AccountId: 011433970860
ContactId: 732f7961-aa8e-4055-b12a-0abf65ca178d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1049579 ms
Total Talk Time (AGENT): 503455 ms
Total Talk Time (CUSTOMER): 575255 ms
Interruptions: 16
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/732f7961-aa8e-4055-b12a-0abf65ca178d_20250411T15:36_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, um, I have a silly question. I was trying to find out is APL just life insurance?
[AGENT][NEUTRAL] No, ma'am, we offer life insurance and medical policies as well.
[CUSTOMER][NEUTRAL] Because it's, it's
[CUSTOMER][NEUTRAL] OK, because it says med link with benefit assignment and I think that means isn't that a type of gap insurance or something?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is. It's a secondary policy to the primary insurance.
[CUSTOMER][NEUTRAL] So how does that exactly work? I've never asked in 40 years what it means and probably missed opportunities.
[AGENT][POSITIVE] All right. Well, do you have a policy we can look at that and, and see what kind of benefits you have? Well, it would be my pleasure to assist you. Mhm.
[CUSTOMER][NEUTRAL] I just, I just
[CUSTOMER][NEUTRAL] And uh, yeah, I do.
[CUSTOMER][NEUTRAL] Yeah, it's 0
[CUSTOMER][NEUTRAL] OK, thank you. I'll take the training. I just, I, I know I've heard it over the years, but I didn't dial in just because I didn't really have health issues, um, and so I just thought sometimes, you know, or even if I might just be under utilizing it and believe it or not, I even got my life insurance, um, um, agent, uh, license, but I, I still don't know a gap insurance is or what it means because it's just not what I cover in, in my sight. Yeah.
[AGENT][NEUTRAL] I feel you.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] So, so it's, uh, I got the policy. It's uh 02260452.
[AGENT][NEUTRAL] Oh, what's that policy number?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] You get older, you need to know what everything means.
[AGENT][POSITIVE] I know, I am right there with you.
[CUSTOMER][NEUTRAL] I said.
[AGENT][NEUTRAL] What is, and I mean, literally, what's your name and date of birth?
[CUSTOMER][NEUTRAL] Now you're listening, yeah, it is [PII].
[AGENT][NEUTRAL] And you're Miss [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you. And do you mind verifying your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sure, sure, [PII]. I'm not sure which email they use. It might be [PII].
[AGENT][NEUTRAL] Actually I don't have either any email which would you prefer?
[CUSTOMER][NEUTRAL] Oh, OK. Let's do the um [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's a [PII] of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And just to make sure that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] All right, and the phone number please, ma'am.
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][POSITIVE] Perfect thank you so much. I appreciate that verification.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And just to let you know, now, do you go by [PII] or [PII] or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], yeah, just [PII].
[AGENT][NEUTRAL] OK. All right, thank you. OK, so Ms. [PII], first of all, let me tell you, we do have a portal. If you're ever interested in creating a login and password, you can actually actually view your policy benefits if you, you know, need to go back and refresh or.
[CUSTOMER][POSITIVE] Yeah. Mhm, no problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whatever that we talk about now that portal is at.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, I would love that.
[AGENT][NEUTRAL] Secured and that's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. In fact, if you're in front of a computer and wanna go ahead and log in, we can look at your policy together to view your benefits.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, let's, let's do that because I have a feeling.
[CUSTOMER][POSITIVE] I, I, I will regret not doing that. So yeah, I am definitely all about the portal because I can't remember [PII] or [PII] these days.
[AGENT][NEUTRAL] Uh, mhm. See, I'm telling you, I understand.
[CUSTOMER][NEUTRAL] So I'll put that down. I, I have become one of them. Like I sound like my mother.
[AGENT][NEUTRAL] Did you ever think you would? Because I didn't think I would.
[CUSTOMER][NEGATIVE] No, of course not. We're gonna live forever and never have gray hair.
[AGENT][NEUTRAL] My best friend and
[AGENT][POSITIVE] That's right, and not have all those complaints or creeks or talk about what's hurting today.
[CUSTOMER][POSITIVE] No. My, mhm. Yeah, it's so funny with my husband, every time I tell him something, I go, oh man, there's this, this. He goes, old.
[CUSTOMER][NEGATIVE] Like, in other words, no sympathy.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] It's just all.
[AGENT][POSITIVE] That's funny.
[CUSTOMER][NEGATIVE] OK, so I'm gonna type in secure. I know it's just so unfair. It just tells me that's all it is old. OK, [PII] and here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, you're gonna go in as a new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna choose the first option.
[CUSTOMER][POSITIVE] New users got it.
[AGENT][NEUTRAL] I'm an individual with an APO policy.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then the next page you're gonna put in your information where it says uh Social Security or member ID it will require your full social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, so type it in the email.
[CUSTOMER][NEUTRAL] to you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And you just take it, take your time and create that account and we'll look at your policy together.
[CUSTOMER][NEUTRAL] There we go.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] I just been carrying this card around for years and I'm like, I don't know exactly what.
[AGENT][NEUTRAL] So you knew that you were supposed to have it, but
[CUSTOMER][NEUTRAL] I, I, yeah, it's like I think I should probably mhm. OK, let's do.
[AGENT][NEUTRAL] What do I do with it?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] it's it's good.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So now submitting.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your account has been successfully created, so now it's going to let me log in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's going to text me.
[CUSTOMER][POSITIVE] [PII]. Yeah, I'm glad you said to do this because truthfully that makes so much more sense.
[CUSTOMER][POSITIVE] To have this portal and have access to it because I, I want my husband to set his up and at least now I can show him.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so we've got [PII] confirm.
[CUSTOMER][NEUTRAL] OK, I did I wrote it wrong. Hold on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so your phone number has been verified.
[CUSTOMER][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] OK, looks like we are in.
[AGENT][NEUTRAL] Beautiful. OK, so if you will click on your policy number under your cover now you can print cards from there as well if you need another card, but if you go down to my coverage and you'll see your policy number, and if you'll click on that, it will upload your policy certificate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's still loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe time down I don't know, getting your files.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Starting download, yeah, just timed out or something. Oh, I see right here it is. It's uh a PDF or something printing, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then click on that.
[CUSTOMER][NEUTRAL] So it printed the PDF.
[AGENT][NEUTRAL] And so if you will click on that and go through your policy, and of course you can look at all the definitions and stuff, but for the sake of benefits within the policy there's a page called a schedule of benefits.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And my document is on page 18. Yours may be a few pages different, you know, up or down. I'm not sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, got it. Let me look my policy trying, yeah, definitely know it's not that far to alone.
[CUSTOMER][NEUTRAL] And you said look for where it says certificate schedule or no?
[AGENT][NEUTRAL] It's called Schedule of Benefits.
[CUSTOMER][NEUTRAL] Go. Oh here it is. It says insert interesting. OK, hold on, I think it's at the.
[CUSTOMER][NEUTRAL] I'm trying to use the um.
[CUSTOMER][NEUTRAL] The um the table of contents because it seemed to.
[CUSTOMER][NEUTRAL] Be better that way.
[CUSTOMER][NEUTRAL] I'm so sorry, excuse me.
[AGENT][POSITIVE] Oh bless you. No, that's fine. It's that time of year.
[CUSTOMER][POSITIVE] No kidding. I got to deal with that too.
[AGENT][NEUTRAL] And when we get older that time of year lasts longer, doesn't it?
[CUSTOMER][NEUTRAL] And so I started to say, yeah, that's welcome to the club. There's my husband, old, old.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I don't think about that, about that when my daughter asked me, how are you doing? And I'm gonna go old.
[CUSTOMER][NEUTRAL] I'm like, I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] You're gonna be like, I got some really good deep advice the other day.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] OK, he helped me, he helped me shorten the conversation.
[CUSTOMER][POSITIVE] I'm so sorry. OK, OK, schedule of benefits, found it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. So, now, of course, the benefits.
[CUSTOMER][NEUTRAL] It was on precise for 18.
[AGENT][NEUTRAL] Mhm and so of course when we're given benefits over the phone, it is a verification of coverage on your policy. It's not a guarantee of payment, which simply means as you know, we just can't pay the claims on the phone.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So for inpatient hospitalization, that is when you are admitted into the hospital and they're there over 18 hours, that is considered inpatient and the benefit amount is $500 per confinement. Now, with your medley gap policy, we pay towards your deductible, co-pay, or co-insurance of your primary.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So everything will depend on how your primary insurance processes the claim and what they actually apply to your deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for your outpatient benefits, the benefit max is $250 per occurrence, and that would include emergency room, urgent care facility, outpatient surgery, diagnostic testing, and an outpatient facility or MRI facility or diagnostic center, and then you have the outpatient treatment for mental or emotional disorder in hospital outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, just that, that per occurrence, per occurrence means every 90 days for the same or related condition.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just to help explain that, for example, if I sprain my ankle and I go to the emergency room on Monday.
[CUSTOMER][NEUTRAL] Oh wow, OK.
[AGENT][NEGATIVE] Um, and that's, that's one diagnosis, sprained ankle. And in 2 weeks, it's still bothering me and I go back to the emergency room for that same diagnosis.
[CUSTOMER][NEUTRAL] Right, right, right.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] It doesn't.
[AGENT][NEUTRAL] That's right. If we maxed out the benefit the first time, it would not be covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, understood.
[AGENT][NEUTRAL] But if you, if I fall down and sprain my right ankle after I sprained my left ankle, right ankle is a different diagnosis. So it would be covered.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that'd be a really bad week. OK, so yeah, that means someone's having a bad week. OK, so um just to make sure I'm understanding, so all it's basically saying is if you go to the hospital and you have to stay overnight that you guys would give a person $500 for that night's stay, so to speak, because it's technically the confinement of 18 hours or more and that would make it the confinement, OK.
[AGENT][NEGATIVE] That would be a bad week.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, always show when unless you're going into um services in a doctor's office, um it services in a doctor's office is not covered, but for these other services, always show your APL card with your primary insurance and the providers can file a claim for you. We can pay them direct so it doesn't have to come out of your pocket.
[CUSTOMER][NEUTRAL] OK, makes sense.
[CUSTOMER][NEUTRAL] Right, this is more.
[AGENT][NEUTRAL] Now, on the flip side of that,
[CUSTOMER][NEUTRAL] OK, you can show.
[AGENT][NEUTRAL] You have had this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Since [PII].
[AGENT][NEUTRAL] So if you were thinking back, you know, see, I went to urgent care last year, you know, yes, you can file a claim for reimbursement for that service because as long as the policy was active, your benefits are covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] And you can go back and pop.
[CUSTOMER][NEUTRAL] And would that be applicable also to any of the other like the outpatient or just the in service?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All of those, any of those benefits, if you realize that you had those services and a claim was not filed, you can submit a claim for reimbursement and there is a claim form on if you're under the claims inform section for [PII] and on the first page it has instructions as to what documents are needed to file a claim, so you would submit that claim form and the requested documents.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's called
[CUSTOMER][NEUTRAL] Meddling
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] [PII] and, and where do I find this again?
[AGENT][NEUTRAL] That would be under the claims and forms section.
[CUSTOMER][NEUTRAL] Or is that
[CUSTOMER][POSITIVE] Oh, claims and forms. OK, got it. I'm making notes because I will forget everything. OK, yeah, because I, what, oh no, what I, what I like is you're explaining it so at least when I hang up I'm gonna, um, because I do, now what I wanna make sure I'm understanding also now the cool thing is is that if my coverage basically I didn't have any out of pocket issues then I don't need to worry because that means we don't use this but if I had to pay.
[AGENT][POSITIVE] Well you can call us again. We'll be happy to help you.
[CUSTOMER][NEUTRAL] A deductible that's when this kicks in to reimburse me for that deductible, so to speak.
[AGENT][POSITIVE] Exactly, exactly. Co-pay or deductible or co-insurance as well.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, OK, so deductible, meaning if your insurance just didn't cover it and you had any out of pocket, you know.
[AGENT][NEUTRAL] That's right. As long as it is applied to a deductible or co-insurance.
[CUSTOMER][NEUTRAL] Coverage, OK.
[AGENT][NEUTRAL] You know, like the the beginning of the year, you have to meet your deductible or, you know, if you have a lot of services or at the end of the year if you haven't met it. So that's what this policy is designed to assist with that.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And what is
[CUSTOMER][NEUTRAL] OK, what is coinsurance again?
[AGENT][NEUTRAL] And co-insurance is sometimes when you meet your deductible, but you have a co-insurance like a 20% that you have to pay, it's not a co-pay for an office visit, but a lot of times for outpatient services or inpatient hospital, depends on your primary policy. Yeah.
[CUSTOMER][NEUTRAL] What is coinsurance?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I
[CUSTOMER][NEUTRAL] OK, that makes sense.
[CUSTOMER][NEUTRAL] No, but that makes sense because now I know that that's when you guys kick in on that 20%, so OK.
[CUSTOMER][POSITIVE] That makes sense. I, I understand it. I should have listened in the past, but I didn't. The good thing is I've had fairly good health, but you know life happens and I'm gonna wanna know this, so I'm gonna, um, I like that you guys have the, the writers and the explanations under the outpatient benefits plan definitions that's really good [PII]uff to have that I can um resource so good, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey, every little bit counts. It's a gas, uh, a tank of gas, and it, it, things keep rising each day, it's becoming more crucial to know what your insurance means.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] It is, it is, and
[CUSTOMER][NEUTRAL] Why you have it.
[AGENT][POSITIVE] And you know, any time along the way, if you have any questions or concerns or just, you know, you don't remember something, you just pick up that phone and call us because we're here to help you any way we can.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][POSITIVE] I will thank you so so much. I really appreciate the information and I will utilize it and thank you for being so lovely.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Oh, well, it's been my pleasure. You've been lovely to assist. And is there anything else you can think of before you go, if I can help you?
[CUSTOMER][POSITIVE] A lot of fun.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No, ma'am. No, just tell your boss to give you a raise. That's all I can say because there's great, great customer service on your side.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, well, I appreciate that and thank you so much, Ms. [PII]. I hope you have a wonderful day and a happy weekend.
[CUSTOMER][POSITIVE] Alright my dear, thank you so much.
[CUSTOMER][NEUTRAL] And what was your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] What was the
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Thank you, Miss.
[CUSTOMER][POSITIVE] I didn't want to say thank you and not know the name, you know. Thank you, [PII]. I appreciate it. All right, my dear. Have a good day. OK, honey. Take care. Bye-bye.
[AGENT][POSITIVE] Oh well, it's been my pleasure. May my day. Thank you, Ms. [PII]. You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Like