AccountId: 011433970860
ContactId: 5929b0c9-2351-4977-b676-549639a7c23b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310040 ms
Total Talk Time (AGENT): 207801 ms
Total Talk Time (CUSTOMER): 84908 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/5929b0c9-2351-4977-b676-549639a7c23b_20250227T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. I'm calling um because I wanted to see if my plan covers um like my hospital responsibility like if I go to the ER.
[AGENT][NEUTRAL] OK, so you're, you're the insured and you have a question regarding benefits related to an emergency room visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And Miss [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Sure it is uh hm, do you need the in hospital or outpatient?
[AGENT][NEUTRAL] Uh, if you'll notice on those two numbers, Ms. [PII], the first part of both of them is the same, uh-huh, and that's actually the policy number. So.
[CUSTOMER][NEUTRAL] Oh it's the same one.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, got it. 02455519.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your information pulled up. And then once I do, I will have to verify several things with you first for security, and also this some any information that I do provide for you will be a verification of benefits and not a guarantee of payment. So give me just a moment, please.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so first off, Ms. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you. And then your email address that is on file and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Oh OK yeah that's fine.
[AGENT][NEUTRAL] OK, what is that? I need you to verify that for me.
[CUSTOMER][NEUTRAL] Oh, sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Now one question while some um your additional information is loading, Ms. [PII], have you ever set up your profile in the APO online service center where you can have access to your ID cards, your policy information, and also claims information online?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I don't probably, but I don't I don't remember.
[AGENT][NEUTRAL] OK, well what I can do is I will email you the user guide to that email address that we have on file for you and the email that I will send will come from [PII] team [PII] and I will put a APL.
[CUSTOMER][POSITIVE] You're done? Oh, thank you, have a good one.
[AGENT][NEUTRAL] In your subject line so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you'll have that in just a few minutes once we get off of our call I'll send that to you. OK, so on this supplemental policy, um, it is designed to help you with your co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][POSITIVE] Oh awesome perfect.
[AGENT][NEUTRAL] So an an emergency room visit would fall under your outpatient benefits and you have an outpatient benefit maximum.
[AGENT][NEUTRAL] Of $2500 per covered person per calendar year, again that's for covered outpatient services and there is no outpatient deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For an emergency room visit. Mhm per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, OK, so I'll be covered basically if I go in.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, I can't guarantee payment. We will have to just receive the claims for review, but those are your benefits on this policy. So what I recommend to [PII] is always present your APL ID card along with your primary insurance card.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because most providers will file both of your insurances, the claim for us um doesn't need to be submitted until it has been filed with your primary insurance because we do have to have a copy of your primary insurance company's explanation of benefits when we review claims.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] But I do not show, let me look at, let's see.
[CUSTOMER][NEUTRAL] Just like none
[CUSTOMER][NEUTRAL] So can I move it.
[CUSTOMER][NEUTRAL] to get
[CUSTOMER][NEUTRAL] So it's just so.
[AGENT][NEUTRAL] And I don't show that you have used any of your benefits for this calendar year as of now.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hearcoal.
[CUSTOMER][POSITIVE] Perfect thank you so much for your help, [PII].
[AGENT][POSITIVE] OK, Mr. [PII]. Well, you're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling. Yes, ma'am, [PII] and I hope you have a nice day also.
[CUSTOMER][POSITIVE] Have a good one.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh.