AccountId: 011433970860
ContactId: 64bd0144-1d88-45f1-a6ef-080fc0af19f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603619 ms
Total Talk Time (AGENT): 265718 ms
Total Talk Time (CUSTOMER): 113724 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/64bd0144-1d88-45f1-a6ef-080fc0af19f6_20250529T20:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, good afternoon, Ms. [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] Um, I was calling because I've been trying to get an appointment, but they keep telling me that this is my secondary insurance, that there should be a primary. I'm not sure if you're able to help me with that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, sure, I should be able to help you with eligibility. Uh, [PII], can I get your phone number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, of course. My phone number is [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] That is going to be 02604421.
[AGENT][NEUTRAL] OK, one moment, let me look that up.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] And [PII], can I get you to verify your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address and phone number that we have on file?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And the phone number on file is [PII]?
[AGENT][POSITIVE] OK, thank you so much for verifying that with me. Let's see what's going on.
[AGENT][NEUTRAL] OK, well this is a hospital indemnity policy. It's technically not a primary insurance, but you shouldn't need.
[AGENT][NEUTRAL] If this isn't secondary insurance, let me see, maybe they were referring to something else.
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you should be able to file, this is a hospital indemnity plan, so you should be able to file a claim with us.
[AGENT][NEUTRAL] As long as it's um related to what's in your.
[AGENT][NEUTRAL] Uh, schedule of benefits.
[CUSTOMER][NEUTRAL] Oh, OK, because, um, it, I mean, it is from the Memorial MRI.
[CUSTOMER][NEUTRAL] Uh, portion. I'm, I'm not sure if that has anything to do with it.
[CUSTOMER][NEUTRAL] But they told me that um this was not my primary, that this should be a primary insurance.
[AGENT][NEUTRAL] Um, yeah, this is a hospital indemnity policy you can put.
[AGENT][NEUTRAL] You can file for just this, uh, you don't need.
[AGENT][NEUTRAL] A major medical insurance for this one.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] But it's, it's not, it's not gap insurance. This is a hospital indemnity policy. Let me see.
[AGENT][NEUTRAL] And you said that you were doing, you're going to submit a claim for an MRI?
[CUSTOMER][NEUTRAL] Well, they, I wanted to go to an appointment and they were asking me for my insurance information and when I provided what I have, uh, what I give you, they said that that's not a primary insurance.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] Yeah, you don't need major medical for for this policy, um.
[AGENT][NEUTRAL] If you would like, I can look and see if MRI's are covered under your policy, but you, this isn't secondary insurance. You don't have to have major medical because it's a hospital indemnity plan, um, unless they're used to APL Medin policies, that's our secondary gap policy, but this one is not.
[AGENT][NEUTRAL] That insurance. So, I don't know why they would suggest that you need that.
[CUSTOMER][NEUTRAL] I'm not sure, like I said, she was the one that uh made me aware that it was a secondary. She's like, you probably have a primary, um, you just have to contact them.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Like to get an ultrasound and stuff.
[AGENT][NEGATIVE] Oh, you shouldn't need that for, not for this policy. Um, they might be thinking maybe for your procedure. Um, I don't know quite what it is. No, you don't need major medical to file for this.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Would an ultrasound be covered or can they file the um claim for an ultrasound?
[AGENT][NEUTRAL] Uh, let me check.
[AGENT][NEUTRAL] Let me pull up your policy document real quick and I'll double check that and um I apologize you said MRI or ultrasound?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The MRI is the
[AGENT][NEUTRAL] All right, let me see what you got.
[AGENT][NEUTRAL] And I do want to say any dollar amount to give you this is just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] Let me see what's covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I am showing that this for this policy you have an outpatient accident and sickness treatment benefit is it related to any of those?
[CUSTOMER][NEGATIVE] Um, I'm, it's a sickness.
[AGENT][NEUTRAL] OK, OK, so it would be covered. Let me double check and see if.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Ultrasounds specifically.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I am showing that an ultrasound would be covered as a minor diagnostic exam and that benefit amount is um $100 per day with a maximum of 3 days per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I would be able to get me an ultrasound and then the insurance would cover partially I believe.
[AGENT][NEUTRAL] Yes, it looks like it would cover 100 $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll go ahead and and give them a call back and how will I be able to tell them about the insurance? Like what is it? Like, is it, um, cause you said the.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What you could do is you could give them whenever you go in there and give them their your insurance card.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] They typically will call us and do an eligibility check you can ask them to do that. I will say that if they will not file the claim on your behalf, um, they're not required to. You are allowed to file a claim on your behalf as well. um I do see that you all have an email address with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you do end up needing to file a claim, you can do so online um if you haven't signed up yet we do have an online service center at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can sign up through there you will need to use the email address uh that we have on file and uh you should be able to see any of your policy documents if you have any ID cards or ID cards will be in there for you to print off um you can show them.
[AGENT][NEUTRAL] Um, part of this policy if you need to, I, I hope it wouldn't come to that, um, but you will have all of your policy documents in there as well and then if you do need to end up filing the claim on your own behalf, you can do so online too, um, and you'll be able to check the status of your claims as well. So that's something to think about um as well just in case.
[CUSTOMER][POSITIVE] OK, sounds great. I really appreciate your help.
[AGENT][NEUTRAL] Alright, is, is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that would be it. Thank you so much.
[AGENT][POSITIVE] Great, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] OK.