AccountId: 011433970860
ContactId: 9fb59d56-cf37-42c0-afaf-3fa863643f7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462109 ms
Total Talk Time (AGENT): 278207 ms
Total Talk Time (CUSTOMER): 142467 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/9fb59d56-cf37-42c0-afaf-3fa863643f7c_20250115T17:56_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I'm calling because I have to have an MRI done, and they're telling me my copay is $500 and I'm trying to determine whether or not my secondary, which is you, will pick up that $500.
[AGENT][NEUTRAL] OK, as well, let's say you're needing benefit information for your outpatient benefits.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and I'm so sorry. What was your last name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And what is a good callback number for you please?
[CUSTOMER][NEGATIVE] Um, [PII]. I just realized the card has got the wrong spelling name on it.
[AGENT][NEUTRAL] OK. All right. Well, um, I can help you with that also. And so as well though, what is your policy number?
[CUSTOMER][NEUTRAL] Um, I've got the group number. Let me see. Oh, it.
[AGENT][NEUTRAL] There should be another number also. It depends on the type of coverage you have as to how that number might be worded on your card.
[AGENT][NEUTRAL] Do you have an in-hospital?
[CUSTOMER][NEGATIVE] Uh, I've got a 0.
[CUSTOMER][NEUTRAL] You have an in hospital and an outpatient, pretty sure it would be the outpatient, correct?
[AGENT][NEUTRAL] Um, yes, sir.
[CUSTOMER][NEUTRAL] OK, so the number is 021-892-17 M [PII] in Michael [PII] in [PII] 8.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get your information pulled up, then I will have to verify several things with you first for security and also any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the correct spelling of your name? You said your name was misspelled?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's [PII] The card has N O I believe [PII], pardon me.
[AGENT][NEUTRAL] OK. So we'll connect to that in just a moment. And then your home mailing address, please, Mr. [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. The phone number that we have on file for you.
[AGENT][NEUTRAL] Um, it's, uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And lastly your email address please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, wait.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, what is it? I forgot. I was [PII]. It's not with an [PII], it's with a [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so again, you said it was [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, thank you very much for verifying your information. So just one moment please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so I can see it's, we have gotten your last name corrected on the spelling, but your ID card, I can see where it did have that [PII]
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So what I can do is I will request for the cards to be updated for you and we can mail a new one out. Now I can see that you're set up as well, Mr. [PII] in the online service center.
[CUSTOMER][NEUTRAL] OK, that'll be fine.
[AGENT][NEUTRAL] So you do have copies of your ID cards and your policy information in the portal. You won't be able to see that new ID card with the correct spelling until probably tomorrow afternoon because it has to go through our overnight processing.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] But, um, I will, I will make that request for you.
[CUSTOMER][POSITIVE] OK, cool.
[AGENT][NEUTRAL] To get that corrected. OK, so on your, like, give me just a moment to look at your policy information.
[AGENT][NEUTRAL] OK. And again, as I explained to you, Mr. [PII], so, any information that I provide for you will be a verification of your benefits and not a guarantee of payment.
[AGENT][NEUTRAL] So, on this supplemental policy, um, make sure that when you do go to the doctor, the facility that you do provide them your APL card along with.
[AGENT][NEUTRAL] Your primary insurance card because most of them will call to verify that you're eligible and to get your benefit information. On this policy, um, your outpatient benefit maximum for coverage outpatient services per calendar year is $2500.
[AGENT][NEUTRAL] And you do not have a deductible, an outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we will have to just receive the claim along with your primary insurance company's explanation of benefits to review.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so question is, is once I go in and have this procedure done, they will bill you the $500 or I need to bill it separately?
[AGENT][NEUTRAL] Well, what you will need to do is to talk with the provider to see if they will file your supplemental insurance, as well as your primary most will because it will have to be filed with your primary first. And then once that has been processed and the explanation of benefits, you know, has been received from your primary, then the claim, whether that be you filing it or your provider filing it would submit the claim to APO.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] I got it. All right. So that's
[AGENT][NEUTRAL] And, and you can just let them know about your typographical error on your ID card. Um, when are you scheduled to go for your scan?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Uh, hopefully in the next week or so, so maybe it will show up, OK, um, maybe we'll get it in time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so you may not have the one right, you may not have the one that's gonna be mailed to you but again you will have access to an updated one in your portal so you could print that off to provide them, you know, with the accurate information, but everything else is correct on your card.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, perfect. So I have up to $2500 after that. I don't have any more benefits for out of pocket, but that's fine. I know what I need to know. Thank you very much for your assistance.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Absolutely. You're certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, perfect. I hope you have a great day.
[AGENT][POSITIVE] Well, yes, sir. I hope you do too. Thank you very much and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.