AccountId: 011433970860
ContactId: c03b3815-fa55-4f3d-9cab-4cfb660ed6dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374760 ms
Total Talk Time (AGENT): 168545 ms
Total Talk Time (CUSTOMER): 152523 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/c03b3815-fa55-4f3d-9cab-4cfb660ed6dd_20250327T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I am trying to understand my medical plan. I want to go in and just get my annual, um, Pap smear done with my gynecologist. And I, I, I, they don't seem to take this insurance, but reading the insurance, it appears that it's like hospital benefit and out outpatient benefit. I'm just trying to understand what's covered and how this works.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with your benefits. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] I have a group number, not a policy number.
[AGENT][NEUTRAL] OK, what is your social, and that'll pull in your policy for us.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], I think I have you pulled up now. Um, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You want the phone number?
[AGENT][NEUTRAL] Yes, your phone number and email address please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a couple of email addresses. I'm not sure which one is attached to this. It's either my name [PII] I.
[AGENT][NEUTRAL] This one's
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Yes, that's it. Yes, ma'am. Thank you so much for verifying that information for me, Ms. [PII]. OK, let me um give you your policy number, so you have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 256-457-0.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify your benefits. It's not a guarantee of payment. This policy is a supplemental insurance policy that's billed secondary to your primary. It helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] So you have, um,
[AGENT][NEUTRAL] An inpatient, like you said, calendar year benefit amount of $6500.
[AGENT][NEUTRAL] And then you also have an outpatient calendar day benefit amount of $750.
[AGENT][NEUTRAL] I'm gonna look to see if you have office visits.
[CUSTOMER][NEUTRAL] So what am I actually so, so you're telling me that if I have a insurance policy with another company, this one is considered a secondary insurance policy to back up the other ones to make the deductibles.
[AGENT][NEUTRAL] Right, for your, for your major medical insurance.
[CUSTOMER][NEGATIVE] OK. So if I don't have a a first insurance, what's the point of this?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you don't have major medical insurance through your company, then this policy will not pay because you have to have active major medical insurance for this one to work.
[AGENT][NEUTRAL] Because it goes by the.
[CUSTOMER][NEGATIVE] So I'm paying for something, so, so I'm paying for something that I don't use. It's basically what sounds like right now. Cause I don't have a first.
[AGENT][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] A primary insurance.
[AGENT][NEUTRAL] You don't have it through Florida Blue through your employer?
[CUSTOMER][NEUTRAL] Um, well, I don't, I, I, I'm not sure actually. Does it appear that I do through yours?
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Uh, this policy is for, um,
[AGENT][NEUTRAL] It's done through your employer.
[CUSTOMER][NEUTRAL] Yes, I realized that.
[AGENT][NEUTRAL] So your benefits that you have with your employer would if you had Blue Cross Blue Shield through Florida Blue.
[AGENT][NEUTRAL] It would um help.
[CUSTOMER][NEUTRAL] That's what I thought was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what I thought was happening, but I, I, I, it, it doesn't appear to be that way. So I guess I should be speaking to human resources to find out.
[CUSTOMER][NEUTRAL] What's going on with this?
[AGENT][NEUTRAL] Yes, ma'am. I would do that because this goes hand in hand with your major medical insurance.
[CUSTOMER][NEUTRAL] So this has to this rides with the primary. This is a secondary insurance. So it really doesn't cover anything.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Right. It helps with the deductible, co-pay, and
[CUSTOMER][POSITIVE] OK, all right, I appreciate it helps with the primer.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct. I understand.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So if I do if I figure out this thing and we do in fact have Florida Blue.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Whatever I put through to Florida Blue, does that automatically then jump to you or am I responsible to submit something to you?
[AGENT][NEUTRAL] Uh, if you hand them both cards, your major medical insurance, and this one, the facilities will normally, uh, send the claim for you for both because the explanation of benefits from your primary insurance needs to be sent with for this insurance.
[AGENT][NEUTRAL] And most of them know that.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yeah, I'm sure there's a, a miscommunication somewhere. OK, I appreciate this. Thanks for your help.
[AGENT][POSITIVE] That's OK. You're very welcome. You're welcome, Ms. [PII]. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.