AccountId: 011433970860
ContactId: 876e2a93-587e-4f5b-99aa-3fdef77dca48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444399 ms
Total Talk Time (AGENT): 175728 ms
Total Talk Time (CUSTOMER): 180919 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/876e2a93-587e-4f5b-99aa-3fdef77dca48_20250409T21:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, um, I'm calling because I was charged a co-payment at an institution and they instructed me to call you back and figure out, uh.
[CUSTOMER][NEGATIVE] Why they charged me a copayment.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Yep. It is 026.
[CUSTOMER][NEUTRAL] 10045.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. Can I get your name and your date of birth?
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][NEUTRAL] OK, and do you have a good callback number just in case I, the call drops?
[CUSTOMER][NEUTRAL] Uh, you can call me back at this number.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I just need to verify a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And is this a claim for yourself or a service for yourself?
[CUSTOMER][NEUTRAL] No, this is for my uh spouse.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK. And what type of service was she getting?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that, please?
[AGENT][NEUTRAL] Um, was she going to the hospital or what kind of services was she going to receive? Or are we checking on a claim?
[CUSTOMER][NEUTRAL] I she
[CUSTOMER][NEUTRAL] Yeah, she, uh, she went to a hospital for a, for an appointment.
[CUSTOMER][NEUTRAL] With a specialist.
[AGENT][NEUTRAL] So was it like a doctor's office visit?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, a doctor's office. We, uh, we gave them the uh insurance information and everything, and they told me that they had called uh the insurance provider, in case, in this case APL and someone told them, hey, uh, we are covering everything but the co-payment.
[CUSTOMER][NEUTRAL] I, I don't know why.
[AGENT][NEUTRAL] OK, let me pull up your plan. Um, and anything I quote today is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Um, OK, so it looks like for your, the plan that you're on, after your primary insurance, your major medical processes a claim, will potentially pick up 5500 per covered person for outpatient services. Now, outpatient services will be what what's defined as outpatient, let me look what that is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] So it, it does not include an actual office visit. It does include a a lot of different things, but the actual office visit is not included. It would include, like, for instance,
[AGENT][NEUTRAL] If you got um surgery in the doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you got diagnostic testing in the physician's office, um, but the office visit itself is not covered under the benefit.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um, so she was right when she told me that uh the insurance provider is, does not include, I mean, does not pay for the, um, co-payment, right?
[AGENT][NEUTRAL] Yes, that's correct. Um, but like I said, any like treatment or procedures performed in the doctor's office are covered under that benefit, just not the actual office visit charge with the co-pay.
[CUSTOMER][NEUTRAL] Mm, OK. And can I ask you, where can I find this information? I mean, is there in a PDF form? Is there a website that I can go to and read through these policies?
[AGENT][NEUTRAL] Yes, there is. Um, it's secured. [PII].
[AGENT][NEUTRAL] And I can email you um the user guide to set up your account if you'd like.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] I already have it set.
[AGENT][NEUTRAL] Oh you do? OK, OK, so yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, uh, just a couple of minutes ago I, um, I set my account on the website, but I couldn't find a, you know, the information that you are reading for me to read it thoroughly and get an understanding of this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there should be.
[CUSTOMER][NEUTRAL] Yeah, you see on the website.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Um, there should be your policy certificate. So did you did create your account with your name that you log in and all of that?
[CUSTOMER][NEUTRAL] Mhm, yep.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Yeah, you should be able to see your policy certificate, um.
[CUSTOMER][NEUTRAL] Uh, I'm, I'm sorry, I.
[AGENT][NEUTRAL] The PDF document.
[CUSTOMER][NEUTRAL] I, I cannot. I see.
[CUSTOMER][NEUTRAL] Uh, the only document that I see is a help document which indicates how to create and log into your account. The other one is policy info, notification preferences, payment preferences, contact us.
[CUSTOMER][NEUTRAL] Claim forms and that's it.
[AGENT][NEUTRAL] OK, um, let's see.
[AGENT][NEUTRAL] That's strange. Let's look, um.
[AGENT][NEUTRAL] Oh, that's strange. I don't know why it would not be in there. Um.
[AGENT][NEUTRAL] I can email it to you. Want me to do that?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Oh please, I would really appreciate that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, OK, give me just a few minutes. I'll get this emailed over to you and if you have any questions once you look through it, please don't hesitate to give us a call back, OK?
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][POSITIVE] OK. Thanks so much.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good evening.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][NEUTRAL] I