AccountId: 011433970860
ContactId: 6a8e3e2a-ae9b-49a3-871a-6902b341452f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597039 ms
Total Talk Time (AGENT): 286320 ms
Total Talk Time (CUSTOMER): 308403 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/6a8e3e2a-ae9b-49a3-871a-6902b341452f_20250228T14:40_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] Uh, hi, so, my name is [PII]. How are you?
[AGENT][POSITIVE] I'm good. How about you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Pretty good thank you. Um listen, I was just giving you a quick call um I have the uh gap insurance with you through my employer and uh they waited a lot to make the changes uh for next year and they said that we will continue with our benefits, um, but I wanna make sure that that's, you know, in the system and I also wanted to double check what kind of deductible.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, I had because I believe I have purchased a high, uh, little higher, uh, than what our next plan will be. I have a group number, payer ID. I'm not sure you need what you need group number I guess.
[AGENT][NEUTRAL] Are
[AGENT][NEUTRAL] Are you calling on behalf of the group or are you calling on behalf of yourself like a personal?
[CUSTOMER][NEUTRAL] On behalf of myself, yeah, I called the HR person, but she's out today, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we're gonna need the policy certificate number. It's gonna be the outpatient or inpatient cert.
[CUSTOMER][NEUTRAL] OK, um, do you want the, uh, the in in hospital or outpatient benefit, which one?
[AGENT][NEUTRAL] Either or, they're the same number. Mhm.
[CUSTOMER][NEUTRAL] Either or, OK, the outpatient benefit certification number is 023.
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] 253
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And the hospital is the same thing, but it's a 7 at the end instead of an 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And may I have um your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, uh, date of birth, um, I didn't give you my last name. Uh it's [PII] This is with Alviso University. My date of birth is [PII].
[AGENT][NEUTRAL] What's the mailing address and email address on file?
[CUSTOMER][NEUTRAL] Mm, I don't know if they put my home. My home is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, yes, that's what we have. Thank you.
[CUSTOMER][NEUTRAL] That's what they put? OK good.
[AGENT][NEUTRAL] OK. Um, let's see.
[AGENT][NEUTRAL] And you said that you should have a new policy with us?
[CUSTOMER][NEUTRAL] Uh well I just wanna continue it but you know I'm, I'm not sure she said uh the HR person that they had sent an inquiry to you because we had yesterday and the day before the enrollment for the renewal of our medical, dental, um, vision, all of that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, that we couldn't enroll until today, but you know, [PII] happens to fall on Saturday tomorrow and my card from you says, um, this one says effective day 31-23. They didn't send me a new card, uh, last year because we just continued the policy, so I'm assuming we just continued the policy.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] But I want to insure so I don't wanna assume so and I wanted to see what kind of deductible I have on my policy there listed.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if it was for 5000 or 6000 that I.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] That I'm being charged.
[AGENT][NEUTRAL] OK, Ms. [PII], um, let me go ahead and pull the group because if they're an open enrollment, we're not gonna have the new information just yet, um, based on what I'm seeing right now in our system, um, I don't see a new one, but that doesn't mean that it's not being worked on. It's just right now it's not showing up in the system. Um, let's see.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] You see the current one?
[AGENT][NEUTRAL] I don't see the current one yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And in the current one, can you see if if my rate is for 5000 or 6000?
[AGENT][NEUTRAL] On the current one which is gonna terminate in on this Saturday, um, let's see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This one has an inpatient of 6000 and the outpatient is.
[AGENT][NEUTRAL] 500 per day.
[CUSTOMER][NEUTRAL] Yeah, OK, so they, they continued because the insurance we had the other year was Aetna, and last year I had asked to, to go to 5000, which was the new deductible, but I guess that didn't go through, well.
[CUSTOMER][NEUTRAL] Is there a big difference between what I pay as an individual for the 5000 deductible or 6000?
[CUSTOMER][NEUTRAL] We can't do anything anyways, right? I have to wait.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, unfortunately because I'm not really sure what you know whenever you get an insurance through your employer, sometimes you're paying a discounted through your employer and then they pay the other half for the other portion so I'm not really sure how much is it. Um, yeah, that's something that you, you need to probably ask your HR department, um, but yeah, right now I'm not showing a new one again, um.
[CUSTOMER][NEUTRAL] Oh, I understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not sure if it's gonna be generated or not because um if you said that it's an open enrollment it's probably because they're working on that, OK? So I would say um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, give it about um maybe a week or two and check back um and check back to see if we have anything indicating that the new policy is going to be generated or not, OK?
[CUSTOMER][NEUTRAL] Maybe a few days. Mhm.
[CUSTOMER][NEUTRAL] Yeah, she did say that it would and that she was writing to you, but we only had in our ADP the options for the medical and uh I, I, you know, didn't have the option for the gap. They said that it possibly could be work next week. It's just that, you know, it's kind of unnerving because then you don't know if policies are terminated and you don't know when something can happen, but.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, yeah, but right now, yeah, right now it is showing that it's gonna terminate in the end of this [PII]h, um, so yeah, just, if she said that she's working on getting um the product again.
[CUSTOMER][NEUTRAL] Um, I'll get back with him, you know.
[AGENT][NEUTRAL] Then yeah, I'll give it a couple of weeks before um you call back and see if you have a policy or you can just get in contact with her and see if they are still getting the, the gap insurance, the secondary insurance with us, OK?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, alright, I'll do that and if uh something is they can get it going next week anyways, right? I would assume.
[AGENT][NEUTRAL] Yeah, if they already work something where um they're gonna get new policies, um, we'll go ahead and have that already in the system or it's it's gonna be notated somewhere um if not it's just gonna terminate uh it's not something that um we sell individually it's through an employer, so if the employer decides that they don't want to continue with the group, um, the whole group will be terminated, OK?
[CUSTOMER][NEUTRAL] Right, right, no, she said they did wanna continue. It's just that we were not send papers and I, um, I, I thought that there has to be some communication between you and HR, and I, since it's not in your system, I'm assuming that they're late with that or it seems like this is gonna go through next week then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And we may have a lapse there or something. um I also have to send you a couple of claims from my medical insurance that um I um I had to uh pay some copays for some testing. um, I in the past I have sent information via fax and via email. What would you say is I know that usually you need the proof of payment, the EOV also.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Um, what would be the best way to file this, uh, couple of claims I have for this year?
[AGENT][NEUTRAL] Right now, yeah, right now since the policy is about to terminate, if you have not registered online, it's not gonna let you register, um, because it's already terminate, well, it's already showing that it's gonna terminate, so it's not gonna let you create an account right now if you have not created an account in the past, um, the, the fastest way will be through the apps, um, online service center which you can upload a claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That is the fastest way, but if you cannot do it like that, and it's gonna be a fax, so you can either fax it or mail it to the information on the claim form. Um, all of our claims, if you're gonna submit your own claim and we need the claim form, the explanation of benefits from the primary insurance, and the itemized bill with diagnosis codes, those are the three documents that we need for any of our claims.
[CUSTOMER][NEUTRAL] I need my bill with diagnosis code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, but I, I can send you the paperwork even after tomorrow, right?
[AGENT][NEUTRAL] Oh yes, you can always submit claims. There is no timely filing limits to submit a claim as long as the policy was active during the time of service, we'll go ahead and um if there is if say payable benefit we'll go ahead and send benefit payment.
[AGENT][NEUTRAL] Based on the policy, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK, perfect. Well, I thank you for all your um kind answers and uh wish you a good day.
[AGENT][POSITIVE] You're welcome. You as well. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Not for today, but thank you so much.
[AGENT][POSITIVE] Yeah, OK. You're welcome and thank you for calling ATL. Have a good day, Mrs.
[CUSTOMER][POSITIVE] Thank you, you too. Bye bye.
[AGENT][NEUTRAL] You know.