AccountId: 011433970860
ContactId: 8e76b593-8d0d-4847-8952-d195b762aba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 994739 ms
Total Talk Time (AGENT): 248668 ms
Total Talk Time (CUSTOMER): 205484 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/8e76b593-8d0d-4847-8952-d195b762aba4_20250224T22:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, um, I was hoping to get some information about my benefits and um how exactly it works, uh, with getting the payments.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that something you can help me with?
[AGENT][NEUTRAL] Yes, mhm, I can. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII] or [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, my phone number is [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEGATIVE] Unfortunately, I don't. Uh, is it possible with my, uh, some other way?
[AGENT][NEUTRAL] So.
[AGENT][POSITIVE] Yeah, I can do the search.
[CUSTOMER][NEUTRAL] With my social security number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it's [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have your address, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, I believe it is one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And if that's not right, I have another.
[CUSTOMER][NEUTRAL] I've moved
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Recently.
[AGENT][NEUTRAL] I think I found you. Let me see, let me pull this one up.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, may I, may I have your date of birth for security?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm, this is your policy. All right, and I just need to verify the email address on file.
[CUSTOMER][NEUTRAL] OK, it is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so you have one of our secondary supplemental plan to the major medical. And let me go ahead and give you benefits and tell you how it works. And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. So this uh policy is set up to help with the high deductibles, co-payment, and co-insurance from your major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, with this one, we do not cover the office visit co-pay, but we do cover co-payments if you go like for an emergency room or a diagnostic center or a surgical center. Um, those are considered. And you have an outpatient maximum of 1500 per calendar year and you have an inpatient of 3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The inpatient is going to be if you're in the hospital 18 hours or more either for observation or admitted and the outpatient is anything that is in and out, like an ER diagnostic center, a surgical center, a surgery in a hospital, or um urgent care facility, cancer treatment or independent lab.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] All right. Is, uh, is there coverage for like inpatient, uh, mental health hospital?
[AGENT][NEUTRAL] Um, let me check and see if this one has that right. One moment, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna pull the documents of the policy and go over them, OK, one moment.
[AGENT][NEUTRAL] I'm still waiting on the documents. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, so yes, um, you do have in-hospital treatment for mental or emotional disorder subject to 30 days of treatment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it has to be 30 days, is that what you're saying?
[AGENT][NEUTRAL] We cover up to 30 days.
[CUSTOMER][NEUTRAL] Well that's it covers 3. I see.
[AGENT][POSITIVE] Yeah, that that's the maximum benefit.
[CUSTOMER][NEUTRAL] OK. And uh it's a total of, would that be the total of 3000?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And then, uh, how does that claim, is the insurance company make the claim? Do the doctors at the facility make the claim? Do I make the claim?
[AGENT][NEUTRAL] Um, it's gonna be either or either you will present the card at the time of service so they can send the claim in for you. Or if you want us to just send you a reimbursement and you take care of the payment, we can also do that. It's really up to you. Um, those are the two options you have to submit claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it possible you can send me a card because I don't think I ever got a card. Can you email me a card or text me a card?
[AGENT][NEUTRAL] Oh yes, mhm.
[AGENT][NEUTRAL] I can email you the card and you can always go to our website and register and you can get a temporary card like that too that you can save to your phone if you want to do that later on, you can.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what's the, it, do I have like a claim number or something like that to add into?
[CUSTOMER][NEUTRAL] Uh, the website.
[AGENT][NEUTRAL] Mm. No, it's just gonna ask you for personal information which is the same information I just verified with you. Um, now, let me have that email address one more time because that is the um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's something you're gonna need to register. So go ahead with that email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEGATIVE] It's DED like deadly.
[AGENT][NEUTRAL] Oh, [PII], OK, [PII] OK. All right. And that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], please.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK. Um, let me go ahead and send you the email with a copy of your card, OK? One moment. I'm gonna put you on a brief hold so I can go ahead and send it right now before I let you go, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK sounds good. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for patient for Miss [PII]. Do you wanna check and see if you got that email?
[CUSTOMER][NEUTRAL] Uh, I believe I got the, got the one that shows the policy information. Let me see now, uh,
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let's see, did you send one with the card like with the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's an attachment.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] This is um
[CUSTOMER][NEUTRAL] I don't know if I see anything that is, oh.
[CUSTOMER][NEUTRAL] I think this might be it.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, yes, I see it.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] OK. That's great. Thank you very much. I appreciate it.
[AGENT][POSITIVE] You're welcome. You're welcome, Miss [PII].
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] The medical team at the hospital can take this information and they can uh put the benefits through.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, they can submit the claim, yes, because this is a secondary policy, so yes, they can go ahead and send in the claim for you. Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. All right. Well, thank you. I appreciate your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] I think that's gonna be it. Thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APR. Have a good afternoon, Ms. [PII].
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.