AccountId: 011433970860
ContactId: 693cb00c-cb39-49d9-b28b-818ec70150a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470190 ms
Total Talk Time (AGENT): 309423 ms
Total Talk Time (CUSTOMER): 115134 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/693cb00c-cb39-49d9-b28b-818ec70150a1_20250603T12:39_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] Yeah, hi [PII]. I was calling, um, I received a, uh.
[CUSTOMER][NEUTRAL] Um, some benefit cards in the mail and um.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And I was, I was just kind of inquiring about it a little bit, um, because I know we just enrolled at at work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh um and I'm not sure because it was so quick what this is if if this is legitimately uh my benefits or what.
[AGENT][NEUTRAL] OK, so you have received ID cards from APL and you just have some questions regarding
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] The coverage, is that correct? Yes, sir. Well, I can help you with that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is that policy number that's on your ID card?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] The group number?
[AGENT][NEUTRAL] No, so there would either, it just, it depends on the type of coverage, [PII], that you have with us. So it may say policy certificate. You may see an in-hospital or an outpatient number.
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I have those.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if you'll notice on the inpatient and the outpatient, the first part of both of those numbers prior to the letters ML are identical. That is actually your policy number. The rest of it just helps us to recognize whether your claim is going to be for an inpatient hospital admission or for an outpatient service. So you can just give me the first part of either one of those numbers.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 02465400.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So one moment please and let me get your information pulled up. Once I do my flight, we will have to verify several things with you first for security. So just one moment, please.
[AGENT][NEUTRAL] OK, so first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you gave me. So again, that is your best contact number that we should have. Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, well thank you and lastly your email address and this does appear to probably be your work email.
[CUSTOMER][NEUTRAL] Um, yeah, it's, uh, the letter [PII].
[AGENT][POSITIVE] OK, Mr. [PII], thank you very much for verifying your information.
[AGENT][NEUTRAL] OK, so Mr. [PII], this policy is a supplemental policy to your primary health care insurance, and it's designed to help you with your co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So you would always present your APL ID card along with your primary healthcare insurance card when you go for medical services. Most providers will call to verify that you're eligible and ask about any specific benefit information. And most of them will also file claims with your primary insurance and with us. In the event that they do not file for your supplemental coverage,
[AGENT][POSITIVE] You can do that and if the need arises you can call us back and we would be happy to give you the information on how to go about doing that.
[AGENT][NEUTRAL] So now, on this policy though, office visits are not a covered service. However, if you receive some type of treatment in the office, you do have an office treatment writer on here. So we could review under your outpatient benefit. So treatment in the office, things like if you had to go to urgent care, the emergency room, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have some form of diagnostic testing or outpatient procedure. Those are things that could be reviewed under here. On your outpatient benefits, you have a $5000 calendar year um excuse me, calendar year maximum benefit for covered outpatient services, and then you have a separate inpatient benefit, which is also $5000 per calendar year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered admissions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so, um, when I present this to like dental and um eye doctor as well? OK, it's just the medical.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, sir. This is only medical, correct. This is only medical, not for dental or vision. That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and, and what about prescriptions?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] Not for prescription.
[CUSTOMER][NEUTRAL] OK, OK, it's just I.
[CUSTOMER][NEUTRAL] All right, I understand now. I, I get it, um.
[AGENT][NEUTRAL] Mhm. And then on your ID cards, it also talks about setting up your profile in our portal.
[AGENT][NEUTRAL] Mr. [PII], where you can have access to your ID cards, there should be a copy of your policy information in your portal with all of your benefits listed in there as well. So, and if you have any trouble when you go to set that up, um, now, it will ask you for an email, so make sure that you use your work email since that is what we have on file for you because for security purposes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would not, you know, if you hypothetically put in your personal email, it's gonna give you an error message and reject you for that.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] So that's an overview of the policy.
[CUSTOMER][NEUTRAL] Alright, I apprec.
[CUSTOMER][NEUTRAL] Yeah, I, I appreciate, I, I, you know, like in this day and age, man, I get something in the mail and like I gotta research it before I put any information in, you know.
[AGENT][POSITIVE] Oh, absolutely. Yes, sir. No, no, sir. You cannot be too careful. I completely understand. I'm the exact same way.
[CUSTOMER][POSITIVE] All right, well I appreciate it. Thank you for all your help.
[AGENT][POSITIVE] Absolutely. You're very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][POSITIVE] No, that'll be it. It's been great. Thank you.
[AGENT][POSITIVE] Well, you're very welcome and it was my pleasure in speaking to you today, Mr. [PII], and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Mm good bye.