AccountId: 011433970860
ContactId: b9fb8895-f6a7-41c4-a72c-a58ebf9d4a2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 949099 ms
Total Talk Time (AGENT): 402058 ms
Total Talk Time (CUSTOMER): 331986 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/b9fb8895-f6a7-41c4-a72c-a58ebf9d4a2e_20241231T19:05_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, hey [PII], this is [PII]. um, we are, I'm a new user, uh, for, uh, for APL, uh, and I was trying to log in and create my, I guess, as a new user, and I have not, I've tried twice now and I'm not able to get through for some reason saying having a problem. I was hoping you could help.
[AGENT][POSITIVE] All right. It would be my pleasure. It would be my pleasure, Mr. [PII], and we just need to verify the, the information. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] I do, um, it is let's 02569251.
[AGENT][NEUTRAL] Thank you. And what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you. It is [PII]. OK. And what is your current mailing address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It should be your residential or business?
[AGENT][NEUTRAL] Looks like residential.
[CUSTOMER][NEUTRAL] OK, it should be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright thank you and what is your email address? Looks like we have your business email on file.
[CUSTOMER][NEUTRAL] Yeah, that should be [PII] or [PII] either one.
[AGENT][NEUTRAL] OK, we do have the lead. Mac on file.
[CUSTOMER][NEUTRAL] OK, that's fine it's easy to remember.
[AGENT][NEUTRAL] Is that the one you've been trying to use to create an account?
[CUSTOMER][NEUTRAL] Well, I used both. I entered the Lee. Mac originally, um, with my social, and then I did that didn't work and then I entered the Lee. Mac one and then that also did not work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is a good call back number for you?
[CUSTOMER][NEUTRAL] Uh, this number I'm calling from, which is [PII].
[AGENT][NEUTRAL] Alright, and finally, can we verify your social please sir?
[CUSTOMER][NEUTRAL] Mhm uh [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] So everything matches.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just check a couple of things here for you.
[AGENT][NEUTRAL] And are you using a laptop or desktop?
[CUSTOMER][NEUTRAL] A desktop, well, laptops, sorry, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Yeah so so it says which role best drive you. I'm sorry, go ahead.
[AGENT][NEUTRAL] And are you using
[AGENT][NEUTRAL] Yeah, you're gonna use that you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Did that um and then it has last name it looks like member ID or social security number.
[AGENT][NEUTRAL] So that would be social.
[CUSTOMER][NEUTRAL] Um, residential zip code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's verify the spelling of your name. Is it [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][NEUTRAL] OK, just making sure on that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] I just, I'm gonna try to, try to see what's happening. Let's see, social is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your residential zip is [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] And we're using the [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Mhm, that's correct.
[AGENT][NEUTRAL] And your date of birth.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, that's it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Come on now.
[CUSTOMER][NEGATIVE] And it took a while even before it gave me anything back. I'll try it on my end as well.
[CUSTOMER][NEUTRAL] OK, so searching.
[AGENT][NEUTRAL] That's what mine is saying.
[AGENT][NEUTRAL] OK, it did take me to the next page to create an account.
[CUSTOMER][POSITIVE] It did, it just did that for me as well.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] It might have just been a, you know, a little glitch in this, uh,
[AGENT][NEUTRAL] System or something but I would like if it's OK with you, I would like to stay on the line, make sure you get that account created.
[CUSTOMER][NEUTRAL] Yeah, no, OK.
[CUSTOMER][NEUTRAL] Sure, no, that'd be fine.
[CUSTOMER][POSITIVE] Go go ahead at least
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so your account has been successfully created. That's great.
[AGENT][NEUTRAL] Yeah, so if you need to look at your policy benefits, let me see if your certificate is on on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you can click on your policy number.
[AGENT][NEGATIVE] And sometimes it does take a while for that to be loaded.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it is available. So you can click on that policy number and it will download your policy documents and you can view what's covered on your plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also if you need to print additional cards that is available online as well.
[AGENT][NEUTRAL] Now for your plan.
[AGENT][NEUTRAL] Providers can file claims for you.
[AGENT][NEUTRAL] And if the provider files the claims, then we pay them direct.
[CUSTOMER][POSITIVE] OK, that's what I'm hopeful that uh that they'll do because I've got the cards in front of me.
[AGENT][NEUTRAL] And just always show your APL card when you go for medical assistance.
[CUSTOMER][NEUTRAL] And it in my
[CUSTOMER][NEUTRAL] OK, um, that sounds good and I'll, I'll give it to them as soon as I, I go for the first time in, in [PII] so they can go ahead and put the other number on file.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, and it looks like it's, uh, yep, so I've got my policy number.
[CUSTOMER][NEUTRAL] There which is same one on the policy number here.
[CUSTOMER][NEUTRAL] OK, I do.
[CUSTOMER][NEUTRAL] OK, my card, so I'm, I believe I'm all set and then is it just while I have you on the phone, um, to confirm that the, the coverage essentially takes is active after I, uh, I meet my deductible which is per our primary insurance, is that correct?
[AGENT][NEUTRAL] So this policy is going to help cover that deductible and co-insurance of your primary insurance.
[AGENT][NEUTRAL] So, let's just say for example, if you are hospitalized.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, in the hospital, more than 18 hours is considered inpatient hospitalization, and you have coverage up to $2500 that we can pay towards your deductible or co-pay or co-insurance of your primary, so you don't have to pay that out of pocket.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for outpatient coverage that is we can pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would include, um, that would include things like.
[CUSTOMER][NEUTRAL] For calendar day.
[AGENT][NEUTRAL] Um, treatment in an outpatient hospital, um, ambulance service, cancer treatment in a cancer facility, diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Durable medical, physical therapy, all those benefits are covered in your policy if you look in in the schedule of benefits page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll do that in there and does that mean that so if I go to a um to a doctor and the doctor orders a lab, some extra lab work that whatever is not covered, um, I guess if I have to pay, I think my deductible is about $500.
[CUSTOMER][NEUTRAL] Originally, um, with the original policy, would it cover any of the lab work and before I meet that deductible, or is it only after I meet the deductible?
[AGENT][NEUTRAL] No, sir, this is designed to help cover your deductible amount. So when you go for, say, lab work, which is covered,
[AGENT][POSITIVE] Then if they submit a claim, well, we can help provide benefits up to that $500. So whatever they apply to your deductible or co-pay or co-insurance for that independent lab work, then we can provide benefits up to $500 per day to cover that, so you don't have to pay out of your pocket for that deductible.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, that's great to know. And then the other, and the only thing is, um, for the physicians, so if I go, for example, and I think I have a copay for our primary policy, then whatever might be charged for the physician's visit, is that a an acceptable charge?
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] That would be covered under the uh.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] The visit co-pay would not be covered. But if you have any treatment in a physician's office, such as diagnostic testing or X-rays or any type of office surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then in a doctor's office, that could be covered under that outpatient benefit of up to $500 per day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I just have to make sure that they would file that accordingly with uh with the policy or.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that's great. And then while I'm in, while I'm in here, where would I download exactly what, what are the acceptable the benefits coverage page where would I find that?
[AGENT][NEUTRAL] If you would click on your policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just click on it and it will download your policy documents. If you click on it it should say um getting file or downloading.
[AGENT][NEUTRAL] Document
[CUSTOMER][NEUTRAL] Yeah, did it.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] You should be able to view your policy documents.
[AGENT][NEUTRAL] And then if you read through the policy, it'll tell you what's covered under the outpatient like speech therapy, sleep study.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Of
[AGENT][NEUTRAL] Treatment
[CUSTOMER][NEGATIVE] Yeah, it's doing it gave me that it gave me the same error that I had before so it looks like it's the site's having a problem. It says oops, there's been an error looks like we're experiencing 10.
[AGENT][NEUTRAL] Yeah, it looked like it was struggling a minute ago when I was trying to do it as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But you do have a policy document in it.
[AGENT][NEUTRAL] If you wanted to try to pull that up later or maybe tomorrow.
[AGENT][NEUTRAL] And view the benefits. Now, I can also email you a copy of your policy if you would like.
[CUSTOMER][POSITIVE] Um, that'd be great yeah if you don't mind that just as, just as a backup.
[AGENT][NEUTRAL] Absolutely, let me just get this right over to you. Now did you want it to go to that email we have on file or do you want it to come to your personal email?
[CUSTOMER][NEUTRAL] Um, if you could send it to my personal email, that'd be great, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And you have that one on file as well?
[AGENT][NEUTRAL] I do not. What is that personal email?
[CUSTOMER][NEUTRAL] OK, that is [PII]. So that uh my last name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So that's [PII]?
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Give me just one second, I'll get this right over for you.
[CUSTOMER][POSITIVE] That's great thank you.
[AGENT][POSITIVE] Oh, it's my pleasure.
[AGENT][NEUTRAL] It takes me just a second to complete this email.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well you're doing that up it says set up direct deposit. Would that be, um, should I go ahead and set that up I guess in the case that I would file because obviously you would pay the uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, via the doctor or the lab, uh, technician service directly.
[AGENT][NEUTRAL] So that's correct. If the provider files a claim, then we will pay them direct. If you file a claim, then any benefits payable would come directly to you. So if you wanted to set that up, that's fine or if it will also give you that option.
[CUSTOMER][NEUTRAL] If they file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you file a claim, so it's, you will get that option again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I just sent that email to you. It's coming to you from the care team.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just got a care team at [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, um, and I see it and I've got the.
[CUSTOMER][POSITIVE] Yeah, the PDF OK, thank you very much.
[AGENT][POSITIVE] It's been a pleasure. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No ma'am, I think that's it.
[AGENT][POSITIVE] Mr. [PII], it's been such a pleasure to assist you today and if you ever have any questions or concerns, never hesitate to give us a call, OK? We're here for you.
[CUSTOMER][POSITIVE] OK, thank you so very much I hope you have a great [PII].
[AGENT][POSITIVE] I hope you have a great new [PII] as well and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you bye bye.