AccountId: 011433970860
ContactId: a0078f24-519b-47b7-8101-efac59faa753
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438369 ms
Total Talk Time (AGENT): 313118 ms
Total Talk Time (CUSTOMER): 93373 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/a0078f24-519b-47b7-8101-efac59faa753_20250529T16:46_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII] my name is [PII]. I want to know how this insurance works, please.
[AGENT][NEUTRAL] OK, [PII], you're the policy holder and you have some questions on your benefits as to how they work, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am. Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please, Ms. [PII].
[CUSTOMER][NEUTRAL] Fax number is 0211.
[CUSTOMER][NEUTRAL] 992 8
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments please to get your policy information pulled up, and once I do, I will have to verify several things with you first for security and also Miss [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thanks one moment.
[AGENT][NEUTRAL] And then also your home mailing address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you and the last piece of information to verify is going to be your email and this may be your work email that's on file.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. Now, Miss [PII], while some other stuff is loading for me, have you ever set up your profile in our portal called the online service center where you can access, OK, so uh in this portal once you set up your profile, you will be able to access your ID cards.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You there's a copy of your policy in there with your benefit information in it. You can see claims that we receive on this policy and should you ever have to submit your own claim with APO you actually can upload it directly into the portal for review.
[AGENT][NEUTRAL] So I will email you the user guide as to how to set that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll do that just as soon as we get off of our call and the email that you're gonna receive from me Miss [PII] will come from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Care team
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] And I will put a PO in your subject line.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] OK, so this policy is a supplemental policy to your primary health care insurance, and it's designed to help you with your co-pays, deductibles, and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] So for you would always really need to present this card along with your major medical insurance card when you go for medical services.
[AGENT][NEUTRAL] Are there specific benefits that you were inquiring about or just general information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, my question is, I already had surgery and I already paid my medical bills. Is it too late to give?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My medical provider, his stuff.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, ma'am. You could, we do not have a timely filing limit like some insurance companies do. So as long as your service date is within range of when your policy went into effect, you can still submit your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You or the provider, whichever.
[CUSTOMER][NEUTRAL] OK, do I submit it to my doctor or or my provider?
[AGENT][NEUTRAL] Well, you would need to.
[CUSTOMER][NEUTRAL] Or you all, um, how's it work?
[AGENT][NEUTRAL] Well, are you going to be filing the claim or is your provider going to file it for you?
[CUSTOMER][NEUTRAL] Uh, me, because I, I've been paying my mem uh my insurance.
[AGENT][NEUTRAL] Your doctor or hospital?
[AGENT][NEUTRAL] OK, so what I so what I can do is you can get our claim form that has the instructions on it as what other documents you will also need to provide us that can be obtained from our main website, but I will include a copy or one of those claim forms um in your email with that user guide that I'm gonna send to you.
[CUSTOMER][NEUTRAL] Oh, go ahead, ma'am. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you would complete the claim form you will need to get the other documents that are required, which again that information is on page one and then once all you have all of that together you may upload it into your portal.
[AGENT][NEUTRAL] Or you can fax it or mail it, and our mailing address and the claims fax number are also on page one at the bottom of that claim form.
[AGENT][NEUTRAL] But we just cannot accept claims via email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you, got you, OK, so you said you email me a form stating what I need to submit and I upload it or fax it to you all.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am. You may upload it, you may fax it or mail it. Obviously.
[AGENT][NEUTRAL] Uploading it is the quickest means for getting it in and then obviously fax and then to mail it would be last but yes I'm going to include the user guide for the online service center portal.
[AGENT][NEUTRAL] And I'm also gonna include the Medin claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I, I, I can upload this myself, not my doctor, correct?
[AGENT][NEUTRAL] Yes ma'am, you can file it yourself. Mhm.
[CUSTOMER][NEUTRAL] OK, if I've already started paying medical bills, is it too late?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Again, we do not have a timely filing limit.
[AGENT][NEUTRAL] So you can still file the claims with you if there are benefits payable then you know they would be paid to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If the provider files it, then we would typically pro you know, if we are able to pay benefits, then they would be paid to the provider.
[CUSTOMER][NEUTRAL] OK, got you, understood.
[CUSTOMER][NEUTRAL] Got you and no benefits are guaranteed, correct?
[AGENT][NEUTRAL] That is correct. Yes, ma'am. We will just have to receive the um information, all of the claims information for review to determine that.
[CUSTOMER][POSITIVE] Got you, got you. OK, clear. OK, I got you, thank you so much, Ms. [PII].
[AGENT][NEUTRAL] Well, you are certainly very welcome, Ms. [PII] and so just give me a couple of minutes to send you that email. Again, it's gonna come from [PII] and I will put [PII] in the subject line for you. I don't think it will go to your junk or spam folder, but if you hadn't seen it within just a few minutes, you might want to check one of those two places.
[CUSTOMER][POSITIVE] OK, thank you so much for all your help, OK?
[AGENT][POSITIVE] Well, you are certainly very welcome and if that is all that I can help you with at the moment, thank you again for calling APL and I hope that you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Same to you. You have a great weekend. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye bye.