AccountId: 011433970860
ContactId: 769533fb-20de-4f4e-a1c4-b837a2a97545
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594969 ms
Total Talk Time (AGENT): 316017 ms
Total Talk Time (CUSTOMER): 120633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/769533fb-20de-4f4e-a1c4-b837a2a97545_20250603T19:58_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am trying to locate my plan to make sure that it is that it is active. Is that something you can help me with?
[AGENT][NEUTRAL] OK, so you're wanting to verify if you do have an active policy with APL is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] Yes, this is [PII].
[AGENT][POSITIVE] Thank you and Ms. [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your uh do you have your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't. I have, I can give you my social.
[AGENT][NEUTRAL] OK. That'll be fine.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, thank you one moment while I try and locate your information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that you gave me, the [PII], is that the best number that we should have on file for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And I do need to add an email address for you, Ms. [PII]. What email would you like to have on file?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's my [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that is [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, perfect, yep.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so Ms. [PII], I do see that you do have an active policy with APL, um, the policy that you currently have.
[AGENT][NEUTRAL] Just went into effect on [PII] and I can give you that policy number and then I can also give you the website that you would go to Ms. [PII] to set up your profile in our portal and once you set up your profile that will give you access to your ID cards, policy information you'll be able to see claims that we receive on this policy and also if you ever have to file your own claim with us, you can actually upload all of your information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would be needed directly into your portal for review.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And you'll see your policy number in there as well, but it is 02.
[AGENT][NEUTRAL] 61.
[AGENT][NEUTRAL] 984 9.
[CUSTOMER][POSITIVE] OK, perfect, excellent and then just to understand it's this is for it's like gap coverage so up to 4, 4000.
[CUSTOMER][NEUTRAL] For the deductible, is that correct?
[AGENT][NEUTRAL] OK, so this is a supplemental policy that helps you with your co-pays and deductibles and co-insurance amounts of covered services. So yes, you have an inpatient benefit maximum per calendar year of 4000, and you have an outpatient benefit maximum for covered outpatient services also of 4000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on the
[AGENT][NEUTRAL] On the outpatient part of it though, now office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you were to receive, yes, if you were to receive some, for example, hypothetically, you went to the doctor, you had cut your finger. OK? We'll just use that as an example. And they charged you an office visit. Well, we couldn't
[CUSTOMER][NEUTRAL] I was just gonna ask because I saw.
[AGENT][NEUTRAL] The office visit portion would not be covered under this policy, but we could review the treatment, you know, if they stitched your fingers, so we could review your treatment that's rendered in the office, just not the visit itself. Does that make sense?
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] It does. So in the case of like obstetric care, so, you know, you're pregnant and then you're going for your routine visits, those appointments are not covered.
[AGENT][MIXED] That's not covered. That is correct. But hypothetically.
[CUSTOMER][NEUTRAL] Yeah, but then the delivery and patient.
[AGENT][NEUTRAL] Right. Or if you had, say, an ultrasound done at the office, in an office setting, you know, we could review that, but just not the visit charge.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So should I be submitting all of my I guess.
[AGENT][NEUTRAL] The best, what I suggest is that you present your APL card along with your primary healthcare insurance card when you go for medical services.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because most providers will file both of your insurances. So you, the way this works is it has to be filed with your primary insurance first, OK? And then with APL since this policy is looking at your deductibles, co-pays, and co-insurance amounts of coverage services, we will always have to have a copy of the primary insurance company's explanation of benefits. That's one of the required documents.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's, it's easier if the providers will file it, and most will but in the event that they don't, you could call us, we do have a specific claim form, you know, and we could get you all of that information that you would need to file your own claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][POSITIVE] Wonderful and then I, I just have not gotten a card yet. um, is that something that you can just request be sent to me?
[AGENT][NEUTRAL] And that is
[AGENT][NEUTRAL] I can actually let me, give me just a moment and I'll see when one was sent out to you. You may just not have had enough time yet to receive it, but let me check that.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, so on here.
[AGENT][NEUTRAL] OK, so the cards were mailed to that address on [PII].
[CUSTOMER][NEUTRAL] Oh weird.
[CUSTOMER][NEGATIVE] Yeah, I have not received them.
[AGENT][NEUTRAL] And it would have
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] Are you able to like cancel that card and?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that, no, ma'am. I mean, it's, it was mailed out and it was mailed to that address. So I have ordered more cards to be mailed. It does take about 10 business days at least to receive those. But in the meantime, you can go to our portal web page again and set up your profile, and you should be able to go ahead and have access to those. And the website that you would go to to set that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh awesome.
[AGENT][POSITIVE] I secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] I think I'm on it actually.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, awesome.
[AGENT][NEUTRAL] Mhm. And you would just do the.
[CUSTOMER][NEUTRAL] And I would click under insured.
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][POSITIVE] OK, wonderful. I'm there. Thank you so much for your help.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. Is there anything else that I can help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] No, that is it. Thank you. Have a good day.
[AGENT][POSITIVE] OK. Well, you're welcome. Yes, ma'am. You too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Bye-bye.