AccountId: 011433970860
ContactId: b7736a21-dfda-4de5-bc44-7e7dda779070
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401890 ms
Total Talk Time (AGENT): 160519 ms
Total Talk Time (CUSTOMER): 129949 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/b7736a21-dfda-4de5-bc44-7e7dda779070_20250616T18:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Hi, um, I'm confused by my coverage. Every time I go to the doctor's, I give my two insurance cards and I always have to pay money. I don't know how to use this insurance.
[AGENT][NEUTRAL] OK. May I have your name, please, and a callback number?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And may I please have the policy number?
[CUSTOMER][NEUTRAL] The policy number.
[AGENT][NEUTRAL] It could be your outpatient benefit certification number.
[CUSTOMER][NEUTRAL] Just a
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] My APO policy number is 02580020.
[AGENT][NEUTRAL] And [PII], could you please verify your date of birth with me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I do need to verify the mailing address listed on file also enter an email personal email address if possible.
[CUSTOMER][NEUTRAL] OK, uh, is it 2 does it start with [PII]?
[AGENT][NEUTRAL] Your mailing address?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I'm needing your mailing address.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] The zip code please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and may I have an email address to go on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I will get that updated in the system and how may I assist you, [PII]?
[CUSTOMER][NEGATIVE] Um, so I'm not sure how to use this insurance, what this insurance covers. Every time I go to a doctor's appointment, uh, they don't know what it is. They don't, they just pretend like they don't take it. I don't know what it is.
[CUSTOMER][NEGATIVE] Um, I've been told by co-workers that I'm not supposed to be paying a copay, so I don't know what I'm doing wrong.
[AGENT][NEUTRAL] OK, so with this policy.
[AGENT][NEUTRAL] It is a supplemental or gap towards your primary insurance and in regards to office visit benefits, let me pull that up for you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Verification of coverage does not guarantee the payment of the claim. Per your policy, it does not have the office visit benefit writer, so if you have an office visit fee, you are responsible for the office visit fee.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But if you have a procedure that is rendered within an office setting, you do have benefits for that.
[AGENT][POSITIVE] And for those benefits, let me get that amount for you.
[AGENT][NEUTRAL] In regards to the office procedure benefits, you do have up to $500 per calendar day that we will pay towards the office procedure benefits.
[CUSTOMER][NEUTRAL] OK, so I have an MRI. I have to get scheduled. I don't know.
[CUSTOMER][NEUTRAL] I don't know, I'm not even from [PII], so this is very different for me.
[CUSTOMER][NEUTRAL] How do I schedule it?
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I mean I know how to schedule it but what is the smartest way so that my insurance is actually working?
[AGENT][NEUTRAL] So what you would do, you would give them your primary card as well, and you would give them this card. They will verify your benefits of your primary. Now it is the provider's discretion if they accept secondary insurance.
[AGENT][NEUTRAL] So, I can go ahead and give you the benefits as well for your outpatient benefits for the MRI as long as it is due to sickness and injury. So for that, you also have up to the $500 per calendar day for the MRI done within a diagnostic facility.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Do you have diagnostic facilities? Do you have a list that accepts APL?
[AGENT][NEUTRAL] It is based off of your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when I schedule an appointment, are they supposed to tell me how much it costs?
[AGENT][NEUTRAL] When you schedule an appointment, that provider will then contact your primary insurance. Your primary will advise them if you have a deductible co-insurance or co-pay that is due.
[AGENT][NEUTRAL] If they accept secondary insurance, then they will contact us and we will verify those benefits that you have as well. And then they will be able to distinguish if you have an amount that it needs to be paid out per patient's responsibility.
[CUSTOMER][NEUTRAL] OK, and is that usually the amount beyond $500?
[AGENT][NEUTRAL] I wouldn't be able to tell you. I don't, I'm not sure how much the provider bills.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then for emergency room, say I was to go get an MRI in an emergency room, how does that work?
[AGENT][NEUTRAL] You do have up to $500 with the emergency room as well.
[CUSTOMER][NEUTRAL] OK, so it doesn't matter if it's an emergency room or a facility, it's only $500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.