AccountId: 011433970860
ContactId: ac101f6d-7a1e-4514-b33e-e6d26ec07960
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323260 ms
Total Talk Time (AGENT): 184971 ms
Total Talk Time (CUSTOMER): 120815 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/ac101f6d-7a1e-4514-b33e-e6d26ec07960_20250310T13:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. I'm a member and I had a question regarding the, the policy. Uh do you guys cover for deductible?
[AGENT][NEUTRAL] OK. All right, ma'am. First of all, can I get your name and your policy number?
[CUSTOMER][NEUTRAL] [PII] policy number 02559263.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Ms. [PII], give me just one moment and let me look up your information, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Alright, Ms. [PII], I believe I've got your policy information pulled up. If you could do some verification with me, I would appreciate that. What is your date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And your um your address and email, please, if you don't mind.
[CUSTOMER][NEUTRAL] My address is [PII]. My email [PII].
[AGENT][POSITIVE] OK, Ms. [PII], I appreciate that information. um, thank you so much. So you're just calling for um benefits for help with your policy benefits?
[CUSTOMER][NEUTRAL] Yes, I just need to know what is it that you guys cover. I know for sure it's not a copay, but do you guys cover for deductible?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, alright, so, um, yes ma'am, this plan, and I can help you with this, so this plan does help pick up with deductibles, coinsurance and co-pay that your major medical doesn't pick up.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm. It's a, it's a gap plan.
[CUSTOMER][NEUTRAL] OK, so am I, am I supposed to submit the, the claims or the, or the doctor's office?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK alright so you it's either way it's assignable which means you can submit the claim to us or if you handed your card to the doctor's office or to the hospital they they should be able to submit the claim um on your behalf.
[CUSTOMER][NEGATIVE] OK, yeah, I'm gonna have to because I've been, I thought that the co-pay was not covered, and I have a $75 co-pay and they've been taking my copay, even though I've been giving my secondary insurance, and not one of them has given me, not one of them has given me a refund.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, OK. Oh, OK. Yeah, I would definitely um ask them about that and see what's going on. Um, your provider, yes, ma'am. But that's what this is, um, it covers certain things, you know, like, um, that your major medical, um, doesn't pick up, such as co-pay, co-insurance and deductibles. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, I, and I also, I just, I just got, um, I don't know if you can tell if they tried to submit a claim, but I got a bill from an MRI that I did back in November.
[CUSTOMER][NEUTRAL] And they're sending me a bill of 209, because they're saying that it's my deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. Let me see if I can take a look to see if there's any claims been submitted, but I'm not on a particular claim, um.
[AGENT][NEUTRAL] I can let you speak to somebody that can help you with that to look further and see what kind of claim you have out there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you know what, don't worry, I'll just give them a call and ask them if they submitted the claim to you. If they tell me that yes and you guys denied it, then I will call back.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, alright, no problem, Ms. [PII]. Now, have you heard about our online service center yet where you can file claims and view claim statuses online?
[CUSTOMER][NEUTRAL] Uh, it says that, OK, yeah, on the back of the card, I do see it, it's [PII]. um [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am, you can um if you it at your convenience it's 24/7 it never closes you can go out there online and you can create an account with us. It's very simple. It only takes like 3 minutes and you can view your claims and your um payments and your claim history, everything out there online and also view your policy benefits as well your policy should be out there too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you, and, and I'm sorry, I know you say yes, but you're sure it covers co-pay also?
[AGENT][NEUTRAL] OK, so co-pay, co-insurance, and our deductibles that your major medical doesn't pick up.
[CUSTOMER][POSITIVE] OK, perfect. Thank you very much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. Thank you. And um Mr. [PII], if you have anything else for us, just call us back and let us know and we'll be glad to help you. I hope you have a wonderful day today.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] All right, thank you. All right, bye-bye.