AccountId: 011433970860
ContactId: 87c5c413-3fa9-4d8d-bec6-f11fc1637820
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661570 ms
Total Talk Time (AGENT): 315163 ms
Total Talk Time (CUSTOMER): 233332 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/87c5c413-3fa9-4d8d-bec6-f11fc1637820_20250103T17:59_UTC.wav
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[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. Um, I was, uh, I have a few questions. Um, so, um,
[CUSTOMER][NEUTRAL] I, I wanted to know whether my service, um, I mean my uh policy covers, um,
[CUSTOMER][NEUTRAL] The gyne that I want to see um and she practiced at um Prisma Health.
[AGENT][NEUTRAL] OK, do you have your policy number and I can pull it up and take a look at it with you?
[CUSTOMER][NEUTRAL] Um, yes, um, so the policy number, um, is 02.
[CUSTOMER][NEUTRAL] 54
[CUSTOMER][NEUTRAL] 1838
[AGENT][NEUTRAL] You said 1838?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK perfect and.
[AGENT][NEUTRAL] All right. And then Miss [PII], could you verify for me your last name and your date of birth, please?
[CUSTOMER][NEUTRAL] Um, yes, my last name is [PII] and my date of birth is [PII].
[AGENT][POSITIVE] Wonderful, and I do just need to verify with you a few other pieces if you could verify for me your email or I'm sorry, your mailing address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][POSITIVE] Perfect. And then if you could verify for me the phone number on file.
[CUSTOMER][NEUTRAL] And the phone number would be my husband's which is um [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII], hold on.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[AGENT][NEUTRAL] Alrighty and then by any chance would you know the email address on file as well?
[CUSTOMER][NEUTRAL] Yeah, uh-huh, it's um [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much for going ahead and doing that with me. And I'm looking at your policy right now. The policy you have with us is gonna be a supplemental um policy and so it is, it doesn't have a network, you can use it, um.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] With any provider.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But I'm so confused because he did this insurance thing me and um uh so like there's APL, it's like a supplemental. What does that mean?
[AGENT][NEUTRAL] Yeah, absolutely. So we're not a major medical, um, so we don't offer major medical insurance. Um, we offer supplemental insurance, which is, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Depending on how you use it, it's just meant to be used to like supplement or help with costs um so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but can I just use it like itself?
[AGENT][NEUTRAL] I guess I like I
[AGENT][NEUTRAL] Yeah, it doesn't have to be used with any other insurance. It can be used on its own, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then as far as the benefits go, let me see if I have that.
[AGENT][NEUTRAL] Loaded, 1 2nd.
[AGENT][NEUTRAL] So it looks like you have a couple different coverage options. Um, the policy has um benefits daily if you're confined to a hospital and benefits daily if you're in an ICU, um, but you also have some benefits to help with diagnostic testing, um, and
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It looks like you have a maximum benefit of.
[AGENT][NEUTRAL] $250 for diagnostic wellness and testing.
[AGENT][NEUTRAL] And then if you become hospitalized,
[AGENT][NEUTRAL] In at any point in the calendar year, you have an annual first incurrence. Um, you also have something to help if you're sick for outpatient visits, um, and it's up to $75 a person, up to, it looks like 10 visits for all combined people. Um, and that's up to $75 for outpatient sickness. And then if you're in a position where you need surgical or anesthesia, you also have a surgical benefit and an anesthesia benefit on there as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. How about like for guy now?
[AGENT][NEUTRAL] For, I'm so sorry, did you say g gynecology?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Um, so unless you're going in for sickness, I'm not sure if it would cover the outpatient sickness. Um, if you do need any wellness exams or tests done, um, it does look like that you'd have the benefit there. If it's a wellness exam or test, it's up to $75. And if it's a diagnostic to diagnose, like if there's an issue, it's up to $250. Um, and so you could receive those benefits from that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Like would blood work count as like a wellness or diagnostic, do you know?
[AGENT][NEUTRAL] Um, I think it depends on the reason why they're doing it. If it's like routine blood work that you get like every 5 to 7 years, it would probably be considered wellness. Um, and if there's something wrong and they're trying to figure out what it is, it might be considered diagnostic. So I really think it's how they code it when they file the claim. Um, and I'm not, I wouldn't be able to know until it came like they submitted the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, also, like I had a question, so, uh, um,
[CUSTOMER][NEUTRAL] I was trying to go on my charts for [PII] and entering the insurance like for APL and it asked for uh like group number or something. So is the medical ID the group number?
[AGENT][NEUTRAL] So the group number is going to be on.
[AGENT][NEUTRAL] I don't know if it'll say it on your card, but it should, but it should be 70056.
[CUSTOMER][NEUTRAL] Um, could you repeat that again because it doesn't say that on here, it only says management analysis and utilization.
[AGENT][NEUTRAL] Oh, you betcha. So the number is 70056.
[CUSTOMER][NEUTRAL] 70056.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And then the um what was the other thing?
[CUSTOMER][NEUTRAL] And that I will, uh, can you just give me a second. I have another question, um.
[CUSTOMER][NEUTRAL] And then the medical, um, I mean the member number would be the medical ID, right?
[AGENT][NEUTRAL] Um, so you actually that medical ID that starts with D is going to be your member number for multi-plan, um, but with us it's going to be the one that says policy slash cert number and it's the 025.
[CUSTOMER][NEUTRAL] OK, so for the member ID it would be um.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] The one that starts with 025.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then two things I want to make note of for you. Uh, the first one, I do want to just let you know that any benefit information we give you over the phone is just verification of coverage and never a guarantee of payment. But the other thing I wanted to mention is that this policy is partnered with Multiplan and some some providers won't, um.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] If they're partnered with multi plan, you have to like ask them for a discount, but if your provider is partnered with multi plan you're on multi plan and they should be giving you a discount. So sometimes you have to ask for it and just be like, Hey, are you a multi plan provider? Can I get my multi plan discount? Um, but I would just make sure to like mention that when you go places and see if that's something that can help you with uh reduce those out of pocket costs.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, because I have like my charts open on the site here and it says multi-plan slash PHCS contracted. Is that what you're talking about here?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um, so like the medical ID that says there that that's a D437, that would be the member number for um multi-plan.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Oh, OK. Um, that was my only question. Um, also, do you think you could like, um, cause this is like it doesn't say here on the card and like I was just sitting here trying to figure it out using CBT that like you could like um send this over email if it's possible.
[AGENT][NEUTRAL] Um, like, a picture of your card over email or?
[CUSTOMER][NEUTRAL] 00, no, not the picture.
[AGENT][NEUTRAL] I guess I'm sorry, what are you?
[CUSTOMER][NEUTRAL] Um, like how, like, um, the medical ID is like for a multi-plan and like um the group um number that's start with [PII]. Um, that's like, that's the group number and like what was the other thing? Uh, for the member number, member ID number, that's gonna be the 02541883, right?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Oh no, wait, I got it. I pull it.
[CUSTOMER][NEUTRAL] Oh yeah, if you could send it over so like my husband can also have it for his record.
[AGENT][POSITIVE] Yeah, I can definitely do that for you today. No worries. Let me get an email going.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And is there anything else I will be able to help you with today, my friend?
[CUSTOMER][NEUTRAL] Um, no, that was it.
[AGENT][POSITIVE] Perfect I will get that email going in the meantime and then if there's anything else you need, don't hesitate to just give us a call and reach on out and we'll do our best to take care of you OK?
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Yes, my pleasure. Thank you so much for giving us a call and I hope you have a fabulous day.
[CUSTOMER][POSITIVE] Thank you. You as well. Bye.
[AGENT][POSITIVE] Thanks. Bye-bye.