AccountId: 011433970860
ContactId: bb1abd32-61d5-435c-bdbf-b24d3ac75e80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1144589 ms
Total Talk Time (AGENT): 369805 ms
Total Talk Time (CUSTOMER): 556228 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/bb1abd32-61d5-435c-bdbf-b24d3ac75e80_20250109T15:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hey, good morning. How are you?
[AGENT][POSITIVE] I'm doing well sir how are you doing this morning?
[CUSTOMER][POSITIVE] Good. It seems like we have a.
[CUSTOMER][NEUTRAL] Line we'll we'll see if we can get through it.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK, could you just remind me your name? My name is [PII], and can you remind me your name? I know you did say it.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEGATIVE] Oh wow, you've got a bad line. What was it? Sorry, [PII], did you say?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, hopefully the the line improves. OK, so, um.
[CUSTOMER][NEUTRAL] I have um.
[CUSTOMER][NEUTRAL] I guess I have coverage.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] You guys
[CUSTOMER][NEUTRAL] Um, APL, but I'm really not sure what it means.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Well help you use it, um.
[CUSTOMER][NEUTRAL] Um, it's through my, um.
[CUSTOMER][NEUTRAL] Employer and I'm just, and when I inquired, you know, the lady um.
[CUSTOMER][NEUTRAL] That handles all that in our office.
[CUSTOMER][NEUTRAL] It was like he was talking another language to me, so, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just wondering if, if you could help me understand what what it.
[CUSTOMER][NEUTRAL] Because you said whenever you, if you go to the doctor, make sure you give both of your insurance cards.
[CUSTOMER][NEUTRAL] That's what he said.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. I understand, [PII].
[CUSTOMER][NEGATIVE] So yeah, so I'm, I'm, I'm completely lost.
[AGENT][NEUTRAL] OK, I can help you with your benefits, [PII]. What is
[CUSTOMER][NEGATIVE] Oh, we got a bad line.
[AGENT][NEUTRAL] What's your call back number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. OK, I'm gonna give you my number [PII].
[CUSTOMER][NEUTRAL] But um just a quick question, do you have headphones on?
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEGATIVE] OK, because it's, um, I, I, I, you know, maybe I'm wrong, um, and, uh, not to be judgmental, um, but it, it, it's, it's cutting in and out and I don't know, uh, um.
[CUSTOMER][NEUTRAL] Like it's you, um, it's choppy when you're speaking.
[AGENT][NEUTRAL] OK, let me see if I can adjust anything on my end to help with that. Hold on please, [PII].
[CUSTOMER][POSITIVE] Thanks sweetie.
[AGENT][POSITIVE] OK, looking on my end it looks like everything is OK. I've got good connection. Are you calling from a cell phone?
[CUSTOMER][NEUTRAL] I am and and and the same here. I was just trying to look for a solution right so we'll just do the best we can thank you.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK [PII], what is your policy number?
[CUSTOMER][NEUTRAL] OK, let's look at this. OK. Um, policy number 025.
[CUSTOMER][NEUTRAL] 01558.
[AGENT][NEUTRAL] OK, let me pull your policy in real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and then for security reasons can I get you to verify your address, phone number and email address?
[CUSTOMER][NEUTRAL] OK. I, I, you know, I didn't sign up for it, so I don't know what they may have, um, what they may have given. They may have given the, our work address. So I'll start with, um, because I know it's a, a group.
[CUSTOMER][NEUTRAL] I think it's a group. I, I don't know, um, but, um, you know, it's, it's through Nuno Builders at [PII]. I don't know if that's the address.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK what is your physical home address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's what I'm showing. And do you have an email address that you'd like to add to the policy?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I'd rather not add it.
[AGENT][POSITIVE] OK, thank you, sir.
[AGENT][NEUTRAL] All right, let's look at your policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, this policy is no longer active.
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][NEUTRAL] You're welcome. So, as of, uh, [PII], it lapsed.
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] All right, so could you in, in case they redo it because I guess we're in um uh uh they would be redoing all of our um.
[CUSTOMER][NEUTRAL] Uh, stuff, um.
[CUSTOMER][NEUTRAL] For the coming year, uh, uh, maybe they've already done it. I just haven't got the information. What, what was it for?
[AGENT][NEUTRAL] OK, I can tell you what it was for, um, it was.
[AGENT][NEUTRAL] And um OK so it's a supplemental insurance policy. Your primary insurance is billed first, and this is just to verify your coverage. It's not a guarantee of payment. Your primary insurance is billed first. This would be billed secondary, so it's a gap insurance that helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] When the policy was active.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] You had an inpatient, if you went into the hospital for more than 18 hours.
[AGENT][NEUTRAL] You had an inpatient benefit of $4100 that helped towards your deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you had anything done outpatient.
[AGENT][POSITIVE] You had a benefit of $2050 that helped towards your deductible co-pay or your co-insurance.
[AGENT][NEUTRAL] So that's why she told you to hand them both cards because your primary insurance card will be billed first and then this one would be billed second.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if, OK, um,
[CUSTOMER][NEUTRAL] So just um hypothetically speaking, hypothetically speaking, if there was an emergency room visit.
[CUSTOMER][NEUTRAL] Um, in November.
[CUSTOMER][NEUTRAL] And um it went through my insurance.
[CUSTOMER][NEUTRAL] Um, and my insurance paid out a certain amount and there was a small amount that I had to still pay. Is that what this covers? A portion of that?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir. Um, so let me see if you had emergency room.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] On your
[AGENT][NEUTRAL] Policy.
[AGENT][NEUTRAL] Yes, sir, you did.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So your insurance wouldn't.
[CUSTOMER][NEUTRAL] Mhm. So, so.
[CUSTOMER][NEUTRAL] Oh, he's, you speak, sorry.
[AGENT][NEUTRAL] So that's OK. The facility that you went to, the hospital that you went to, to the emergency room can file a claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] For this secondary insurance, they'll have to send in the explanation of benefits from the primary insurance with their claim to show that the primary paid for their part.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. Yeah. Uh, like, so, all right. So,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If I have the paperwork from, say, um,
[CUSTOMER][NEUTRAL] United um Healthcare, which lists everything, what, what they covered and what is remaining.
[CUSTOMER][NEUTRAL] Can I send that to you or not?
[AGENT][POSITIVE] Yes you can.
[CUSTOMER][NEUTRAL] OK, and then what happened?
[AGENT][NEUTRAL] And what you would
[AGENT][NEUTRAL] So what you would need to send it to us, there's 3 things that we're going to need. We're going to need the explanation of benefits from your primary.
[AGENT][NEUTRAL] We'll also need an itemized statement.
[AGENT][NEUTRAL] From your um.
[AGENT][NEUTRAL] The facility that you went to, the itemized statement will have the diagnosis and procedure codes on it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, this is a hypothetical just so you know.
[AGENT][NEUTRAL] And then you'll have
[AGENT][NEUTRAL] Yes, OK, and then we'll also need your, you'll you'll need to fill out the med link claim form and I can give you the website where to get that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. All right. So, so ideally, and I'm, and I'm um
[CUSTOMER][NEUTRAL] I guess I'm, I, I, I'm going to be expecting soon from our office an updated medical because it's renewed every year, uh, you know, um, so, um.
[CUSTOMER][POSITIVE] And hopefully they do this again and and and I I did have a few um.
[CUSTOMER][NEUTRAL] Um, I did, it's not many, maybe there was, uh, I, I went to, I went to an orthopedist and, you know, um,
[CUSTOMER][NEUTRAL] It, uh, and I completely forgot about this. I, I, I found it in the back of my wallet the other day and I was like, what is this? Like, I'm like,
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][POSITIVE] I know, and, and then, and then my, the memory come back to me that, oh my God, I remember being told back in January that, you know, to hand this in whenever you got anything and I didn't. And I'm like, oh my goodness, I, I, I probably, you know.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, ma'am, yes sir, so.
[CUSTOMER][NEUTRAL] Yeah, I mean, it, it does, it's too, I don't know, it's probably too late now, but anyway, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, um, so hopefully, we have it again. Um, hopefully, they, they do it again. So, so basically, what I'm understanding is that there's certain areas that it would help to cover as a secondary insurance. And basically, my primary insurance, hypothetically, United Healthcare, they would cover the most and then whatever is left for me to pay, then, then the secondary insurance could possibly kick in and cover some of that.
[AGENT][NEUTRAL] It only covers the deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] I got you. I got you. So, so, and the best way for me to um handle it all is make sure I give this uh both cards when I uh show both cards so they can have it on file whenever I have a visit anyway.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. All right. Well, it's too late now for me, I guess, but um, better to get the information late than never at all.
[AGENT][NEUTRAL] Yes, sir, that's correct. Now, if you wanted to file a claim, there's not a timely filing limit.
[AGENT][NEUTRAL] So as long as you were covered on the date that you went to the hospital, to the ER you can still file a claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] I got you. I, I never went to the hospital uh I never went to the hospital. Yeah, that was just a hypothetical.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. Yeah, yeah, that's what I said just a hypothetical, but I did go to, I did go to an orthopedist back in um January slash February, and I, I should have handed it out. I forgot all about it.
[AGENT][NEUTRAL] OK. Yes, sir.
[AGENT][NEUTRAL] Yes, sir. I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, it was that, uh, and I was only it was only my co-pays that I was paying anyway, but what, what you're saying is that that would have been covered?
[AGENT][NEUTRAL] the policy does help with deductible, co-pay or co-insurance.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Hm, so I, I, uh, my mistake.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] But are you, are you saying I can still send that in or no?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Hm. So what, what would, what would I what would I have to do though? So I, I would have to um find those receipts.
[AGENT][NEUTRAL] You would need the explanation of benefits from your primary insurance to show that they paid their part. You'll need the itemized statement from the facility that you went to, the orthopedic facility you went to.
[CUSTOMER][NEUTRAL] All right, OK, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, the itemized statement has your diagnosis codes and procedure codes, and then you'd need to go to our website, which is [PII].
[AGENT][NEUTRAL] You would need to download the Medin claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Fill out the claim form and I can give you the address to um mail it into.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um, hmm, OK, interesting.
[AGENT][NEUTRAL] Would you like the address or the fax number to send the claim in?
[CUSTOMER][NEGATIVE] I should have just given
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Not at this moment. I, I guess I'm just gathering information and, you know, and, and kind of weighing up, you know, I've already paid it, I've already paid it, you know, is, is, you know, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You know, I don't even know what I'd be getting back, you know, maybe nothing, who knows, you know, so I'm trying to weigh out, weigh up, you know, is it even worth it?
[AGENT][NEUTRAL] Yes, sir. I understand.
[CUSTOMER][NEGATIVE] Plus, I don't even know if I have all, I don't even know if I kept all that stuff. You know, I may have, I may have got rid of it. But then I still have to go back to the hos to the orthopedist and request all this stuff, you know, it may not be worth it. It might be like hours of work for, you know, nothing. So, um,
[AGENT][NEUTRAL] Right, I understand that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I just gotta remember for next time, hand the card in. And I was told that by, by the lady in the office, but I just forgot.
[AGENT][NEUTRAL] I understand, sir. OK. Well, [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, um,
[CUSTOMER][NEUTRAL] I know where you guys located?
[AGENT][NEUTRAL] Uh, our corporate office is in [PII].
[CUSTOMER][NEUTRAL] Uh, I, I, I, all right. OK, so you work from home, I can tell.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So you didn't even say it, but I knew it.
[AGENT][NEUTRAL] Because of my accent? Did that, did that give me away?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, did my accent give me away? Where am I calling from?
[AGENT][NEUTRAL] Uh, I have no idea.
[AGENT][NEUTRAL] Where you're calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, yeah, no, no, it, it didn't give it away, but, um, sometimes.
[CUSTOMER][NEUTRAL] Sometimes, um,
[CUSTOMER][NEUTRAL] It's not what people say, it's what people don't say that has the information.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] I, I understand.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, so when you said, you know that, uh, when I asked, when I asked you, you know, where you're located, um.
[CUSTOMER][NEUTRAL] The way in which you answered told me that you're working from home.
[CUSTOMER][NEUTRAL] Even though you didn't stop working from home.
[AGENT][NEUTRAL] When I told you that our corporate office is in [PII].
[AGENT][NEUTRAL] If I had just said [PII], you would have known that I might have been in the office?
[CUSTOMER][NEUTRAL] Yeah, the the the
[CUSTOMER][NEUTRAL] Um, well,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, there was a a a hesitation in your answer, like there was a pause.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] Um, they told me that the information that you are giving me.
[CUSTOMER][MIXED] Um, was accurate, but there was something else attached to it that was missing.
[AGENT][POSITIVE] Very intuitive.
[CUSTOMER][POSITIVE] Yeah, well, thank you, um.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Thank you for being so um polite, um, in, in, in having the conversation relating to that, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][MIXED] You know, it might sound silly, but I was forgetful about the card, but I'm pretty astute and aware of a lot of things that are going on, you know, around me, so, but I guess I was pretty naive in regards to the card.
[AGENT][NEUTRAL] Yes, sir. That's OK, that happens. That happens more than you know.
[CUSTOMER][NEUTRAL] The APL card.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I guess I, um, something that I've learned recently is in listening to what people share with you, sometimes it's about what they don't say.
[CUSTOMER][NEUTRAL] There's a lot of information in that.
[AGENT][POSITIVE] I agree.
[CUSTOMER][POSITIVE] Yes, all right, um, well, you sound like a, a nice lady, and I could probably talk to you for longer, but I will because I gotta keep moving here and I'm sure you got calls to answer and things to do as well, but you have a blessed day and thank you for all the information and, and hopefully we have this thing again, um, for the coming year in regards to my work. It would be helpful and this next time I will use it.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK. All right, [PII]. Well, you have a blessed day also, and we thank you so much for calling APL.
[CUSTOMER][POSITIVE] You got it thanks a lot. Have a wonderful day yourself bye.
[AGENT][POSITIVE] Thank you, sir. Bye-bye.