AccountId: 011433970860
ContactId: bba9de3e-00f1-4bcb-b072-b3f7cc9987a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 844979 ms
Total Talk Time (AGENT): 577910 ms
Total Talk Time (CUSTOMER): 267270 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/bba9de3e-00f1-4bcb-b072-b3f7cc9987a6_20250211T19:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII] and I had a couple of questions about my benefits, um, before moving forward with the, uh, procedure at a doctor's office.
[AGENT][NEUTRAL] OK, so you said your first, I'm sorry, your first name was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], yeah, last name is [PII], yep.
[AGENT][NEUTRAL] [PII] and [PII]
[AGENT][NEUTRAL] OK, yes ma'am. And you have some questions on your benefits, you said? Is that correct? Yes, ma'am, I can help you with that. And [PII], what is your callback number first off?
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] And the group number? I don't know if I see a policy number uh I'm like logged into your portal, um, and I.
[AGENT][NEUTRAL] OK, so you would say under my coverage, it's going to give you your policy number.
[CUSTOMER][NEUTRAL] Oh, look at that. It sure does. Um, 213-7447. Sorry about that. I had the card uh downloaded and I was looking at that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] Uh, sure. OK. So give me just a moment, uh, please, I need to get your information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I will need to verify all of your information first for security purposes and also any information Ms. [PII] that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yes, it's the only phone number.
[AGENT][NEUTRAL] All right, thank you. And lastly your email address, please, and this does appear to be your work email that's on file.
[CUSTOMER][NEUTRAL] Oh, OK, well it's through work, um, so then it's [PII], but I can also provide you with my personal email if that's helpful.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, no, we do have your work email on file that is what is on file for you. Now I could update it um for you [PII], if you wanted to change it to your personal. however, there's a possibility that the way your employer sends enrollment information.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] If it still comes up, yep, it will certainly change. If they are showing your work email on their enrollment file that they send to us, yes, it will.
[CUSTOMER][NEGATIVE] It gets overridden again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The system will change it all by itself. Um, let me look. Have you already changed it before?
[CUSTOMER][NEUTRAL] OK, no, totally understand, um.
[AGENT][NEUTRAL] Oh yeah, you did. Yes, because, well,
[CUSTOMER][NEUTRAL] Honestly, I'm not sure. Did I?
[AGENT][NEUTRAL] I don't know what it was changed from, but I can see that on [PII], it did change it.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Uh, to your work email, so.
[CUSTOMER][NEUTRAL] I changed it to my work email?
[AGENT][NEUTRAL] No, the system did. So we received a file that had your work email on it and the system.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yep, it was probably the open enrollment file.
[AGENT][NEUTRAL] Mhm. Probably, yes.
[CUSTOMER][NEUTRAL] OK, all right, so I guess that's fine. I don't know that I need to communicate over email, I guess.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, the only thing is really, no, because our communication via email we can't accept claims information in over email. This is really just to set up your profile and the online service center that has been done, but most everything is done through the portal or via the phone instead of via the email, especially anything related to claims would not be emailed.
[CUSTOMER][NEUTRAL] Or we can change it I.
[CUSTOMER][POSITIVE] In an email anyways great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Fabulous then we'll leave it as is. That's fine.
[AGENT][NEUTRAL] OK. OK. All right. And so, how can I help you today?
[CUSTOMER][NEUTRAL] OK, so I am exploring um.
[CUSTOMER][NEUTRAL] Egg freezing. And it sounds like I'm talking with my
[CUSTOMER][NEUTRAL] Like my
[CUSTOMER][NEUTRAL] Primary health coverage, is that the right word? That it's not covered there. So I wasn't sure if I had any coverage even if it was for some of the actual procedure like it's an out, it's like a 20 minute procedure um if there was any coverage because it's um.
[AGENT][NEUTRAL] Primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like outpatient and it would be um.
[CUSTOMER][NEUTRAL] At a facility. I didn't know if there was any coverage there or if there was any coverage for um medication that is not covered under my regular insurance.
[AGENT][NEUTRAL] OK. So, [PII], anything not covered by your primary insurance would not have any benefits under this policy either, because this policy is designed to help you with your co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So if they don't cover it, this, there's nothing, you know what I mean, there's nothing for us to, there's not gonna be anything applied to your deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] If it's not covered by them.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's how this plan works. So any time a claim is submitted to us for review, [PII], we always have to have a copy of your primary insurance company's explanation of benefits associated with that data service. So yes, if it's not covered by them, there would not be any coverage under this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Interesting. OK. And if the, if like medication ended up being partially covered, would that be something I could submit a claim for?
[AGENT][NEUTRAL] Yeah, because they're like.
[AGENT][NEUTRAL] Medication is not covered under this supplemental policy of any type.
[CUSTOMER][NEUTRAL] Nothing. OK, OK.
[AGENT][NEUTRAL] Mhm. Yeah. Let me look, um, I'm gonna pull, let me just look at one thing.
[AGENT][NEGATIVE] Yeah, see this plan doesn't have um.
[AGENT][NEUTRAL] Pharmacy benefits on it.
[CUSTOMER][NEUTRAL] Got you, OK.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] I see where it starts, so I can, because there's a copy of your policy certificate in your portal also it's in a PDF format.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You can go, there's a list of exclusions.
[AGENT][NEUTRAL] Your total document is 50 pages in length. So if you're looking at the overall total pages, it would be page.
[CUSTOMER][NEUTRAL] Oof.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't, where do I see that? I can see available ID cards and I can click for a PDF, but.
[AGENT][NEUTRAL] OK. So you need to go to the policy itself, not to the ID cards, but the policy certificate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Alright, I clicked on that it says starting download.
[AGENT][NEUTRAL] Download, OK. So yes, it's a total of 50 pages. So you can um
[AGENT][NEUTRAL] Under the exclusions section, which is section 6.
[AGENT][NEUTRAL] And then it, it runs over into two. No, you're fine, but it lists out um.
[CUSTOMER][NEUTRAL] Yeah, it hasn't opened sorry it hasn't opened yet.
[AGENT][NEUTRAL] Like 22 things.
[CUSTOMER][NEGATIVE] OK, yeah, it's not downloading for some reason.
[AGENT][NEUTRAL] And you can see under there.
[CUSTOMER][NEGATIVE] When I click on like I'm looking at my coverage, it says product policy number effective date when I click on the policy number it says that it's starting to download but nothing happens.
[AGENT][NEUTRAL] Uh-huh. Uh-huh.
[AGENT][NEUTRAL] Are you on, are you on a computer? I forgot to ask you that or on your phone trying to download the computer?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Or phone. OK.
[CUSTOMER][NEUTRAL] I'm on a computer, uh, computer.
[AGENT][NEUTRAL] OK, so there have been a few, I don't know if they possibly are doing a little work in the online service center today. You're the first person that I've spoken with that's had an issue with it, but I do know some of my team members have inquired if anyone else was having um an issue, but this is not the same issue as.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A team member of mine had reported earlier, said it's, it's possible that they might be working in it. I'm not sure. Oh, OK. So if you go to your exclusion section, um, [PII], it does talk about the medication and it does drugs, prescription and non-prescription for use outside of a a covered facility as defined in the certificate.
[CUSTOMER][POSITIVE] No worries, I actually just got it, so I think we're OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] And then it goes on to state an expenses or service that's under number 20 an expenses or service, no, I'm sorry, that's not what I meant to OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, just a minute.
[AGENT][NEUTRAL] 21, any extent for which benefits are not payable under the other medical plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that you can
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, cause there would, there wouldn't be anything for your deductible, co-pay or co-insurance if they're not covering it. And that's what this policy is designed to help with.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting. Alright, well, it was worth asking. Um, I can give this a closer read, but that makes sense.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes. And then again, and then there's two different sections. Uh, there's one's your schedule of benefits like if you were admitted as an inpatient into the hospital, and then farther over, there's another schedule for outpatient benefits and it gives you like the places of service that we can review for um for covered services and your benefit amounts.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then there's definitions, you know, that correlate with the bolded words, for example, you know, that breaks down what each thing actually means.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, no, this is very helpful. I will take a closer look at this. Thank you for pointing me to it, um.
[AGENT][POSITIVE] Oh, you are certainly very welcome.
[CUSTOMER][NEUTRAL] I think that is all my questions for right now.
[AGENT][NEUTRAL] OK, well, if there's anything else, and always, which you may already do this, [PII], but anytime you go for medical services, always present your APL card along with your primary insurance card because most providers will handle both for you since they have to file with your primary first and then with APL because of us having to have that explanation of benefits from your primary insurance. But in the event,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, but in the event,
[CUSTOMER][NEUTRAL] I didn't know that.
[AGENT][NEUTRAL] That the provider doesn't, or, for example, like on your policy, office visits aren't covered, right? But we could review treatment within the doctor's office that's covered. We could review the treatment itself but not the office visit. So a lot of times they will call to verify that your policy is active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And say, you know, we need to check benefits for office visits and procedures done in the office. And at that point, we would give them the same disclaimer I gave you about not guaranteeing payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And explain office visits aren't covered, however, we can review the treatment and it would fall under her outpatient benefit maximum which on your policy is I believe $1000 per calendar day for covered outpatient services. So and they'll they'll handle everything, but in the event they don't, you can call us, we can tell you where to find the claim form which has all the instructions, and you can upload that all into your portal.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For our review.
[CUSTOMER][NEUTRAL] OK, that is helpful. And do you, do you mail the cards or is it just getting the PDF online? I don't know that I received a physical card this year.
[AGENT][NEUTRAL] Let me see how your employer.
[AGENT][NEUTRAL] So, we don't mail them out every year, [PII], unless there's been some type of change.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To your organization's offerings, you know, it's not a once a year thing, um, so unless something changes we don't unless you request them now I'll be happy to request some more cards mailed to you. Mhm, sure. I.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you mail me one?
[CUSTOMER][POSITIVE] That would be great. Thank you.
[AGENT][NEUTRAL] Uh, absolutely. And it does take about 10 business days, give or take, with the mail, but they should come in an envelope that would be labeled, you know, APL to, um.
[CUSTOMER][POSITIVE] OK, no problem, yeah.
[AGENT][POSITIVE] For you to pretty easily recognize them, but yes, I will submit that request for you right now.
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate your help today.
[AGENT][POSITIVE] You are certainly so welcome. And is, again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, not right now. You've been great, thank you so much.
[AGENT][POSITIVE] Well, you are certainly welcome and it was my pleasure and have a wonderful afternoon. Thanks again, [PII], for calling APL.
[CUSTOMER][POSITIVE] Thank you, take care.
[AGENT][NEUTRAL] Uh, you too. Bye-bye.
[CUSTOMER][NEUTRAL] I