AccountId: 011433970860
ContactId: be156446-80fb-4883-bfe5-5184c59db451
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668700 ms
Total Talk Time (AGENT): 295213 ms
Total Talk Time (CUSTOMER): 315835 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/be156446-80fb-4883-bfe5-5184c59db451_20250109T21:19_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] [PII], um,
[CUSTOMER][NEUTRAL] My husband handed me this, this, um,
[CUSTOMER][NEUTRAL] I guess ID cards from APL and uh we have no idea.
[CUSTOMER][NEUTRAL] What is, what is the, the additional coverage for or the, the, the plan that link uh and how to use this, this program? Can I give you my payer ID number?
[AGENT][NEUTRAL] Actually what we need is the policy certificate number. It could be at the bottom under the inpatient or outpatient. OK, that's fine thank you.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] Yeah, it's on the card.
[CUSTOMER][NEUTRAL] It's 0255.
[CUSTOMER][NEUTRAL] 0857.
[AGENT][POSITIVE] Thank you. And what is your husband's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is his date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. Is he available to give me permission to speak with you?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Yeah, let me see if I can, I can interrupt him real quick. Bear with me, please. I got good.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Ma'am, she's right, he's right here.
[AGENT][NEUTRAL] Good afternoon, Mr. [PII]. Hi, this is [PII] with APL. Do I have permission to speak with your wife regarding your policy benefits?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Yes you do, ma'am.
[AGENT][POSITIVE] All right. Now, this will just be for this call and I'll be happy to assist her. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, ma'am. Take care.
[AGENT][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. So, I do need to verify the current mailing address, please.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you and it looks like we may have [PII] work email on file can you verify that?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Is it A [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so do you work [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Well, I own the company that they come.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I think you worked there then.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Yeah. So, anyway.
[AGENT][NEUTRAL] Yeah, it looks like we actually have your email on file and what is a good callback number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And what was your first name again?
[CUSTOMER][NEUTRAL] So [PII], but you can call me [PII] easier that way.
[AGENT][POSITIVE] And thank you.
[AGENT][NEUTRAL] Thank you, ma'am. OK, so this is your secondary gap policy.
[CUSTOMER][NEUTRAL] Secondary gas, it's called.
[AGENT][POSITIVE] Mhm. And this is going to help cover your deductibles or co-insurance of your major medical.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And how do we, how do we use, use that to cover our
[CUSTOMER][NEUTRAL] Uh, deductible and, and co-pay.
[AGENT][NEUTRAL] Mhm, so I would tell you that all benefits given over the phone is a verification of coverage on your policy. It is not a guarantee of payment just means that we can't process the claims until we have them in house.
[CUSTOMER][NEUTRAL] Oh yeah, I understand that. I'm just trying to understand how, how, how I can use it is this.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Is this coverage just for him individually or is a spouse too I have?
[AGENT][NEUTRAL] It is just for your husband, [PII]. That's why I had to get verification that I could speak to you.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That, that's fine.
[AGENT][NEUTRAL] Now he's gonna show his APL card with his primary insurance when he goes, say to a hospital if he's confined in a hospital.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Well, if he goes to an emergency room, urgent care facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] Or a diagnostic testing in an outpatient hospital facility or an MRI facility. That is what is covered under his plan.
[CUSTOMER][NEUTRAL] OK, so, OK, let me understand, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This will have to provide this to, let's say he's gonna have his X-ray taken.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so we'll, we'll provide this card as well because we already in the system, uh, where medical facilities we're going, they have our primary coverage. So this APL is additional if I provide the information for them, what's, what's the benefit? They will apply the APL deductible or what?
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what they'll do is they'll follow with your your primary insurance first. Once your primary insurance has processed a claim, then they will send a claim to us, and they'll also include how your primary insurance process the claim and what they applied to your deductible or co-insurance.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] And then if it's a covered service, then we can pay for that deductible co-pay or co-insurance up to the benefit amount listed on the policy.
[AGENT][NEUTRAL] Now it looks like you have an active account online on our APL portal.
[CUSTOMER][NEUTRAL] Understand.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you click on the policy number, it will download your policy document.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And within the policy document, there is a page called the Schedule of benefits page.
[AGENT][NEUTRAL] And that'll have it all in one page of the services that are covered through APL.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, but it just tells us this card also say.
[CUSTOMER][NEUTRAL] That we have to.
[CUSTOMER][NEUTRAL] What did you say here because you registered online service. I think we have the online service already.
[AGENT][NEUTRAL] You do, yes ma'am. I see that that is active and that is where you can actually view your policy benefits is on that portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, it's under [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I need to put, I think I must be the one that set it up and I forgot about it.
[AGENT][NEUTRAL] It looks like it.
[CUSTOMER][NEUTRAL] I mean, you know, I, all this thing just slip through your fingers, um.
[AGENT][POSITIVE] It does, it's so easy.
[CUSTOMER][NEUTRAL] Yeah, so, OK, I'm gonna see if I can access them and get all the information. So just on a in a nutshell, uh, I'm gonna see if I got it right. With this card, I put it in his wallet and I have to remember that everywhere we go for any medical services in terms of uh imaging.
[CUSTOMER][NEUTRAL] Even, even, um, like dermatology or any kind of medical.
[CUSTOMER][NEUTRAL] Coverage that we have with our primary. We show them this card.
[AGENT][NEUTRAL] Except for services in a doctor's office, services in a doctor's office is not clear a covered benefit for the policy guidelines.
[CUSTOMER][NEUTRAL] And they were
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So this is, what is this gap policy um that you just mentioned, deductible and copays for, uh, you say MRI imaging?
[AGENT][NEUTRAL] If you go to an outpatient imaging facility or outpatient hospital.
[AGENT][NEUTRAL] Or an MRI facility, imaging would be covered in those facilities.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Also for outpatient surgery in an outpatient hospital or an ambulatory ambulatory.
[AGENT][NEUTRAL] A free standing facility.
[AGENT][NEUTRAL] Um, he can go to an urgent care 3 visits per calendar year is covered.
[CUSTOMER][NEUTRAL] Mm, hopefully, um we're pretty healthy, but I don't know why we have that but sometimes last minute emergency. OK, urgent care, yeah, you say ambulance services too?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like in an ambulatory outpatient surgical center?
[CUSTOMER][NEUTRAL] Oh, what is that?
[AGENT][NEUTRAL] That would be like if you go, say for outpatient surgery, and you're not going to the hospital, but they have a surgical facility that's not attached to a hospital.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I say, but still belongs, but still belongs to the, the main hospital, but they do have other.
[CUSTOMER][NEUTRAL] Uh, facilities and clinics for, for outpatient surgeries, that does, does that mean that it's covered too?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it is billed as an outpatient facility, then it can be considered for benefits as well.
[CUSTOMER][NEUTRAL] But it's connected to the hospital, it's still OK, right?
[AGENT][POSITIVE] Should be fine, yes ma'am.
[CUSTOMER][POSITIVE] OK, got you. All right, then those are good to know. Um um, all right, thank you so much. You've been very kind. I will go ahead and try and lock in. And is there anything if I get into to get back online to the, to the online service center, is there something that he, I can also put there on file that I can be the one to.
[CUSTOMER][NEUTRAL] Call and, and ask questions in case there is future claims and stuff like that or no?
[AGENT][NEUTRAL] Yes, ma'am. So there is what's called an authorization form online.
[CUSTOMER][NEUTRAL] In his profile.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that can be completed and uploaded on his policy.
[AGENT][NEUTRAL] All of that can be done online on that portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I will look into the puzzle. Thank you so much.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Ms. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am. You make my day. You are the, you are the one of the rare ones that are so patient and kind. And some, a lot of them like, I don't, yeah, you, you, your, your verbage was just so, so very kind and, and professional. Thank you so much. You have a wonderful day.
[AGENT][POSITIVE] Well, we've got to help each other these days.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] I hope you do too, Ms. [PII]. You stay warm, OK? And I hope you and Mr. [PII] have a lovely evening. Thank you for calling ATL. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[CUSTOMER][NEUTRAL] Bye.