AccountId: 011433970860
ContactId: 7a6c381b-02ee-4edf-a592-1272c56c1384
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 811270 ms
Total Talk Time (AGENT): 498228 ms
Total Talk Time (CUSTOMER): 380908 ms
Interruptions: 13
Overall Sentiment: AGENT=2.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/7a6c381b-02ee-4edf-a592-1272c56c1384_20250429T21:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon. How are you?
[AGENT][POSITIVE] I am doing well how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, I just found out my husband has this detail insurance for the family, and I'm not sure I understand how to use it if the, if the service I'm going to be having done is covered by it. So I'm hoping you can help me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, we could take a look at those benefits for sure um what was your name please?
[CUSTOMER][NEUTRAL] My name is [PII]. First, that's first name. Last name is [PII] Do you want the uh the number of his on his card?
[AGENT][POSITIVE] Um, yes, please, if you've got that policy number, that'd be great.
[CUSTOMER][NEUTRAL] I do. Hold on one sec. Let's just go back on the screen.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, the ID card says.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you want the group number?
[AGENT][NEUTRAL] Um, you're looking at the card right now?
[CUSTOMER][NEUTRAL] Or the policy or or the benefit card.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you see anything on there that says uh like in hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yes, so this would be outpatient benefiter number.
[AGENT][NEUTRAL] That either one of those, please.
[AGENT][POSITIVE] That's perfectly fine.
[CUSTOMER][NEUTRAL] OK. 024.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's OK. 02417219 M as in Mary L as in lollipop 8.
[AGENT][POSITIVE] OK, and then really quick if you don't mind [PII] can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Absolutely. Area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. And what was your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I appreciate your help today.
[AGENT][NEUTRAL] Yes, definitely, um, I'm just gonna verify some information really quick [PII], can I get your date of birth please?
[CUSTOMER][POSITIVE] Perfect. My date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, um, I, well, let's see.
[AGENT][POSITIVE] Yes, OK, perfect, thank you for verifying all of that. OK, so in short.
[CUSTOMER][NEUTRAL] Um, it hasn't changed, so I'm like, OK.
[AGENT][NEUTRAL] No, no, no, you're fine. I was going to no, I'm sorry, I'm used to talking to the actual policyholder. I was gonna verify the email but it looks like it's his, so that's perfectly fine, um.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I can give you that. It's probably [PII].
[AGENT][POSITIVE] That's it thank you I appreciate it. um, OK, so in short, um.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] There's, our roles are kind of split. I always joke that like, I get all the medical stuff. I'll pay the bills, I'll pay, uh, I will deal with all medical.
[AGENT][POSITIVE] Oh yeah that's the fun stuff to deal with, isn't it?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um, OK, so, uh, in short, this is a secondary medical policy and it is designed to help with co-pay, deductible and co-insurance after major medical pays. So this policy is very dependent on major medical, uh, some people do get kind of confused. This can't be used instead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Amazing.
[CUSTOMER][NEUTRAL] So when you say me me me.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, so when you say major medical, we're talking like my Cigna insurance, correct?
[AGENT][NEUTRAL] Correct, yes, so that that is your major medical. This plan can't be used instead, so if you were to go somewhere, receive treatment and Cigna said they weren't going to pay, then this policy can't, so it's designed to help with what Cigna leaves left over essentially, um, let's take a look here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty and then I'm more than happy as well to answer any questions you have over the phone, but I can also send a copy of this policy to you, um, just so you've got it for your records um it's very easy to read and it does go over, uh, what is and is not covered dollar amounts, frequencies, things like that.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I ask a few questions, even though you're gonna send it to me. You can send it to him. I'll forward it to him.
[AGENT][NEUTRAL] You want me to send it to um.
[AGENT][POSITIVE] Oh, absolutely.
[AGENT][NEUTRAL] OK, yeah, I'll send it to that email. Yes, what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEGATIVE] My son needs an MRI. And apparently, when you go to set up an MRI if you have insurance, you can't pay cash because the cash price is like a joke versus they're charging you $425.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I've heard, yes.
[CUSTOMER][NEUTRAL] Which is just like, I'm like, well, what if I don't want to use my insurance? You're like, well, we don't have a choice. I'm thinking, hm, maybe we don't use you. But then I was talking to someone and said, hey, I think you have APL and, and so I'm like, I don't know what that is. So I called my broker, my broker said, yes, you indeed have this. So, would an MRI be covered if he, if it was costing me $425 and what do I do with that information?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But again Cigna is going to contribute to some of that correct?
[CUSTOMER][NEUTRAL] No, that would be my portion of signing.
[AGENT][NEUTRAL] Oh, after, after Cigna, I understand. OK, sorry about the confusion. OK, so.
[CUSTOMER][NEUTRAL] Correct. So I have the approved, I have the right. So Cigna has approved the service, but apparently the first whatever dollar amount goes towards the deductible and it's $425.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and that's exactly what this policy is supposed to help with um OK so not to add to the confusion and I apologize for the way that this the outpatient benefits work, um, is it depends on the facility so where the MRI would be taking place so for example uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK. No, no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It specifically mentions diagnostic testing performed in an outpatient or excuse me, an outpatient hospital, um, facility or an actual, you know, magnetic resonance imaging facility, so an MRI facility. Do you know where this would be taking place?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is uh, yes, it's gonna be at Reyes, R A Y U S and I believe it's a freestanding facility.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, yes, so as long as it's in an actual hospital outpatient facility or an a designated MRI, uh, facility, then that is definitely going to be covered, um, so treatment received in emergency room or urgent care. Yes, and that is specifically what it states. So your outpatient benefit, it pays on a per calendar day basis, so there's no yearly maximum. There is simply a daily maximum, and that daily maximum is $500.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, could you say that one more, you say that one more time for me? I'm so sorry.
[AGENT][MIXED] Sure, no, you're fine. It's confusing, trust me.
[AGENT][NEUTRAL] So there's no yearly maximum for the outpatient benefit. It pays, um, it's a daily maximum of $500 per calendar day and again that's towards co-pay deductible coinsurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK, great.
[CUSTOMER][NEUTRAL] So if God forbid something else happened, I could use it again.
[AGENT][NEUTRAL] Yes, oh, daily, absolutely. So the thing that I would like to, you know, if he went and had this and he was sent somewhere else immediately after, um, it would all still go towards that $500. However, if he waited till the next day, you would have that $500 replenished.
[CUSTOMER][NEGATIVE] Which we don't want to do all this.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Amazing. This is a great policy. OK.
[AGENT][NEUTRAL] It's, yeah.
[CUSTOMER][POSITIVE] I had never heard of this and I'm so glad I had called my broker to say, hey, by the way.
[AGENT][NEUTRAL] It's different and yeah and all of them are very different so for example this policy doesn't cover any sort of treatment received in like a physician's office environment so nothing like that would be covered um this seems to be more around you know emergency room urgent care, um, there's physical therapy benefits, um, things like that.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure. So that's physical therapy, it doesn't do physical therapy?
[AGENT][NEUTRAL] Yes, uh, physical therapy performed in a physical therapy facility, um, is definitely covered under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK. That is really good to know. I had no idea. OK. Um, so,
[AGENT][NEUTRAL] Absolutely and as this policy has been effective since [PII], um, so if you've had anything, well, let me make sure that's for everyone. I know that's for.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] Love, let me make sure that's effective for everyone.
[CUSTOMER][NEUTRAL] So this is actually for uh [PII] that I'm not looking for.
[AGENT][NEUTRAL] [PII], OK, yes, so everyone was effective then, um, except your effective date was uh [PII], so anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yep.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yup, no, no, that's fine. I know about that.
[AGENT][NEUTRAL] Yes, yes, so, yeah, for sure, just so that you're aware, but um there's no timely filing limit so if there was anything in the past that you or anyone else covered under this policy, uh, received, you can file those claims still to get reimbursement.
[CUSTOMER][POSITIVE] OK. This is really phenomenal. OK. Can I ask another question? Um, the, the emergency room, because, of course, you know, we had a very busy month this month. I takes over to the emergency room too. So that's covered under this as well, correct? OK.
[AGENT][POSITIVE] Absolutely, absolutely.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, treatment received in hospital emergency room and treatment received in urgent care facility, yes.
[CUSTOMER][POSITIVE] Terrific. And it's per person, the $500 on a daily limit.
[AGENT][NEUTRAL] That is correct, yes, um, and now I don't know, I know you said it was a busy month, hopefully it wasn't this bad, um, but inpatient benefits do work differently than outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, we've been to the emergency room. We've been, I was gonna say we've been to the emergency room. We've been to urgent care and now we're going to get an MRI. So, you know.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Got you, yes, so like inpatient would be different than outpatient and all that means is, you know, general rule of thumb is if someone had to stay longer than a day, um, hospitalized then that would be considered inpatient and that benefit is on a per calendar year basis uh that benefit is $2500 per calendar year and again, yes, that's going to be per um per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Amazing, amazing, amazing. I'm so glad I called you guys for clarification. Um, OK, so let me ask you a question. Do I give them this card when I apply, or do I, or, or do they give me a receipt and then I have to do it?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So unfortunately it really does depend each provider, every facility they're all different. So some of them I would always say going forward anywhere you or anyone else goes for medical treatment of any kind, give them this card as well as your Cigna, um, just and just explain it's a secondary medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Some providers really just don't like messing with secondary medical or supplemental insurance at all and if that's the case y'all can still file the claim yourself um we do have an online portal um I would say that's gonna be the quickest and easiest way to get claim information to us is through our online portal um in the email I'll that I send for this policy, I'll include a link to that as well.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and to set that up you would just use all of the information that you just verified including that same email address.
[CUSTOMER][POSITIVE] Perfect. You've been so helpful today and it's really like taking a huge stress off my life.
[AGENT][POSITIVE] Oh, look, this is really confusing and I, no, I understand. Yes, and I'm, I'm happy to help with that. I know this is beyond confusing and it's always nice to have with, you know, as expensive as medical treatment can be.
[CUSTOMER][NEUTRAL] Yeah, I mean $400 is just a lot of money.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEGATIVE] But you have to do it and I'm like, I literally I'm like, had I known that it was gonna cost me that much, I wouldn't have told them I had insurance when you could spend $180 without insurance. It's it and that's why, you know, our medical system is messed up, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know that's crazy, isn't it?
[AGENT][NEUTRAL] I know.
[AGENT][POSITIVE] Yeah, it's, it's wild.
[CUSTOMER][POSITIVE] But it's OK. Thank [PII] for insurance.
[AGENT][POSITIVE] Absolutely, yes.
[AGENT][NEUTRAL] All right, well did you have any other questions for me at the moment [PII]? I know that was information overload.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I am good. Thank you. No, this is great. You've been so helpful. I'm so appreciative and thank you.
[AGENT][POSITIVE] I'm good, yes, absolutely, yes, if you'll have any other questions, especially after getting the policy or anything like that, feel free to give us a call back we'll help you out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, terrific. Thank you again so much for your help. Um, you've been great. And let me ask you a question. It would help you, can I share with your boss what great customer service you gave me?
[AGENT][POSITIVE] Alright, you are very welcome. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You can. Um, give me just a moment. I don't know that she's available, but you can.
[AGENT][NEUTRAL] Leave her a voicemail um if you would like to do that.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] I would be happy to do that.
[AGENT][POSITIVE] Well, I appreciate it thank you um I'm just gonna put you on a brief hold and I'll connect um.
[CUSTOMER][POSITIVE] Listen, I know all too, I have to tell you, I know all too well that people just have nothing nice and complain. Sometimes it makes a difference. So thank you so much for your help. You've really like helped me a lot today, so thank you.
[AGENT][POSITIVE] That means the world to me, thank you, yes.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yeah, no that's my pleasure that's why I like this role. I like being able to tell people it's OK. Here's how this works.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][POSITIVE] All [PII]. Well, thank you, Ms. [PII], and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you so much, [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.