AccountId: 011433970860
ContactId: 7a72cd5c-8f72-4abf-9fe1-d79b22f623c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410070 ms
Total Talk Time (AGENT): 190258 ms
Total Talk Time (CUSTOMER): 190402 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/7a72cd5c-8f72-4abf-9fe1-d79b22f623c6_20250307T18:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. Um, it's on my card is [PII], which is my middle name. Um, I'm, I'm calling.
[AGENT][NEUTRAL] So sorry. I heard, oh, I'm so sorry, but I heard your first name was [PII], but I wasn't able to understand.
[AGENT][NEUTRAL] After that,
[CUSTOMER][NEUTRAL] And my last name [PII] [PII]
[AGENT][POSITIVE] OK, Ms. Lawyer, thank you. And what's the good go ahead and give me a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you and how can I help you today, Miss [PII]?
[CUSTOMER][NEUTRAL] Hi. Um, I have the, um, APL insurance as my gap insurance and the Center, Centera insurance, my primary insurance. Um, a couple of weeks ago, my, my primary care doctor sent me for a CT scan in my abdomen and um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I just got a um adverse benefit determination for that from them. And my question is, I guess, will my gap insurance cover it if my regular insurance didn't cover it or no?
[AGENT][NEUTRAL] OK, Ms. So you, so you have a benefits question regarding your coverage that you have with APL?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that correct? Yes, ma'am. OK, well I can help you with that. First I will need to pull up your policy information and verify some things with you for security. So first off, um, do you have your policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, 02440107.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] OK, Ms. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number you gave me, the [PII]. That is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, it's my cell phone.
[AGENT][NEUTRAL] OK, thank you. Alright, and then the last piece of information to verify with me would be your email address and this does appear to be your work email that is on file.
[CUSTOMER][NEUTRAL] My work email? Oh, I thought it was my alley. OK, my work email is [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] OK, Ms. [PII], so this policy is a supplemental policy to your primary healthcare insurance, but if it is not covered by your primary, it would not be covered by APL.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] See, I thought when, cause she sent me over there cause I was having such bad pains in my stomach, she sent me over for a CT scan and um
[CUSTOMER][NEUTRAL] They said because they didn't, they sent me to um.
[CUSTOMER][NEUTRAL] The Lakeview place to have it done. Um
[CUSTOMER][NEUTRAL] Without waiting because they said it could take, you know, a while to get an approval or whatever from Santera that they, and she wanted it done right away. um.
[CUSTOMER][NEUTRAL] That they may not cover it, and, but they were covering it because they didn't think it, it, they said it was not medically necessary.
[CUSTOMER][NEUTRAL] So, um, and I thought, well, um, I, I thought maybe if, if they said they wouldn't cover it because Center, you know, didn't get like an authorization or whatever not because it wasn't medically necessary, then I thought the gap insurance would pick it up, but I guess I'm wrong, so it has to be.
[AGENT][NEUTRAL] No, ma'am, this policy, yes, ma'am, this policy is designed to help with co-pays, deductibles, and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] So, yes, ma'am. If it's not covered by your primary, it would not, there would not be any benefits on this plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] All right. Well, that's unfortunate. So now I got to call them and I, I took the thing up to my doctor and she was surprised and she's gonna um
[CUSTOMER][NEUTRAL] Um, contested or, you know, ask for an appeal on her end. So let me, let me call some [PII] and go from that end and and see what I can do to.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, so,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now if, if it ends up being approved by your primary insurance company, Ms. [PII], the claim can still be filed with APL at that point.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes ma'am. And then I am going to, I am also going to email you a user guide for our portal where you can set up your profile so that you can have access to your ID cards, policy information and also the claims information that we have for you with APO uh online and that email that I will send to you is going to come from [PII].
[CUSTOMER][NEUTRAL] All righty. Well,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will put APL in the subject line for you and I will be sending it to your email address that we verified.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] With each other.
[CUSTOMER][NEUTRAL] All right. So I'll get it, I'll get it on Monday when I go back to work. So, um.
[CUSTOMER][NEUTRAL] Yeah, because I'm, I'm, I've already got a link as the benefits administrator to APL, but I don't think that as through that portal I can accept, so I have to do different.
[AGENT][NEUTRAL] No, well, no, that would be right if you're the group administrator, then that is a different level of approval that you know that what I'm going to send you is for your own personal portal. I mean it's the same portal but this gives you access to your personal information, whereas the administrator side does not do that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, I, I appreciate it. You have a good weekend. Thank you for your help.
[AGENT][POSITIVE] Well, yes, uh, you're very welcome. So if that is all I can help you with, and thank you again for calling APL and I hope you have a nice weekend also.
[CUSTOMER][POSITIVE] All right, thanks. All right, bye.
[AGENT][POSITIVE] You're welcome. Bye bye.