AccountId: 011433970860
ContactId: 706732b0-0d2b-40cb-94c0-8796cc7476df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 915539 ms
Total Talk Time (AGENT): 329844 ms
Total Talk Time (CUSTOMER): 358885 ms
Interruptions: 5
Overall Sentiment: AGENT=1.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/706732b0-0d2b-40cb-94c0-8796cc7476df_20250408T22:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, my name is [PII], and
[CUSTOMER][NEUTRAL] Um, we just switched, um.
[CUSTOMER][NEUTRAL] Plan providers uh at my work and I ended up electing a gaps gap uh insurance product from APL.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, and I'm trying to learn more about the product and I'm currently unsuccessful in being able to log in as a new user it keeps on saying it doesn't recognize me.
[AGENT][NEUTRAL] OK, yes, so on our online portal, the information you entered does have to match what we have in our system. 9 times out of 10 it's a different email so we can go through and we can verify all of that. Um, [PII], first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's area code [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] 02593748.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alrighty, I'm just gonna verify some information really quick uh [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Uh, it's [PII]
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Could you give me the zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect thank you so much for verifying that. OK, so all of that of course is correct now here's gonna be the kickers that we don't have an email address on file for you uh so what would you like that email address to be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, I will go ahead and get that added um give me just a moment.
[AGENT][NEUTRAL] OK, and are you to where you can give that a shot while we're on the phone?
[CUSTOMER][NEUTRAL] I'm, I'm sorry, what's, what was the question?
[AGENT][NEUTRAL] For you to where you can give that a try while we're on the phone? Are you able to uh try it again?
[CUSTOMER][POSITIVE] Oh yeah, yeah. Absolutely, I am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me give that a shot, um, and I would, uh, sign in as an employer group, right?
[AGENT][NEUTRAL] Uh, individual. It would be an individual.
[CUSTOMER][NEUTRAL] Um, I'm an employer or.
[CUSTOMER][NEUTRAL] Individual, OK, so it's not like a group, OK, so it's not like a group policy. I got you, um.
[AGENT][POSITIVE] Yes sir it'll be that top option.
[AGENT][NEUTRAL] That would be for if you were like a group admin over an entire group so as this is for your individual policy that's what that means.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost there.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so now it gets me into uh selecting a user name.
[AGENT][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Um, let me see here.
[AGENT][NEUTRAL] Are you still there, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's still in the process of submitting here. I don't know if it's stuck or not.
[AGENT][POSITIVE] Oh sure, no worries, just wanted to make sure I didn't lose you.
[CUSTOMER][NEUTRAL] OK, it looks like it was created here.
[CUSTOMER][NEUTRAL] Let me try to log in.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, it asked me to end up putting in a username which was different. I didn't think to put my email in. I just put another one in.
[CUSTOMER][NEUTRAL] And it keeps on defaulting back here let me see if I can.
[CUSTOMER][NEUTRAL] Somehow like correct this, but then it's
[CUSTOMER][NEGATIVE] Not recognizing my password with like my email.
[AGENT][NEUTRAL] I can look at what
[AGENT][NEUTRAL] OK, I can, uh, double check if you need me to as what the um what you did make your user name. Did you want me to check that for you?
[CUSTOMER][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] Uh, sure, sure.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, so I've got that user name as [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, so I need to change that over here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, text message notifications. Alright, I see my information there with my dependents, um.
[CUSTOMER][NEUTRAL] Just sent me a code.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] It looks like I'm I'm in and.
[CUSTOMER][NEUTRAL] OK, don't need to set up direct deposit because this is coming in and automatically from an employer plan like whatever is owed for this, I'm supposing right so.
[AGENT][NEUTRAL] Direct deposit that would be for um claims so if you were to file a claim on your own uh then that would be how you would receive that payment otherwise we would send a paper check and that's of course if the provider does not file the claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um, all right, so how is it that I know where this becomes, um, eligible, um, because I'm somewhat familiar with like hospital indemnity, um, but you know, when our company was kind of, uh, provided the demonstration on, on this, it was comingled with every benefit, you know, that we were, we were switching over from, you know, health and 401ks and everything.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But the guy kept on pitching he ended up saying, well this is this is good not only for the hospital benefits but they're outpay patient benefits too where deductibles that you uh end up paying, you know, if you're an HSA could end up getting covered over on this side. So, um, that was about the, the end of my, my intro to it and I'm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] As I'm going through through the year I'm receiving bills with.
[CUSTOMER][NEUTRAL] You know, my, the, the switch, all of our prescription costs are like higher and um you know, the, the even the deductibles like that are coming through compared to our prior prior uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Health savings account with United Healthcare, like Blue Cross Blue Shield, like, everything across the board is like more expensive.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I'm curious if having um.
[CUSTOMER][NEUTRAL] This, uh, this gap covers.
[CUSTOMER][NEUTRAL] Like how it works, what kind of coverage and, and what types of, how do I know what to submit that is eligible.
[AGENT][NEUTRAL] Absolutely. OK, yes, so I can kind of give you a bit more of a crash course in it and make it a little bit easier to understand. So in short, as this is a secondary medical uh plan, it is designed to help with copay, deductible and co-insurance after your major medical pays. That's probably the biggest thing to know with this plan, so it can't be used instead of your.
[AGENT][NEUTRAL] Major medical it is very dependent on them so if you were to go to a facility, any sort of medical procedure treatment and your major medical is not willing to pay, then this policy can't if they are then this policy can as it's supposed to help with those kinds of things so I would say and of course I can also send you a copy of your actual policy.
[AGENT][POSITIVE] Um, it is very easy to read, not just a bunch of jargon, I promise, but it does go in depth as to specifically what is and is not covered, dollar amounts, frequencies, things like that, um, and of course if you have any questions you're more than welcome to give us a call, but I would say wherever you would go normally, um, or any of your dependents, uh, on your plan.
[AGENT][NEUTRAL] Uh, wherever you would go for any sort of medical treatment, present them with both insurance, um, information, so your primary and then this information as well. If for some reason you run across anyone who's not willing to file the claim, some providers just don't like messing with any sort of supplemental or secondary coverage. um, you can still file the claims, so that that that's what the portal is for, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sounds good. um, and let's say for example I would appreciate that very much if you could email me the uh um.
[AGENT][POSITIVE] Absolutely, yes, I'll go ahead and get that sent to you.
[CUSTOMER][NEUTRAL] That policy information and I'm assuming there's certain things like with the HSA, let's say that they were covered, you know, bills that I've paid that maybe would have been covered because they're somewhat tied with the HSA, um.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm kind of moving forward with like the idea of like if there are any further benefits moving forward, it's a lesson learned in the past and submit with the insurance because if I paid my HSA then I would assume it would be very difficult to receive a payment back from a reimbursement from AP APL.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To compensate for what was paid there because it's out of the qualified plan.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] Not necessarily.
[AGENT][NEUTRAL] So this policy has been effective since [PII] of this year, so with that there is no timely filing limit so there's no time, you know, if you have to have a surgery tomorrow and you completely forgot it and it's 6 months down the line, you can still file those claims, um, as long as the policy was active during that time whenever you're able to, you can get that to us. So that being said.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All the information that we need and I get the providers will have all of this but it's gonna be the itemized statements and then the explanation of benefits just showing what your primary, your major medical paid so it's not going to be anything after the fact any bills that you were left to pay over that's not going to be a factor in this. It's simply going to be what was uh towards co-pay, deductible and co-insurance after your major medical pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, but if by some chance like it it was uh paid by my qualified health savings account, the reimbursement, like if it was made to me, I would have to make sure that it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got deposited back to me my HSA, right? I didn't know if that's possible, but it probably isn't.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Not necessarily so again if it was something that was already paid that you had it's already done with you would be of course the one to file the claim as the provider you know they got their money so they're not going to do it so in that case it would just kind of go to reimburse you for that um and so you could put it back in your HSA, but that's what that direct deposit is for um otherwise if you don't set up direct deposit we would just send it as a paper check in the mail.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's your benefit information that's your benefits that you have this policy for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, sounds good. um, and.
[AGENT][NEUTRAL] Yeah, I know that was information overload. Any other questions for me?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, it's, it's good, it's good. Um, I previously worked in insurance, so it, it sticks a tiny bit more with me, um, but, um, OK, so yeah, if I ever want to submit something, I'll provide this to my health care providers, um, and all of our dependent doctors and anything that I think I may be able to submit through the portal, I need, uh, like the itemized statements and the explanation of benefits to go along with it to.
[AGENT][POSITIVE] OK, good, yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, investigate the, the refund or the reimbursement, uh.
[CUSTOMER][NEUTRAL] The ability to reimburse.
[AGENT][NEUTRAL] Right and then um so for the itemized statement it does specifically have to show diagnosis and procedure codes as well uh but that's going to be it itemized statement showing those codes and then the explanation of benefits from benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good. All right, thank you so much for your help. I look forward to reviewing that info in the email, and I think I'm good to go for that.
[AGENT][POSITIVE] You are very welcome.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] All right. Yep, yep.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.