NEUTRAL] But in the event that they would not follow your supplemental plan with us, you can call us back and we could give you the information on how to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So as I understand it, I, I am covered for the $75 copay, but they may or may not do it themselves if I, if they do not, I would pay for it and then file a claim with you.
[AGENT][NEUTRAL] OK, now when you say a $75 co-pay, is this for the CT scan or for your office visit?
[CUSTOMER][NEUTRAL] No, for the CT scan.
[AGENT][NEUTRAL] OK, so for the CT scan again, that is, I can't guarantee payment. I can only verify what your benefits are, but yes, in the event that they did not file the claim, then once it had been filed and processed by your primary insurance, you could submit the claim to us for review.
[AGENT][NEUTRAL] And you could call us
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now, again, most providers will file both if you present them with both of your insurance information, excuse me, both of your insurance information.
[AGENT][NEUTRAL] They will typically call us to verify you're eligible and ask about benefits.
[CUSTOMER][POSITIVE] You know, it, it, it, it's funny because I, I use this is Acumen is a radiology company I use and there I've used them at least, uh, I don't know 20 times in the last few years, and I just had a CT done, uh, two months ago and it, it covered everything 100%. I went in. I showed him my APL. I showed him my Aetna card and it covered 100%, no copay, no nothing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, but I, I scheduled one now and, and the girl on the phone told me, oh, your copay with your insurance is $237 and, and then of course I call Aetna and they say no, it's covered at 100%.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, but you have a somebody filed a copay, but that they're making me go through everything, but I was just there a couple, couple months ago and everything worked out, so, uh, but you know, I, it's a little inconsistent.
[AGENT][POSITIVE] Yes, sir, and I can.
[CUSTOMER][NEUTRAL] So I'm just doing a little homework here so I don't.
[AGENT][NEUTRAL] Uh, I totally understand. It's, um, the same time, it can, inconsistency can kinda be a thing. So, unfortunately, I mean, obviously I have to
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I have to deal with certain circumstances very similar, um, so it's always best to do your homework. Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Yeah, OK, well thank you very much for your, for your help, and I'll be looking for those emails and I'll try and set up the portal so I can access, uh, stuff in the future.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] OK. And again, that new, that new ID card that I emailed you, um, that is also the one that's going to be coming to you in the mail, and it does have your correct policy number on it for your active policy with us at this time.
[CUSTOMER][POSITIVE] Thank you, thank you very much, ma'am. You have a great day.
[AGENT][POSITIVE] Uh, uh, well, I hope you have a, a very nice day as well. And thank you again, Mr. [PII], for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.