AccountId: 011433970860
ContactId: 6c247164-d7ec-47c7-848e-b43381ea3b49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1167469 ms
Total Talk Time (AGENT): 741387 ms
Total Talk Time (CUSTOMER): 284320 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/6c247164-d7ec-47c7-848e-b43381ea3b49_20250527T17:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes, my name is [PII]. Um, I'm, uh, I'm insured with, um, APL. I want, I was calling to find out what all my policy holds. Do it hold life insurance also. I was just trying to get information on my policy.
[AGENT][NEUTRAL] OK, um, [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have your policy number with us, with you?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, that's OK, it's 026.
[CUSTOMER][NEUTRAL] 08826
[AGENT][NEUTRAL] OK, one moment while I look that up.
[AGENT][NEUTRAL] And can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address and phone number that we have on file?
[CUSTOMER][NEUTRAL] Phone number is [PII] I mean I'm sorry [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, the policy you gave me is a dental policy.
[CUSTOMER][NEUTRAL] Yes, so who now?
[AGENT][NEUTRAL] It's a dental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's what this what this is, this straight and that's all I have on me here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, it looks like you also have a hospital indemnity policy with me with us. Is that what you were wanting me to look up for you?
[CUSTOMER][NEUTRAL] Um, yeah, I, based on kind of what the policy all, uh, carries.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do they have life insurance on there also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, you won't have life insurance through these two policies because one is dental and one is for hospital.
[AGENT][NEUTRAL] Uh, life for your life insurance, you'll wanna check with your employer for that if they, if you signed up for for life insurance, um, it might not be through us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And would you like the policy number for your hospital indemnity?
[AGENT][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] Um, I mean, they sent me a card. I mean, would it be this, uh, would it be on another card? I believe it's something to.
[CUSTOMER][NEUTRAL] Oh, but in a way, I'm not, um, give me a, give me a moment and let me get a.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so this here, this is just covered the approval and health.
[AGENT][NEUTRAL] Yeah, the first policy number you gave me is your dental policy, and then the number I'm about to give you is for medical.
[CUSTOMER][NEUTRAL] Your policy here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me know whenever you're ready and I'll give you that number.
[CUSTOMER][NEUTRAL] What's the what's the number?
[AGENT][NEUTRAL] It's 02.
[AGENT][NEUTRAL] 60.
[AGENT][NEUTRAL] 882 5.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do see that you have an email on file with us. Um, if you would like, you can also sign up for an online portal uh through [PII] and on that portal you'll be able to access any um cards that you might have say you lose the card that you have with you or you didn't bring it, um, and it'll also have your policy numbers and your policy uh documents.
[AGENT][NEUTRAL] So, if you are wanting to look at something specific on your policy, you can search through your policy documents.
[AGENT][NEUTRAL] And you're also allowed to file a claim on there too, so that's something else you can, uh, you might want to consider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me pull up your policy and we can go over some stuff today too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, [PII] is where you'll sign up for the uh.
[AGENT][NEUTRAL] For your online portal.
[CUSTOMER][NEUTRAL] You, you said [PII] what?
[AGENT][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will need to sign up with the email that we have on file so what email um did you give us? do you know?
[CUSTOMER][NEUTRAL] Um, I think I believe I believe it was [PII].
[AGENT][NEUTRAL] OK, because we have a different one, is that the one that you would like?
[CUSTOMER][NEUTRAL] Oh, I, I got two, so it might be [PII]. Yeah, [PII]. Yeah, that's fine.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, OK, so you'll want to use that one when you sign up because sometimes the people when they have multiple emails and they try to sign up and they wonder why they get a message saying that they don't have one, it's because it's not the email that we have on file so just make sure you use that one and if for any reason if you ever need to change that email um go ahead and give us a call you should be able to do it on the service on the online service center as well, but you can go ahead and give us a call as well.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this one here is this one here is do uh.
[CUSTOMER][NEUTRAL] My, my, one of my jobs, right?
[AGENT][NEUTRAL] Let me see if it's through your employer.
[AGENT][NEUTRAL] Yes, so this one is through your employer.
[AGENT][NEUTRAL] Um, would you like me to go over some of the benefits that you have on your indemnity policy?
[CUSTOMER][POSITIVE] Um, yes, cause I'm sorry.
[AGENT][NEUTRAL] Or is there anything? OK, OK, you've got a lot, so I'll give you some, some big ones and I do want to just say that this is a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So with this hospital indemnity policy, you do have a hospital confinement benefit of up to $50 per day with a maximum of 30 days per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Confinement means you are in the hospital staying overnight for at least 18 hours.
[AGENT][NEUTRAL] You have a hospital admission benefit of up to $500 per day with a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have an accident and it means that when you've been admitted into the hospital, um you're allotted up to $500 for that admission, but it looks like for your policy, um you have a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] What does that mean there?
[CUSTOMER][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So say you go into the emer say you go into the hospital, you're admitted into the hospital today and you file a claim, you, you could get up to $500 for that claim. Let's say you go back to the hospital and you're admitted again, say later on in the, the same year, it will get denied because you've used up that benefit. So you'll have to do it each calendar year. Hopefully, you don't get admitted into the hospital twice a year, let alone once a year.
[AGENT][NEUTRAL] But this policy is showing that you have a maximum of one day per calendar year.
[CUSTOMER][NEUTRAL] OK, and after that I will have to pay after that one after that next business.
[AGENT][NEUTRAL] Right. And that's just for the hospital admission. Mhm.
[CUSTOMER][NEUTRAL] out of, out of pocket.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's just for the admission, so there are other options that there are on here.
[AGENT][NEUTRAL] You have an emergency room benefit of up to $50 per day with a maximum of 2 days per calendar year.
[AGENT][NEUTRAL] An urgent care facility benefit of up to $50 per day with a maximum of 4 days per calendar year and did you have a question?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, that's what the, that's what the company APL pay the $50 per day, or I will have to pay that out of pocket.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, that's what we pay.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So when you file a claim.
[AGENT][NEUTRAL] Whenever you get admitted or you get discharged, you will want to ask them because not all hospitals do this you'll want to ask them for an itemized bill because we will go based off of that itemized bill with procedure codes, some hospitals will give it to you some you have to ask for they just give you a regular invoice or bill um you wanna make sure that you have procedure codes on there.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, and then you'll file under this policy you'll want to submit everything that you, um, think will be relevant and on your claim form it will tell you what documents you'll need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But um as I like to say just anything and everything you think is relevant, make sure you have those itemized bills uh or itemized receipts, um make sure that you have information on.
[AGENT][NEUTRAL] What you were in for, um, how they treated you, anything like that, you'll wanna keep all of that on file and we do look at everything that you send us with the claim. So if you think it's even if you think it might be nothing, if you see something with a number on it and a.
[AGENT][NEUTRAL] Uh, like a dollar amount, go ahead and send it in.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][POSITIVE] Yeah, I, I like to be safe.
[AGENT][POSITIVE] And make sure that I'm filing everything that I need.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And then whenever you do go on to your, whenever you do sign up for your online portal account, you'll be able to click something that says a policy certificate and everything that I've read you today and you do have more benefits you'll look at the schedule of benefits on page 22.
[AGENT][NEUTRAL] And that's where the actual benefits start where you can actually see them laid out kind of in a little bit more plain language and then the rest of the policy just has some of your policy um standard language but then it also has definitions on there too so if you ever wonder if something counts towards that it'll be in your policy uh document as well.
[CUSTOMER][NEUTRAL] OK, OK, so basically, you say you say I have a lot of stuff on on on this policy?
[AGENT][POSITIVE] Yes, you do have quite a bit of benefits on here. You even have an ambulance policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] If you're on the, if you're using just a regular ambulance, say on the ground driving, um, you're allotted up to $100 per day.
[AGENT][NEUTRAL] With a maximum of 1 day per calendar year, if you have to be flown anywhere for an ambulance, you're allotted up to $200 per day, uh, with a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK. So.
[AGENT][NEUTRAL] You also have some office, some physician office benefits and uh physical therapy benefits as well, and it'll all be laid out in that policy certificate.
[CUSTOMER][NEUTRAL] OK, OK. Now, um, just say if I can, you know, call or do policy, uh, could someone else call and, you know, you know, make a claim or a relative or someone like that, or would I have to do it?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, just in case, I mean sort of happened, happened.
[AGENT][NEUTRAL] So the only people who can file a claim on your behalf are you you can either file the claim yourself um or the hospital will file the claim, um, if you used a broker, which I I don't know if you used a broker, which it doesn't look like um they did um but those are the only people who can submit on your behalf since you don't have anyone else on this policy, um.
[AGENT][NEUTRAL] It's up to you if you want to file a claim or if the hospital is going to file. What we do is we, we go, um, by whichever one submitted first, so say you submitted your claim first and then the hospital did the hospital claim would get denied and it would go towards your claim or vice versa if the hospital filed the claim first.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Then it would go to them.
[CUSTOMER][NEUTRAL] OK, yeah, I thought I, I thought I had my, uh, I thought when I got put my fiance's name on there.
[CUSTOMER][NEUTRAL] But I don't know I I guess that's why I added her.
[AGENT][NEUTRAL] Yeah and you will be able to submit claims online as well once you once you start your portal account, you will be able to file claims online as well.
[AGENT][NEUTRAL] And if you ever wonder, I mean it should tell you the status of the claims as well, but if you ever need to you can also call us and check and we can check the status of your claim for you if it was paid or denied so we can help you with that as well.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so if I wanna add um my um fiance name or someone on there on my policy, um, could I do that long or or no?
[AGENT][NEUTRAL] No, you'll want to go through your employer if you need to add someone to your policy that'll go through your employer.
[CUSTOMER][NEUTRAL] OK, OK, alright, alright.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then, well thank you very much. I just wanna get a follow up on what all this policy care hold what what is on there.
[AGENT][NEUTRAL] Oh, certainly.
[AGENT][NEUTRAL] There's a lot of stuff.
[CUSTOMER][NEUTRAL] Yeah, uh, they, they, I guess everything would be in the, the pamphlet, the, the, um, the book that they sent me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, and then once you get like I said once you get into your online service center account.
[AGENT][NEUTRAL] You'll be able to see any ID cards, you'll be able to see your uh policy for this and you should be able to see your dental benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So basically, my dental, well that's another thing, you know, on my dental, what does all that cover, if you don't mind um explaining that to me if I, cause I'm thinking about going to the um the dental, uh, the dentist, I should say, soon. So I'm sometimes I really need to find out what that cover.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give me just a moment let me get, let me get back to it.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] And whenever you go into a dental office, um, most of them check for eligibility first as well um they typically will call us to see what you're allowed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like and again this is a verification of benefits, not a guarantee of payment you do have a calendar year maximum.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Of $500?
[AGENT][NEUTRAL] And a $50.
[AGENT][NEUTRAL] Calendar year deductible.
[AGENT][NEUTRAL] Um, that deductible does not apply to pre preventative services. Your dental insurance covers, um, basic expenses, so no surgeries or anything like that, um.
[AGENT][NEUTRAL] So that's something to keep in mind.
[AGENT][NEUTRAL] Your policy goes by percentage of covered expenses.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So preventative services such as the cleaning.
[AGENT][POSITIVE] Um, you get 100% of allowable.
[AGENT][NEUTRAL] If you need any other basic expensive or restorative expenses, um, it's about 80% of allowable radiographs, um, so whenever they take um dental imaging or anything like that, that's 80% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're allotted 1 cleaning every 6 months.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] An oral evaluation? Oh, go ahead.
[CUSTOMER][NEUTRAL] So anything like if you get teeth pulled or you wanna get like uh uh replacement, you wanna get your teeth replaced things like that um does that, is that all on that policy or no?
[AGENT][NEUTRAL] You do have an extraction um on here now if it's just a simple basic extraction you are covered that but if they have to surgically remove the tooth for what any for whatever reason, that one won't be covered.
[AGENT][NEUTRAL] So just keep that in mind.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, but if it's just a simple extraction, you're, you're fine.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And let me see, um, and another thing is if you go on our website [PII] and if you let me get to it so I can.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Go all the way through there with you.
[AGENT][NEUTRAL] So if you go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you'll scroll almost all the way down.
[AGENT][NEUTRAL] To see provider resources you'll see a little magnifying glass with a tooth that says Carrington Dental provider search your dental policy is under that provider search, so you're through APL, but if you find a dental office within that Carrington network you're given um an extra benefit as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, depending on the provider that you use, you are allotted, um, sometimes you get a discount on services.
[AGENT][POSITIVE] And so, um, what I recommend is going through that Carrington dental provider search, um, and you can search by whatever you're looking for such as general dentistry, um, anything like that, and you'll get an extra benefit on top of that, um, and what I mean by that is it's not going to pay you more, but you do get a discount on services and so that can be pretty helpful based off of your benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK, OK. Well, thank you very much.
[AGENT][POSITIVE] Yeah, it's not required but it does help.
[CUSTOMER][POSITIVE] Yes, but thank you for answering all my questions. Um, I appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, that'll be it. That's all I needed to find out about it.
[AGENT][POSITIVE] Alright, well, [PII], you have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Alright, bye.