AccountId: 011433970860
ContactId: b535a17f-98cb-4193-a0f6-360a566d61f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1024550 ms
Total Talk Time (AGENT): 537462 ms
Total Talk Time (CUSTOMER): 354698 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/b535a17f-98cb-4193-a0f6-360a566d61f1_20250423T12:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APOs. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. How are you?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] Good, good. Um, I was calling because um I just wanted to review my coverage. I have um something going on with my ear. I can't hear well and so I'm gonna go to an urgent care that I have by me that I know is in network. I did already call my primary insurance.
[CUSTOMER][NEUTRAL] shield and they shared that uh I have I have to go through my deductible before they would kick in, but since this is the secondary insurance, I wanted to give you guys a call to see what you guys would cover. Is that something that you can help me determine?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you have a question on your benefits for outpatients specifically for urgent care, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] OK. Thank you, Ms. [PII]. What is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] It is, mm.
[CUSTOMER][NEUTRAL] Is it the payer ID or the group number that I gotta give you? Oh, maybe the outpatient benefit cert number?
[AGENT][NEUTRAL] You should
[AGENT][NEUTRAL] Yes, ma'am. That would be the one. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you, so it's 02370286, the letters M as in mom, L as in lollipop, and the number 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get your.
[AGENT][NEUTRAL] Information pulled up.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, [PII], so I will need to verify several things with you first for security and any
[AGENT][NEUTRAL] The information that I provide for you today would be a verified this and not a guarantee of payment. So if you could first please verify the primary insured's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] Sure, so the primary insurance is [PII] and his date of birth is [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then your home mailing address.
[CUSTOMER][NEUTRAL] Uh, we recently moved, so I'm gonna give you the updated address. If it's not that one, I'll give you the old address. So it should be [PII]. Is that the one you have or do you have a [PII] address?
[AGENT][NEUTRAL] No, ma'am. That is the first address is not what we have.
[CUSTOMER][NEUTRAL] OK, so then you probably have the [PII].
[AGENT][NEUTRAL] OK, yes, ma'am. That is
[AGENT][NEUTRAL] So what we have on file and then what is a good phone number for this?
[CUSTOMER][NEUTRAL] Uh, so a good phone number for me would be [PII] or did you need my husband?
[AGENT][NEUTRAL] No, no, no, for him.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, so his is [PII].
[AGENT][NEUTRAL] Yes, Mr. [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yeah, sorry, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we do also have a different phone number other than that on file for him.
[CUSTOMER][NEUTRAL] Oh, I wonder if it's his work number then. Give me a second. Let me ask him.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I love apparently they don't have your cell phone. This is uh, uh, APL, the secondary. So what's your work number? I don't know if you didn't have that. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's not it either. Uh, this one ends, it's a [PII] area code, but it ends in [PII].
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] [PII]. What number is that?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let me see if it's.
[CUSTOMER][NEUTRAL] No, I.
[AGENT][NEUTRAL] Now, if
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mr. [PII] is there with you, Mr. [PII], if I'm, I can get your address updated and also his phone number.
[CUSTOMER][NEUTRAL] Yes, you're here.
[AGENT][POSITIVE] Um, OK, because there's only, we can only do that type of thing with him. So yes, ma'am, if he's there, I'll be happy to speak to him so I can get this.
[CUSTOMER][NEUTRAL] OK, yeah, I have.
[CUSTOMER][NEUTRAL] Yep, he's here. Oh yeah, I think I know what number you have. It's gonna be, it's gonna be the main company line. It's [PII]. I'm assuming.
[AGENT][NEUTRAL] Updated in our system.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, sir. So that is what we um have. Now, what is your updated address and then I can also update the phone number if, as well.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's your new address?
[CUSTOMER][NEUTRAL] Yes, of course, uh, address.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Alright, alright, let's just.
[AGENT][NEUTRAL] OK, and then what phone number do you want to have on file for you?
[CUSTOMER][NEUTRAL] So, yeah, so my cellphone. Let's go ahead and put there um [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. So again, your address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Street, Cape Coral, 339[PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] OK. And your phone number is [PII].
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK. Now, have you updated your address, Mr. [PII], with your employer?
[CUSTOMER][NEUTRAL] That's a good question. Um, probably not. I probably need to do that, yeah.
[AGENT][NEUTRAL] Yes, sir, you would need to do that because if the way we receive enrollment information for your employer.
[AGENT][NEUTRAL] The file that we receive electronically can override this change, so I don't want you all to call back and think I did not change it, but if they still have your old address, it's going to override what I just did.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Noted. OK. I, I'll go ahead and take care of that on my part.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, and then the last thing, if you'll go ahead and verify your email address, and this does appear to be your work email that we have on file.
[CUSTOMER][NEUTRAL] So that's gonna be [PII].
[AGENT][NEUTRAL] OK, so now, have we changed it because it's a little different than that.
[CUSTOMER][NEUTRAL] OK. OK. So there must be the secondary there which is [PII].
[AGENT][NEUTRAL] OK, so, yes, sir, that is the, that is what we have on file for you. So, is that still valid?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's fine. You can't put your purse on?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Now if you want me to update that, if you wanna leave that updated that's fine, but again that is one thing that you would, if we change it to your personal, you just need to let them know that we now have your personal email on file because again that change.
[AGENT][NEUTRAL] Could be overridden based on how we receive information from your company.
[AGENT][NEUTRAL] So it's entirely up to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you want to leave this or change it.
[CUSTOMER][NEGATIVE] No, leave it as this, please.
[AGENT][NEUTRAL] OK, so have you ever set up your profile, Mr. [PII], in our portal called the online service center where you can have access to your ID cards, policy information, and claims information online?
[CUSTOMER][NEUTRAL] Um, I, I don't believe so. I do everything from the our company HR portal, so I don't know if that's separate.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, this would be separate. So I can do, I can actually email you the user guide for our portal and you can set that up to have access to that information. So I'll email that once Ms. [PII] and I are done with our portion of the call, and the email that you're gonna receive will come from [PII] team [PII].
[AGENT][NEUTRAL] And I will put APL online service center in your subject line so that that's easy for you to recognize it's not being junk mail.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] OK. All right. Well, you're very welcome and thank you for getting the timeline with me to get this information updated for you. So if that's all that, if you don't have any other questions, I'll be happy to speak back to Ms. [PII] to answer anything else she needs help with.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] Thank you, ma'am. Thank you so much. um, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're wanting
[CUSTOMER][NEUTRAL] So what I wanted to figure out.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] To find out about urgent care?
[AGENT][NEUTRAL] Oh, let me make, give me one moment to make sure that the system has.
[CUSTOMER][NEUTRAL] Yeah, I just, I wanna know basically.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, it is. So, OK, go ahead with your question.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I just wanna see basically um as I had noted at the start of the call I called sort of through the primary and basically I had to go through my deductible first um they did suggest that an urgent care is better than a hospital. I have an urgent care identified that I would go because it's in network, um, but I wanted to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Verify since you guys are the secondary uh if you would cover this visit and to what extent just so that I know kind of what cost to expect so with that in mind, what information would you need from me to see if we can figure this out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, I won't be able to, OK, as again, as I mentioned to you in the beginning of our call, Miss, I cannot guarantee payment, but I can provide you your benefit information. So, on this supplemental policy, it is designed to help you with your co-pays, deductibles, and co-insurance amounts of covered services up to your benefit maximum on this policy. You have an outpatient benefit maximum per calendar year.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of $1500 for covered outpatient services and there is no outpatient deductible.
[AGENT][NEUTRAL] Park cover
[AGENT][NEUTRAL] Person on this policy.
[AGENT][NEUTRAL] So you would present PO ID card along with your primary insurance card when you go to any.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anytime you go for medical services, always parts because most providers will call us to verify you're eligible, they will ask us, you know.
[AGENT][NEUTRAL] Specific questions that they need answered about your coverage.
[AGENT][NEUTRAL] And then they will take care of filing your primary insurance and then with APO. In the event that a provider says they don't file secondary insurance, then you can file your own claim with us. And once Mr. [PII] gets the portal set up,
[AGENT][NEUTRAL] The claims could be uploaded through that portal if you all were to have to submit them and that user guide will give instructions on submitting claims but if that need arises y'all can call us back to get the claim form and and additional information.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] So just uh make sure to present both cards from when you go for medical treatment.
[CUSTOMER][NEUTRAL] Got you. OK, so I'll do that. I'll present that and then, uh, just to, to verify, you said that if they don't file and then I missed the word that you had said, then we can go into the portal once it's set up and make the claim there. So can you just fill in that blank that I missed?
[AGENT][NEUTRAL] Um, yes, if for any reason the pro.
[AGENT][NEUTRAL] [PII] says that they do not file a secondary and supplemental insurance, you all can do it. And then you could call us back. We could tell you where to get the claim form that you would need to submit, and the claim form has the additional um documents on it that would also need to be submitted with the claim form, and that could all be uploaded.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Directly into that portal once Mr. [PII] gets.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] The profile set up.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Yeah, that makes sense. OK, perfect. So I've got the information.
[AGENT][NEUTRAL] Mhm. Now, on this policy for, for you to
[AGENT][NEUTRAL] OK, so one last thing, I just want you to be aware, we can review, you know, urgent care would fall under this if you receive treatment done within a doctor's office, but a doctor's office visit charge is not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just to make you aware of that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. Now, uh, with that in mind, is there anything specific that I should ask or say once I'm in urgent care to determine whether or not it would be considered a doctor visit?
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Well, urgent care should be separate. I mean, urgent care has a different type of billing. I just wanted to make you aware. A lot of people think that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know that office visits are automatically covered and under this particular plan that his employer selected, they are not.
[AGENT][NEUTRAL] If you were to hypothetically, if you went, let's um as an example.
[CUSTOMER][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] Cut your finger and you want to say your primary care doctor, not urgent care, but primary. And they charged you an office visit fee, but they also maybe stitched up your finger. OK. This is just an example. We could review that, the stitching part, the procedure that they did.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Under this
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Same outpatient benefit that I just gave you, office visit portion would not be covered under this supplemental policy.
[CUSTOMER][POSITIVE] Got you. That makes sense. OK, perfect. I think I got all the information that I needed then. I so appreciate your help, [PII], with all of this and with the help of my husband.
[AGENT][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, well, it was my pleasure. So do you all have any other questions at the moment that I can help you with?
[CUSTOMER][POSITIVE] No, no more questions you've answered them all again. I appreciate your time and all the information you provided. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly welcome.
[CUSTOMER][POSITIVE] So, I wish you a wonderful rest of your day.
[AGENT][POSITIVE] So thank you both for calling APL and I hope that you both have a
[AGENT][POSITIVE] Oh, thank you so much. You too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Take care. Bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] You too. Bye bye.