AccountId: 011433970860
ContactId: b1b375ca-0e4e-462d-b856-60a34ff5bb0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 981219 ms
Total Talk Time (AGENT): 319833 ms
Total Talk Time (CUSTOMER): 558649 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/b1b375ca-0e4e-462d-b856-60a34ff5bb0e_20250625T19:49_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I hope you can, [PII]. Um, my name is [PII]. Um, I've never used American Public Life, my insurance, GA, whatever you'd call this policy, and I don't know how to get started, um, and I can't seem to log in, so I guess I need your assistance.
[AGENT][NEUTRAL] Yes, I'll be glad to. What is your policy number, uh, please, [PII]?
[CUSTOMER][NEUTRAL] Well, I don't know what a policy number is. I have.
[CUSTOMER][NEUTRAL] Because is the policy number not on the card?
[AGENT][NEUTRAL] It should be, it should, uh, sometimes it will say outpatient or inpatient services and then you begin with a 01 or.
[CUSTOMER][NEUTRAL] That's it. OK, so it says inpatient. OK, so in hospital benefits cert number and outpatient benefits cert number.
[AGENT][NEUTRAL] Yes, that would be fine, one of those two.
[CUSTOMER][NEUTRAL] Is that what you're considering a policy number?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, because it didn't take that in the system, um, 02473183 ML 7.
[CUSTOMER][NEUTRAL] is in hospital and ML 8 is outpatient.
[AGENT][NEUTRAL] Thank you. If I could just verify your date of birth and the phone number, please, and then we'll start looking at your policy.
[CUSTOMER][NEUTRAL] Yeah you're a little muffled. Um, I don't know why you sound kind of a little different.
[AGENT][NEUTRAL] I'm sorry, can, can you hear me a little bit better now?
[CUSTOMER][NEUTRAL] Um, yeah, a little bit. Um, what was your question?
[AGENT][NEUTRAL] Yes, but
[AGENT][NEUTRAL] I just need to verify your date of birth and a phone number, please.
[CUSTOMER][NEUTRAL] Oh, OK, um, my date of birth is [PII].
[AGENT][NEUTRAL] And is there a phone number that I could could verify?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, yes, it's [PII] unless you have my work number, but that's my only personal number.
[AGENT][POSITIVE] Oh, that's great. Thank you very much. Now, you said that you're trying to go online right now to build your account, is that correct?
[CUSTOMER][NEUTRAL] Well, I wanna go online and see what my benefit is and kind of help myself but in the APL, you know, I don't have an already I don't have an online account.
[CUSTOMER][NEGATIVE] So when I go to sign up it says error no user was found with any of this information, not my name, my zip my email.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEGATIVE] My member ID I had put in my social, my birthday, and it's like, I don't exist.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What is your, um, what is the email address you'd like to have associated with this account, please?
[CUSTOMER][NEUTRAL] You mean what is the email address? Not what would I like, but what is the email? It is [PII] L.
[CUSTOMER][NEUTRAL] [PII] which is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm sorry, you said it's [PII]?
[CUSTOMER][NEUTRAL] No, uh uh, um, like my, OK, it's like my last name. It's [PII], the email is [PII].
[CUSTOMER][NEUTRAL] [PII], which is [PII] A.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can't put that in. I, it doesn't look like we have an email address for you, so, um, let me just put that in really quickly and then we'll see if that doesn't help.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Or maybe they wanted to insert an H in my email which is different than my last name spelling. Sometimes they think it's like a mistake.
[CUSTOMER][NEUTRAL] When it's done on purpose.
[CUSTOMER][NEUTRAL] Yeah, I've put in so many numbers and I said I'm just picking up the phone.
[AGENT][NEUTRAL] OK, let's see if this doesn't work, um.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Now when uh when you go into the online service center it says uh it says welcome to the online service center.
[AGENT][NEUTRAL] And you should be able to click the the um
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Pardon?
[CUSTOMER][NEUTRAL] I mean, I don't know I'd have to go backwards to the OK so OK it did go back. OK, I'm I'm sorry it locked me out. Alright, so what it's just um.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Online service center sign up which role best describes you. I'm the insured. I go to next.
[AGENT][NEUTRAL] Yes, and if you're
[AGENT][NEUTRAL] Yes, we're
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It wasn't recognizing me. OK, now, OK, so now I have to put in my birthday.
[AGENT][NEUTRAL] Yes, uh, your last
[CUSTOMER][NEUTRAL] And I need to put in either so you're saying either either the ML7 or the ML8 would be fine.
[AGENT][NEUTRAL] OK, um, let's.
[CUSTOMER][POSITIVE] In other words, the outpatient, I'm gonna, I'm gonna do the outpatient benefit.
[AGENT][NEUTRAL] If you don't mind
[CUSTOMER][NEUTRAL] And I'm gonna do it again.
[CUSTOMER][NEGATIVE] Maybe the mistake was that there was no email.
[CUSTOMER][NEUTRAL] Oh yeah it let me do it that time so it was on your end.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You guys didn't have me set up completely, OK, so alright, so now I'm getting through that.
[CUSTOMER][NEUTRAL] And verification code.
[CUSTOMER][POSITIVE] Uh, I hope I can do this while I'm on the phone with you.
[CUSTOMER][NEUTRAL] But could you tell me what this benefit is?
[AGENT][NEUTRAL] Yes, of course. Let me, let me tell you what your benefits are.
[AGENT][NEUTRAL] OK, so what we do is we're meant to pick up the deductible, co-payment or co-insurance from your major medical.
[AGENT][NEUTRAL] And uh so what we will do for inpatient hospital services, we'll pick up that deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I, I'm, I'm writing, I'm, I'm, I'm not that fast, um, OK, you say you pick up my deductible.
[AGENT][NEUTRAL] Sure, just let me know.
[CUSTOMER][NEGATIVE] My deductible for any expenses that are that are going towards my deductible, no.
[AGENT][NEUTRAL] No, no, that's what.
[AGENT][NEUTRAL] No, um, so what, what we will do is we will pick up the deductible.
[AGENT][NEUTRAL] Co-payment or co-insurance?
[AGENT][NEUTRAL] From your major medical.
[AGENT][NEUTRAL] For inpatient services.
[AGENT][NEUTRAL] So if you're in the hospital for 18 hours or more.
[AGENT][NEUTRAL] Up to $3000 per occasion.
[AGENT][NEUTRAL] So, so if you went into the hospital.
[CUSTOMER][NEUTRAL] Up to $3000 per per occasion you said?
[AGENT][NEUTRAL] For per occasion, yeah. Yeah, for sickness. Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For outpatient hospital services like the ER, the urgent care, um, surgery, outpatient surgery, we will pay up to $300 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Up to 300 per day, that's not very much, OK.
[AGENT][NEUTRAL] And then that also includes durable medical equipment, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And cancer treatment.
[CUSTOMER][NEGATIVE] You're so, you're so faint.
[AGENT][NEUTRAL] OK, yeah, I'm sorry, I'm, I'm not hearing you very well. It's yeah.
[CUSTOMER][NEUTRAL] OK, question um if.
[CUSTOMER][NEUTRAL] Yeah, um, if it is, if I had.
[CUSTOMER][NEUTRAL] An ultrasound done in the hospital.
[CUSTOMER][NEUTRAL] Is that considered outpatient or is that considered a diagnostic center?
[AGENT][NEUTRAL] It, it would be it would be considered outpatient hospital.
[CUSTOMER][NEUTRAL] OK, so if I, so that would help to once I get that bill for my ultrasound, that's considered outpatient hospital since I was in the outpatient, so that would be $300 for that day.
[AGENT][POSITIVE] That, that's correct.
[CUSTOMER][NEUTRAL] And then OK and then um.
[CUSTOMER][NEUTRAL] Alright, so then if I was getting my pre-authorization for the surgery.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And and getting like the pre-op visit with the EKG, is that also considered outpatient hospital or is that considered, oh that's Cleveland Clinic, the clinic side.
[AGENT][NEUTRAL] If it's, if it's in an outpatient hospital facility, then it would be covered. If it's in your physician's office, then it would not be covered.
[CUSTOMER][NEUTRAL] So it may pay for me to use Cleveland Clinic.
[CUSTOMER][NEUTRAL] Because I'd be getting $300 to in this policy.
[CUSTOMER][NEUTRAL] Except that the difference in cost is probably a lot more than that. OK, so that's how that benefit works.
[CUSTOMER][NEUTRAL] I don't know if I fully still understand it so I'm going in for a.
[CUSTOMER][NEUTRAL] Um, I guess it, it, it's considered a minor surgery, um, at an outpatient Cleveland Clinic surgical center.
[CUSTOMER][NEUTRAL] So beyond the $300 I'll get for that day.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] If they and they have to put it in right? Cleveland Clinic has to file it or do I file it?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You, you could file it or they could file it. So for, for whatever, um, whatever the deductible, co-payment or co-insurance is for all the services for that day for that minor surgery, we will pay up to $300 for that day and either the surgery center or your or your doctor will file the claim or you can file the claim.
[CUSTOMER][NEUTRAL] OK and then so.
[AGENT][NEUTRAL] But when you go
[CUSTOMER][NEUTRAL] But I'm not sure if I understood the originally the first thing you said to me was that you helped him to pay for the deductibles, the copays, and the co-insurance.
[CUSTOMER][NEGATIVE] So that's the part that throws me because it doesn't look like none of this matters it's just a like a like a flat amount of money.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, the, the benefit is a flat amount of
[CUSTOMER][NEUTRAL] So what do you mean that APL helps to pay for the deductible co-insurance and co-pays?
[AGENT][NEUTRAL] Well, the, the benefit
[CUSTOMER][NEUTRAL] You're saying that $300 helps that.
[AGENT][NEUTRAL] Right, the, the benefit is, uh, it is a flat rate, but whenever you, uh, present your major medical card, your primary insurance card,
[AGENT][NEUTRAL] To the surgery center or, or to the, the hospital.
[AGENT][NEUTRAL] They will put the money towards your deductible, co-payment, or coinsurance. So what they will do is they will give you an explanation of benefits and, and when they process the claim, they will put the charges that that you that normally you would pay out of pocket. It will either go to your deductible, co-payment, or coinsurance, and that is what we pay. So the the deductible, co-payment or co-insurance is is basically an out of pocket that sense that you would normally have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, and what we would do is we pay up to $300 of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basically.
[CUSTOMER][NEUTRAL] It's irrelevant how much of each of those things. It's just that you, that's the benefit of the $300 but I had an option of doing this actually, but I had the option of actually doing this as a patient in the actual hospital.
[AGENT][POSITIVE] That, that's correct, yes.
[CUSTOMER][NEUTRAL] And I'm not, uh, to me that sounded like super expensive, but then that one pays up to $3000 of my.
[AGENT][NEUTRAL] If you're in the right, if you're in the hospital for 18 hours or more, that's considered an in-hospital event and, and they pay up to $3000.
[CUSTOMER][NEUTRAL] Oh, I, right, right, right, right, right, you did say that, yes, and I wouldn't be in there for 18 hours, right? OK, I got it. OK, so this benefit is $300.
[AGENT][POSITIVE] Yes, yes, that's correct.
[CUSTOMER][NEUTRAL] Bottom, that's it.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And it could be another 300 for the ultrasound when I was there for that day.
[AGENT][NEUTRAL] Yeah, for a different day, yeah.
[CUSTOMER][NEUTRAL] But what about when I'm in Cleveland Clinic?
[CUSTOMER][NEUTRAL] And what about when I was in there to have my doctor's appointment at the Cleveland Clinic?
[AGENT][NEGATIVE] Now, that, that would not be covered.
[CUSTOMER][NEUTRAL] The other day is that also.
[AGENT][NEGATIVE] Yeah, that, that's not gonna be covered. It's, it actually has to be the, it, it's a hospital um policy.
[CUSTOMER][NEUTRAL] But the ultrasound does.
[AGENT][NEUTRAL] If it's in the hospital, yeah.
[CUSTOMER][NEUTRAL] The ultrasound would be covered that day but not the doctor's visit. OK, OK, well, listen, $300 instead of the nothing, right?
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Um, is there anything else, as, as, is there anything else that's part of my benefit that I should know about?
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][POSITIVE] Yes, durable medical equipment if you needed something like a walking boot or, or uh any sort of uh like a CPAP, something like that, that is also covered.
[AGENT][NEUTRAL] And cancer treatment is covered too.
[CUSTOMER][NEUTRAL] Cancer treatment.
[CUSTOMER][POSITIVE] Cancer treatment. So if I had cancer, the treatment is actually covered no matter if it's inpatient or outpatient. Well, that's a nice benefit.
[AGENT][NEUTRAL] But,
[AGENT][POSITIVE] That's right.
[CUSTOMER][MIXED] I mean, God forbid, God forbid, right, but at least it's good.
[AGENT][NEUTRAL] Oh, of course, yes.
[CUSTOMER][NEUTRAL] OK, so I need to provide my APL information called into the insurance department at Cleveland Clinic so they can bill.
[AGENT][NEUTRAL] That's right, yes, when.
[CUSTOMER][NEUTRAL] And I'll explain to them.
[CUSTOMER][NEUTRAL] I'll give them both policy numbers so that they're aware because otherwise this would not have gone through.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because you guys didn't have any set up in your system.
[AGENT][NEUTRAL] Uh, well, we would have, um, actually the, the claim itself would have gone through it's just that you wouldn't have been able to go online, um, so we can go ahead and process the claim whether we, yeah, it's really just more for us to get you online so you can see your benefits and you can see the claims being processed.
[CUSTOMER][NEUTRAL] OK, yeah, oh, I see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, so that, so now when I just was trying to set myself up online.
[CUSTOMER][NEGATIVE] I didn't get a, I did not get a.
[CUSTOMER][NEGATIVE] I didn't get
[CUSTOMER][NEGATIVE] I didn't get a text.
[CUSTOMER][NEUTRAL] So unless they send it, do you know if they send it through email?
[AGENT][NEUTRAL] Yes, you should get a text. You, you should get a text through email and sometimes it takes a little bit of time to get it through. Um, I don't know why, um, you think that it would just go through quickly, but uh sometimes it's.
[CUSTOMER][NEUTRAL] OK, so it's not so it's not a tax.
[CUSTOMER][NEGATIVE] It's not a text it's an email verification code that they send doesn't say what they're sending actually.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, but you know it's text and not email, OK.
[AGENT][NEUTRAL] Well, it is, it is email, it is email.
[CUSTOMER][NEGATIVE] Well, I didn't get it.
[AGENT][POSITIVE] Yes, so, so I would give it another uh.
[CUSTOMER][NEUTRAL] Oh, you just a text, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] I swear you said text and I was like, oh, I was on email, OK, because I didn't get.
[AGENT][NEUTRAL] Oh no, I'm sorry. It, it, it's not a, yeah, it's not, it's email. It's definitely email and so it takes, it takes a couple of minutes.
[CUSTOMER][NEUTRAL] It's email OK so OK alright so so far.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I did not get anything and it says more than a few minutes.
[AGENT][NEUTRAL] I would, I would still wait because it, it sometimes it takes a little bit of time.
[CUSTOMER][NEUTRAL] But I guess if it doesn't go.
[CUSTOMER][NEUTRAL] Yeah, they want me to put in the verification code and it's telling me it's like that they.
[AGENT][POSITIVE] Yeah, that's great, yeah.
[CUSTOMER][POSITIVE] OK, I'll give it a, I'll give it like a half hour. I don't know if we're usually these things pretty much right away. All right, thank you. I'm gonna have to run. Thank you so much.
[AGENT][NEUTRAL] OK, thank you for contacting API.