AccountId: 011433970860
ContactId: 896140b7-d1af-446f-9d59-f2494943fa36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713109 ms
Total Talk Time (AGENT): 312886 ms
Total Talk Time (CUSTOMER): 254618 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/896140b7-d1af-446f-9d59-f2494943fa36_20250407T19:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, um, I was recently hospitalized and, um,
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] Wanted to find out about my gap insurance and how to um have that be used towards the bill.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I can help you with that. Do you have a good policy number?
[CUSTOMER][NEUTRAL] Uh, let me get it here real quick.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Let's see.
[CUSTOMER][NEUTRAL] Uh, for in hospitals benefit.
[CUSTOMER][NEUTRAL] Certificate number.
[CUSTOMER][NEUTRAL] I have 2406268 ML 7.
[AGENT][NEUTRAL] OK. And can I get your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And just need a few pieces of information. What is your birth date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] Um, I have, I've recently moved and I don't know if my address got changed. So, um, probably my, uh, address is
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] If that's not it, it would be [PII].
[AGENT][NEUTRAL] OK, is
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Which one is the correct one?
[CUSTOMER][NEUTRAL] [PII] is where I am now.
[AGENT][NEUTRAL] OK, so we need to get that changed.
[AGENT][NEUTRAL] Um, what about your email address?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's update your address real quick, um.
[AGENT][NEUTRAL] OK, will you give me your new address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how do you spell that?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Next word is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I just want to repeat it back to you. [PII], and that's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] That is
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um, you were wanting, I'm sorry, did you say benefits for your policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's look at your benefits.
[AGENT][NEUTRAL] And that was for inpatient hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm pulling up your policy and this is not a guarantee of payment. It's just a basic outline of your policy.
[AGENT][NEUTRAL] Let's see what we have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for your inpatient hospital benefit, you have a $3000 per covered person per calendar year benefit.
[AGENT][NEUTRAL] And so, basically, after your primary insurance processes the claim, whatever patient responsibility is left over, we would potentially pay up to $3000 of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, can I, I've recently been in the hospital, and I did give them this card when I was admitted into the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I'm not sure how I apply for that benefit.
[AGENT][NEUTRAL] So, um, you might clarify with them, are they gonna file the claims for you because the first, if they, if they have your card, I, I assume they'll file for you, but I, I'm not sure so you'd want to double check so because they have to submit to us and we would need the same thing from you if you chose to submit it. We need the actual claim and then we need the primary explanation of benefits from whoever your primary insurance is to show how it processed.
[CUSTOMER][NEUTRAL] OK. So, I have a feeling they're not going to do it, that the hospital is not going to do that. So I would have to do that. So, um, if you can explain one more time what you need from me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. So, you'll want to get a claim from the hospital. So it's called, for your hospital claim, it's called a UB, so that's U as in umbrella, B as in boy, 04. It's a UBO4 claim. That's gonna give us all the information you need, and then also, who is your primary insurance through, like your major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Aetna.
[AGENT][NEUTRAL] OK, so then you will want your explanation of benefits from Aetna showing how they process the claim for your hospital stay. So we need those two pieces of information.
[CUSTOMER][NEUTRAL] Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So the, um, the hospital's gonna have the UB 04.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then the explanation of benefits is gonna come from the insurance company.
[AGENT][NEUTRAL] That is correct. And have you set up your online account on our online portal?
[CUSTOMER][NEGATIVE] I don't believe so. It's possible, but I don't believe I did.
[AGENT][NEUTRAL] OK, that's, that's usually if you're interested, that is the easiest way to, you can upload the information we just discussed, fill out the claim form, um, to, to get reimbursed, and then, um, you know, that's the easiest way to really submit these things otherwise you'd have to mail it in or you can fax it in to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the email or the um website for that?
[AGENT][POSITIVE] So the website is secured.
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] Or secured, I'm sorry, secured. [PII].
[CUSTOMER][POSITIVE] Secured.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And if you like, um, I can send you the, I can email you that website and then the user guide on how to set everything up or if you, if you have time we can walk through it together.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh that would be great.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you wanna do it right now or do you want?
[CUSTOMER][NEUTRAL] You know what,
[CUSTOMER][NEUTRAL] If you don't mind.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] You know what, I, I have COVID, so I'm a little less than 100% right now. Um, so let me see.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's on speakerphone. Now, I would have to do this on my phone. Does that work OK for you?
[AGENT][NEUTRAL] Um, you cannot do it on your phone. It does have to be a laptop or a desktop.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] Well, I'm gonna have to uh use my other computer then, unfortunately.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I don't have.
[CUSTOMER][NEUTRAL] I, um
[CUSTOMER][NEUTRAL] Yeah, I can't because I have COVID, I can't go where my uh computer is right now, so.
[AGENT][NEUTRAL] OK, OK. Um, do you want me to go ahead and email you the website and then those instructions for when you can, um, go to your computer?
[CUSTOMER][POSITIVE] Yes, that'd be great.
[AGENT][NEUTRAL] OK, I'll do that so when you get ready um look through those and then if you have any questions of course please don't hesitate to call us back because we'll walk we can walk you through it so, um, and just unfortunately it has to be done from a computer like a laptop or a desktop.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, also, I have been, um,
[CUSTOMER][NEUTRAL] I stepped down in care to now it's uh like an outpatient, it's partial hospitalization. Um, is, um, can that be included in with this? Or is that a different claim, or how do I go about that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it depends on how they bill it. Um, you do have a separate outpatient benefit.
[AGENT][NEUTRAL] Um, so which is uh 1500 per calendar year, so it, it is gonna depend on on how they build the claims. If they lump it all together, it would just be under that 3000, um, if they bill it separately on separate dates, you could potentially have access to both benefits. So it just depends it depends on how it's billed and then how Aetna processes the claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Let's see, if I've met my deductible.
[CUSTOMER][NEUTRAL] Um, then this will not, uh,
[CUSTOMER][NEUTRAL] If I understand it.
[CUSTOMER][NEUTRAL] I won't need the insurance anymore if I've met my deductible. Is that how this works?
[AGENT][NEUTRAL] Well, you'll have, so this will pick up deductible and co-insurance potentially. So if you've met your deductible through Aetna, let's just, for example, say it's $1000 and then Aetna pays 80% of the bill, that 20% that's left over, this could potentially be picked up by this plan. So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, it does, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Well, I'll um keep an eye out for the, um, the email, and we'll go from there.
[AGENT][POSITIVE] OK, Ms. [PII], I'll get that sent over to you um in just a few moments and then please don't hesitate to call back if we can help with anything else.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you get to feeling better.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] All right. Bye.