AccountId: 011433970860
ContactId: 9be1b6a9-55c2-4935-9e55-28e52e3f98cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745950 ms
Total Talk Time (AGENT): 481971 ms
Total Talk Time (CUSTOMER): 148807 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/9be1b6a9-55c2-4935-9e55-28e52e3f98cb_20250115T13:49_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I wanted to know how this, uh, program works. Is it, is it like for, uh, emergency visits?
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] Or I, I, I don't, I really don't understand it.
[AGENT][NEUTRAL] OK, so you have a policy with APL that you're needing to, you have some benefits questions on as far as how it works. Is that correct?
[CUSTOMER][NEUTRAL] Yes, well, yes, I went to the ER and I got a $300 bill. I wonder if does it cover something like that or?
[AGENT][POSITIVE] OK, yes, I will, I can help you.
[CUSTOMER][NEUTRAL] What is the actual cost?
[AGENT][NEUTRAL] Yes, sir. I can help you with this, but first I'll need to pull up your policy information and verify several things with you first for security. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and Mr. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Uh, I don't see a policy number.
[AGENT][NEUTRAL] OK. What type of numbers do you see on the front of your ID card?
[CUSTOMER][NEGATIVE] Oh, I never, oh, I haven't received an ID card.
[AGENT][NEUTRAL] OK, Mr. [PII], so this is for your employer that you have our coverage?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so what is your full social security number so I can see if I can locate your information.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I may have located your policy, Mr. [PII]. So again, as I stated before, I'll need to verify several things with you first for security, and then any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one you gave me, so that again is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, is that a cell number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And then lastly I do need to add an email address on file for you, Mr. [PII], so that you'll have the ability to create your profile in our portal. So what email would you like to have added?
[CUSTOMER][NEUTRAL] [PII] mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh. I'm sorry. Go ahead.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK. And I'm just gonna repeat it. [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you very much for verifying your information. Now, I can give you your policy number, Mr. [PII]. Now, ID cards were mailed to that address. They were mailed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, back in October, on [PII]. Now I can request.
[CUSTOMER][NEUTRAL] OK, I, I'll
[AGENT][POSITIVE] I'll be happy to request additional cards be mailed again, but I'm also going to email you a user guide for our online portal.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's called the online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you set up your profile in there, you will have access to your ID cards. There's also a full copy of your policy certificate with all of your benefit information, but give me just a moment, I'll go ahead and send this request for your ID card.
[AGENT][NEUTRAL] And that typically takes about 10 business days, but the cards that are in your portal are the same, you know, as what you're gonna be receiving.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so your policy number is 02.
[AGENT][NEUTRAL] 553-585
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me a moment to go ahead and send you this email with this user guide while we're on the phone.
[AGENT][NEUTRAL] And then I can go over some of your benefit information with you.
[AGENT][NEUTRAL] And [PII] is spelled [PII] Is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I have just emailed you that user guide and that email that you will be receiving is going to come from care team at [PII] and I did put APL in your subject line so that you can easily recognize that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy, Mr. [PII], it's a supplemental policy to your primary insurance, your primary health care insurance, and this policy is designed to help you with your co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, you said that you had gone to the emergency room. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so this would fall under your outpatient benefit maximum, and on this policy, your outpatient benefit maximum is $500 per covered person.
[AGENT][NEUTRAL] Per occurrence for covered outpatient services.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] OK. So, and the, there's a definite, I'll be happy to read you what the definition of per occurrence means, um, if you would like, but in addition to your benefit to that same information that I just provided for you.
[AGENT][NEUTRAL] There are definitions also included in your certificate of what per occurrence or per calendar date, those type of terms mean. But per occurrence means
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Treatment, it would be for the treatment for same or related condition unless separated by a period of 90 days.
[AGENT][NEUTRAL] Treatment for the same or related conditions, separated by 90 days or an unrelated condition will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So any time did you go to uh for medical services?
[AGENT][NEUTRAL] Always present your APL information along with your primary healthcare information because most providers
[AGENT][NEUTRAL] We'll file your claims with APL for you. In the event that you have to submit your own claim to us for review, you can do that. You can submit your claim through the portal and if that need arises, I mean you can call us back.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] We can tell you where to obtain your claim form that has the instructions on it for the additional documents that you would need and then again that user guide explains how you can upload all of that information directly into your portal for review.
[CUSTOMER][NEUTRAL] OK. Um, all right.
[AGENT][NEUTRAL] Now, on this policy, yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] I'll uh.
[AGENT][NEUTRAL] I'm sorry, go ahead. I didn't mean to stop you.
[CUSTOMER][NEUTRAL] 00, no, no, no, I, I kinda understand. I, I'll just um.
[CUSTOMER][NEUTRAL] You know, sign in or create a user account and then I will submit the uh ER.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh bill and we'll see what happens.
[AGENT][NEUTRAL] OK, so I can, let me give you the website so that you can get the correct claim form.
[AGENT][NEUTRAL] And again this claim form is gonna have the instructions on there because you will have to have an itemized bill that includes your diagnosis code and a copy of the primary insurance company's explanation of benefits also.
[AGENT][NEUTRAL] But again, that information is on the claim form. So, to get our claim form, go to [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At the top when that page pulls up at the top, don't click anything, but I wanna just tell you a couple of things. So you should see where it says claims and forms, then you should also see where it says sign in.
[AGENT][NEUTRAL] You can also get to that online service center by clicking the sign in there, but don't do that right now, but you can get there from that page.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you would click on claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you're gonna scroll down about middle of the page.
[AGENT][NEUTRAL] And there's a little box that says filter byproduct.
[AGENT][NEUTRAL] With a green drop down arrow in it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Files claims.
[CUSTOMER][NEUTRAL] Filter by product, yes I see it.
[AGENT][NEUTRAL] Uh-huh. So click that arrow. It's gonna give you a list. You're looking for the word medlink, M E D L I N K.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] Click on that word.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then now out to the right on your screen, you should see a blue button that says download form.
[CUSTOMER][NEUTRAL] I see it. I, I, I see it now.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yep, and that if you'll click there that's gonna open up the claim form and then you can just print that out.
[AGENT][NEUTRAL] And again, the instructions are at the top of of the of the page.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] OK, so the instructions are at the top of the bill. OK, I see, ma'am. And can I have, you know what, my, I don't know why, but my screen did not take the, uh, when I was typing in the policy number, can I have that one more time?
[AGENT][NEUTRAL] 02553585. But in setting up your profile, yes, in setting up your profile, you will not use that policy number to actually set it up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, but I'll just need that in the future. OK, I got it.
[AGENT][NEUTRAL] Yes, sir, but you'll see that in the um in the portal.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can click on it and that'll give you, you know, you should see ID cards and you should also see a PDF icon that you can download your policy certificate with all your benefit information.
[CUSTOMER][POSITIVE] OK, thank you very much, ma'am. I appreciate your help.
[AGENT][POSITIVE] You are certainly, well, you are certainly welcome. Do you have any other questions or is there anything else that I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Oh no, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're certainly welcome and again, thank you for calling APL. I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] OK, you do the same.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Bye-bye.