AccountId: 011433970860
ContactId: b8e8c0e5-422b-403d-8943-dcf093b29fb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339339 ms
Total Talk Time (AGENT): 181924 ms
Total Talk Time (CUSTOMER): 99136 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/b8e8c0e5-422b-403d-8943-dcf093b29fb4_20250401T15:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Can you explain to me what what this is for? I'm, I'm unsure and I've never used it. I've had it since August, but I'm, I'm, I'm not really understanding what APL does.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, yeah, we could take a look at what kind of policies you might have and how they work um what was your name?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then, uh, do you have a policy number?
[CUSTOMER][NEUTRAL] Um, I have a payer ID, a coverage, a group number.
[AGENT][NEUTRAL] Are you looking at the card?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you see anything on there that says um like outpatient or in hospital uh certification number?
[CUSTOMER][NEUTRAL] Yeah, it says plan meds, so uh it says in hospital benefits cert number and outpatient benefits cert number.
[AGENT][POSITIVE] Perfect. Either one of those, please.
[CUSTOMER][NEUTRAL] 0250.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 493 7
[CUSTOMER][NEUTRAL] Mary Lima 7.
[AGENT][NEUTRAL] Got it thank you. Alrighty and then I'm just gonna verify some information really quick, uh, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I have several. I have [PII]. I have [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] That's it. That's the one. Alright, thank you so much for verifying that. OK, so this is a secondary medical policy. So in short it is designed to help with co-pay, deductible and co-insurance after your major medical pays. And if you'd like, I can send you a copy of this policy. It's very easy to read. It's not just a bunch of jargon, I promise, but it does go through what is and is not covered dollar amounts, frequencies, things like that.
[CUSTOMER][NEUTRAL] OK, so like, um.
[CUSTOMER][NEUTRAL] You know, uh, I, I have to see a specialist. It's a $60 copay, um, I think that they might be out of network, so I'm not really sure, and I didn't, I was wondering why don't I have like an HSA card or I thought maybe this worked as an HSA card, so I didn't know, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, so this isn't, um, not necessarily with an HSA, uh, it is simply a secondary medical policy, so it's designed to work with your major medical. It can't be used instead of your major medical. So if you know you like you said, if uh your major medical would not pay or they're not willing to pay for any procedure or anything like that, this policy can't.
[CUSTOMER][NEUTRAL] Cause, you know,
[AGENT][NEUTRAL] If they do, this policy can help with those co-pays, deductibles, and then co-insurance as well, but it does have its own policy as well for specific things that are and are not covered. So if you'll give me one moment, I will check to see if office visits are covered under this policy. Give me just a moment.
[CUSTOMER][NEUTRAL] It's actually going to be telehealth appointment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment, let me find your outpatient benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So covered outpatient benefits are not going to include any sort of office visit or telehealth visits. Um, this looks like it's going to be more um hospital emergency room, urgent care, um, any sort of outpatient surgery, uh, diagnostic testings like MRIs, and then, um,
[AGENT][NEUTRAL] Let's see, physical therapy is covered and then the ambulance benefits as well.
[CUSTOMER][NEUTRAL] OK, so what I'm the appointment I have today is not something that's covered.
[AGENT][NEUTRAL] Right, if it's a telehealth or something like that then that's not gonna be a covered benefit, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, good to know.
[AGENT][NEUTRAL] Yeah, did you want me to go ahead and send you a copy of this policy? I can email it to you.
[CUSTOMER][POSITIVE] Oh, that would be great thank you.
[AGENT][NEUTRAL] Sure, absolutely, um, just to this Gmail that we've got on file for you?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK perfect I'll go ahead and send that to you um you know you could give it a read and if you find something you don't quite understand you need clarification, feel free to give us a call back with this can definitely be very confusing.
[CUSTOMER][POSITIVE] For sure. Thank you. I appreciate it.
[AGENT][NEUTRAL] Yeah, did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] Alright well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.