AccountId: 011433970860
ContactId: 90886f62-b58d-49c3-ba96-40a32ed36293
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328019 ms
Total Talk Time (AGENT): 138701 ms
Total Talk Time (CUSTOMER): 149091 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/90886f62-b58d-49c3-ba96-40a32ed36293_20250116T21:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII].
[CUSTOMER][NEUTRAL] I have a secondary insurance with you guys and I just wanted to know actually what this covers.
[AGENT][NEUTRAL] OK. Well, I can help you with your coverage, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII], yes, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, the policy number you need that?
[AGENT][POSITIVE] Yes, ma'am, and then a good contact number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, [PII]. Policy number 02538094.
[AGENT][NEUTRAL] Thank you for that. And then for the phone number, I made a mistake and I think I erased the one. It was [PII], was it [PII]? OK.
[CUSTOMER][NEUTRAL] [PII], yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And thank you for that. Hold on one moment while I pull up your policy.
[AGENT][NEUTRAL] And [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Well, date of birth is [PII]. My email address is [PII].
[CUSTOMER][NEUTRAL] And what else you asked for?
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Um, your email address.
[CUSTOMER][NEUTRAL] Um, my work, [PII] work or my [PII].
[CUSTOMER][NEUTRAL] Or work it's [PII] injury [PII].
[AGENT][NEUTRAL] Yes, right, and thank you so much for verifying and all the information provided is a verification of benefits, not a guarantee of payment. So let me pull up your coverage.
[AGENT][NEUTRAL] Per current.
[AGENT][NEUTRAL] Let me pull it up this way. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so I'm just waiting for your document to populate here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the policy is broken down into inhospital and outpatient. Um, so if you were ever admitted to the hospital and confined, um, the policy would pay up to $1500 per confinement. Um, confinement is any time that you're in the hospital over 18 hours.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It also covers outpatient expenses. So, um, for outpatient, it will pay up to $500 per occurrence. So occurrence is like if you go for your knee, everything for your knee is one occurrence, and then if you go for your shoulder, that's another occurrence. Um, there's no deductible, it covers hospital emergency rooms, urgent care, um, if you ever need like an outpatient surgery, diagnostic testing, and then, um,
[AGENT][NEUTRAL] Like mental or emotional treatment, if you do need it in an outpatient facility, there's coverage for that as well.
[CUSTOMER][NEUTRAL] OK, does it cover for any, let's say, dental or uh glasses, um, anything like that?
[AGENT][NEUTRAL] No, not for your um policy with APL. So this policy is only for medical and is second only to your Aetna policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, right, so this is the secondary. OK, so like let's say I, I have an appointment for dental work um at Greenberg Dental, don't give them this information.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no, ma'am. Um, now Aetna, your Aetna may have dental benefits, but not the second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, right, yeah, so I'm not gonna give them this, um, so it's just for hospital and basically medical as far as um outpatient. It really doesn't do too much. It's mostly hospital.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Because I, I mean, I don't do anything for knees or anything like that, um.
[AGENT][NEUTRAL] Oh, that was just an example. I'm just saying anybody part. That's just if you go for one thing, anytime you go for that one thing, that's one occurrence.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, OK. Well, I mean, I really don't go, I mean, just mostly hospital, uh, because I did have a seizure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was in a hospital last month, um, and so I do see like the neurologist, um, things like that, but I'm good to go now um and they have the information, but anything else I really don't. I'm just gonna get dental work done, but I won't do that and then eyelasses, they don't cover that, so that I'll pay for, um, outside of Aetna because I always give my Aetna. I just wanted to know what you guys covered.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Um, OK, alrighty, well, we're good to go. Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, no, no, that's it thank you.
[AGENT][POSITIVE] You're welcome thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] OK bye.