AccountId: 011433970860
ContactId: 8d047bdd-f5ff-466a-8ab0-53507ff3cbd5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490140 ms
Total Talk Time (AGENT): 291781 ms
Total Talk Time (CUSTOMER): 177085 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/8d047bdd-f5ff-466a-8ab0-53507ff3cbd5_20250613T13:45_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good morning, [PII]. I'm uh trying to log in and um I'm trying to create a profile and I'm getting an error.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So I was wondering if um you can help me out with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me take a look. Could I get your uh policy number, please?
[CUSTOMER][NEUTRAL] Um, sure, one sec.
[CUSTOMER][NEUTRAL] Sure it's 02455070.
[AGENT][NEUTRAL] OK, if you could verify your name, date of birth, and mailing address please.
[CUSTOMER][NEUTRAL] Uh sure, [PII]. Date of birth [PII], and the address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for that and if you could verify the email address we should have on file for you.
[CUSTOMER][NEUTRAL] Sure. So the email address that, that we should be using for my personal um account would be [PII].
[AGENT][NEUTRAL] OK, so that may be where the problem is. OK, what, uh, go ahead and give me that one more time. So it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] One
[CUSTOMER][NEUTRAL] 022
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Let me repeat that, make sure we have it right. So I have [PII].
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] Yep, that's right.
[AGENT][NEUTRAL] OK, let me update that for you.
[AGENT][NEUTRAL] OK, so now.
[CUSTOMER][NEUTRAL] Yeah, so the thing is that I'm, I'm also the administrator at the company, so, um, I, I have my company address or company email address of the administrator, so I can go in there and I can, I've got that set up, but for my personal, um, it's not allowing me to do that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so now that I have the email address updated.
[AGENT][NEUTRAL] Uh, you shouldn't have a problem, so let's, you know, I can stay on the line with you, go through the steps, and just see if that was the issue.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Anything worked. I, I clicked on the button and now I'm not getting an error.
[AGENT][POSITIVE] OK, so you're good.
[CUSTOMER][NEUTRAL] Yeah, can I ask you another question real quick while I have you?
[AGENT][NEUTRAL] OK. Is there
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Except for the gap insurance, I, I, I tried to use it at my primary care physician in order to pay $20 co-pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, then it got rejected. It is the gap insurance, can I use it for co-pays or is it just for deductibles?
[AGENT][NEUTRAL] Let me check a look. So it, it, you can use it for deductible, co-pay and co-insurance for covered services. So your policy does not cover benefits for
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] The physician office visit co-pay. So it's the physician office visit. If your, if your um balance is only towards the office visit, it would not uh cover the office visit, um, patient responsibility.
[AGENT][NEUTRAL] But let me, let me take a look.
[CUSTOMER][NEUTRAL] So, uh just, just an ordinary physical or just uh a regular visit to the, to my primary care wouldn't be covered?
[AGENT][NEUTRAL] Correct. Now, you do have benefits for treatment in the office. So let's just say you go for your office visit while you're there, they want to do an ultrasound.
[AGENT][NEUTRAL] Um, if the ultrasound has, um, let's let's just say your primary applies the copay to the ultrasound, then your policy would pick up the, uh, co-pay for the ultrasound, whether it be co-pay, deductible, whatever it could be that goes towards the ultrasound. But if any patient responsibility goes towards the office visit, the office visit is not covered.
[CUSTOMER][NEUTRAL] OK. Um, admittedly, that is a little bit confusing.
[AGENT][POSITIVE] No, I'm sorry. I mean, if you have any questions, just, you know, just let me know and I can kinda help you.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] [PII], let, let me, um, would you be so kind? I, I've got my wife here too, and, and I just wanna make sure that we're both on the same page. Would you be so kind? Could you just repeat that for me one more time, please?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No problem. I sure can.
[AGENT][NEUTRAL] So, the policy you have would not cover any expenses applied to the office visit. But if you have other treatment while you're there, it could be an ultrasound, it could be lab work. Let's just say they need to do it in-office uh surgery or some type of procedure. You do have coverage for the procedure or the other treatment. So if patient responsibility is applied to
[AGENT][NEUTRAL] The other treatment you have, you know, your gap insurance will pick that um patient responsibility up. But if it's the office visit co-pay,
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, quick question for you. So like, um, the doctor's office, um, visit co-pay is not included. Um, what about ER visit co-pays? Is that?
[AGENT][NEUTRAL] Yes, ma'am. So your emergency room would be covered under your outpatient benefit. It looks like it pays up to $3000 a calendar year. So under outpatient, what would be covered is the emergency room. If you had to go to urgent care, let's just say your doctor's office has an after-hour care, which is considered urgent care, that is considered outpatient.
[AGENT][NEUTRAL] Um, you have like diagnostic services, [PII], um, you have an outpatient surgery at a surgical center, uh, independent laboratories, like if you have lab work that's sent to like Quest Diagnostic or LabCorp, that is all covered under your outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then one more question um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's speech therapy and like um
[CUSTOMER][NEUTRAL] Just physical therapy, is that covered as well?
[AGENT][NEUTRAL] Yes, ma'am. So I do show that the policy will cover speech therapy and outpatient, I'm sorry, and physical therapy. All those services are covered also under your outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I believe I tried to place my son Emery's speech therapy, um, send over bills for that, and I was told I need the um.
[CUSTOMER][NEUTRAL] Is that EBO EOBs, but I'm not sure. Do I get that from my primary insurance or do I get that? OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yeah, so like when you go to the doctor, you normally receive either by mail or if you have a portal set up, you'll get a notification. We've received the claim for you. This is not a bill. Um, it'll say something like, this is what we pay, this is what you owe, and it'll show what you owe, and if it's applied to your deductible, co-pay or co-insurance. We need that um statement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Since so we know what, you know, the amount that we're, we're covering based on your primary insurance.
[CUSTOMER][NEUTRAL] OK, OK, got it.
[AGENT][POSITIVE] OK, is there no problem. Is there anything else I can help you guys with?
[CUSTOMER][POSITIVE] Thank you so much I appreciate it.
[CUSTOMER][POSITIVE] No, I think that was it. Thank you so much, sure. I appreciate it.
[AGENT][POSITIVE] You're welcome. You have a wonderful weekend. Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.