AccountId: 011433970860
ContactId: b282579a-49ce-47e3-ba99-ac8944d9c90b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525409 ms
Total Talk Time (AGENT): 235773 ms
Total Talk Time (CUSTOMER): 108713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/b282579a-49ce-47e3-ba99-ac8944d9c90b_20250530T18:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII]. I just had a question in regards to my policy and coverages and so forth.
[AGENT][POSITIVE] OK, I can help you with benefits. Um, can I get a good call back number in case we get disconnected, [PII]?
[CUSTOMER][NEUTRAL] Absolutely it's area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Policy number is 02587823.
[AGENT][NEUTRAL] Give me just a moment to look that up.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Can I get you to verify your date of birth please, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am. That is [PII].
[AGENT][NEUTRAL] And the mailing address that we have on file?
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Um, that should be [PII].
[CUSTOMER][NEUTRAL] Middle Fork Road.
[CUSTOMER][NEUTRAL] Kenner, West Virginia.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Great, thank you so much.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And you were just wanting to know what's covered on your policy?
[CUSTOMER][NEUTRAL] Yes, um, the reason I'm asking, I had an emergency room visit, uh, on the [PII].
[CUSTOMER][NEUTRAL] And um I have like a pretty high co-insurance after my like I owe almost $2000 and I wasn't sure what this supplemental policy covered.
[AGENT][NEUTRAL] OK, yeah, this is secondary gap insurance, so if you file a claim or if the ER or whomever you saw files a claim, they will need to file through your primary first and when filing a claim for this policy, we'll need the explanation of benefits or the EOB from your primary showing that some benefits were paid.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And let me see what all is covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just in verification of benefits, not a guarantee of payment. Uh, you have a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Benefit maximum per calendar year of up to $3000 for covered in hospital and outpatient services.
[AGENT][NEUTRAL] Uh, you also have an in-hospital benefit maximum of up to $3000 per calendar year.
[AGENT][NEUTRAL] Uh, and let me see. You, you said you went to the emergency room?
[CUSTOMER][NEGATIVE] Yeah, so what it is, which is crazy because I pay like $700 a month just for my insurance, but if I go to the emergency room, they charge me a $250 co-pay and then 20% of the allowed amount. So like my total bill that I owe is like $1,888.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, so this policy does help.
[CUSTOMER][NEUTRAL] I wasn't sure if you guys covered.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][POSITIVE] OK good.
[CUSTOMER][NEUTRAL] No, no, that's fine. That's what I was actually gonna ask because.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, this policy helps with co-insurance, co-deductible, and co-pay. Um, so sometimes, um, if we have that like, like I said, whenever I mention that $3000 sometimes it will go towards your co-pay or your deductible. Um, so just keep that in mind. Um, it, I do show that you have a hospital emergency room treatment, a maximum of up to 2 emergency room visits per year.
[CUSTOMER][POSITIVE] Beautiful.
[AGENT][NEUTRAL] Um, and let me see, but yeah, the, yeah, this will help pick up after your primary pays partial, um, partial or all, um, yeah, so you will want that, um, explanation of benefits from your primary first because it, it sounds like you're going to be the one filing the claim or are you going to have them file it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Unfortunately it'll have to be me. They won't file it for me.
[AGENT][NEUTRAL] OK, and do you have an online portal account with us?
[CUSTOMER][NEUTRAL] I do not. I'll have to set that up and I see that's at [PII].
[AGENT][NEUTRAL] Yeah, it's [PII]. You'll need to put in, I believe it's just your last name, your social security number, uh, the zip code that we have on file, which is the one that you gave me, um.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] And then I believe that also it will ask for your email address. It's gotta be the email address that we have on file um sometimes people will get an error message um because they'll try to use a different email and it's not the one they gave us and it it it's a system that talks through our system so you just wanna make sure that it's the email address we have on file. Do you want to confirm that with me?
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Uh, I just have the one. It should be [PII].
[AGENT][NEUTRAL] OK, that's not the one that we have on file let me see, do you want me to change it?
[CUSTOMER][NEUTRAL] OK, well then it's probably.
[CUSTOMER][NEUTRAL] No, is it [PII]?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK, then that's, that's fine. I, that's my personal. The other one's my work. I usually use it more, but I'll just remember that for this policy.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, you will need that that email address uh to to log in um because it'll ask you for that and once you sign up for that portal account, you will be able to access any um ID cards that you'll need you'll have the um policies that you have with us, so I'm reading you from the schedule of benefits from your policy certification you'll have that right there with you, so you'll be able to read everything and it's laid out on page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6, so you'll go down to it, it says certificate of insurance, um, but it's a schedule of benefits and that's what will show you all of the amounts and everything that you're allotted to.
[AGENT][NEUTRAL] Um, and so that should be pretty helpful, and you'll be able to file a claim through the online portal and you'll be able to check the status of those claims as well.
[AGENT][POSITIVE] So it's pretty handy.
[AGENT][NEUTRAL] And were there any other questions that you might have for us?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Are you able to hear me?
[AGENT][NEUTRAL] [PII], are you still there?
[AGENT][NEUTRAL] Hello?