AccountId: 011433970860
ContactId: c1b23df7-4c5a-47ff-a3df-1cb387fc39b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 662169 ms
Total Talk Time (AGENT): 405521 ms
Total Talk Time (CUSTOMER): 226118 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c1b23df7-4c5a-47ff-a3df-1cb387fc39b5_20250415T16:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, morning was no, no, no, I'm sorry, good afternoon, how are you?
[AGENT][POSITIVE] I'm doing well how are you? I think it's still technically morning where I'm at, yeah.
[CUSTOMER][NEUTRAL] Oh OK, OK, I'm out of [PII], so and I'm just, I'm just getting out of bed.
[AGENT][NEUTRAL] I'm in [PII], so we're almost [PII].
[CUSTOMER][NEUTRAL] Oh, I, uh, I had this APL, uh,
[CUSTOMER][NEUTRAL] The cards come in. I and I never paid attention to them and I'm trying to get the information on what it's all about uh I, I just seen.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, in hospitals benefit certified on an outpatient. What is this, is this got to do with my gap or something like that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um, so that exactly tells me that this is for your secondary medical policy. And if you'd like, I can get that pulled up and kind of give you a brief rundown of how it works and how you can use it.
[CUSTOMER][NEUTRAL] Please, please, please.
[AGENT][POSITIVE] Absolutely. And what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and then if you would, um, could you give me either one the in hospital or outpatient uh certification number please?
[CUSTOMER][NEUTRAL] OK, it is hospital benefits certain number uh inhos it's uh 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 607992
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and the number 7.
[AGENT][NEUTRAL] OK, thank you and then just gonna verify some information really quick, uh, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you so much for verifying that. OK, so in short, uh, this policy as it is secondary medical, it is designed to help with co-pay, deductible and co-insurance after your major medical pays. So it is very dependent on whoever you have as your primary. If you go for medical treatment anywhere and they are not willing to pay, this policy can't. It is designed to kind of help with those things after they pay.
[AGENT][NEUTRAL] So you have uh a little bucket um per calendar year of uh benefit amount for inpatient and for outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] This is a this is an extreme emergency like hospitalization or or.
[AGENT][NEUTRAL] Oh no, no, I mean that can you absolutely still can, um, and of course I'm looking at your policy right now. All of them are different, so I had to see which ones you have, but you also have benefits for regular office visits as well. So I would say a general rule of thumb is anywhere you go for any kind of medical treatment, um, present them with both of your cards, so your primary and this one as well.
[AGENT][NEUTRAL] And it unfortunately every provider is different some of them really don't like messing with uh any sort of secondary or supplemental insurance at all, but that doesn't mean you can't still file those claims in those kinds of instances um I of course would encourage them to give us a call first um if there's any confusion, but otherwise you can still file the claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, you know what, I've never used it.
[AGENT][NEUTRAL] OK, well, let's see.
[CUSTOMER][NEUTRAL] I've never used it and I, I, I'm, I'm thinking like when I go and it's, it's uh just uh tell me if I'm wrong or not. I'm, I'm thinking outside of [PII] like if I go to the chiropractor, if I go to uh
[CUSTOMER][NEUTRAL] My, my, my primary physician, they say, well, we don't pay for this, but the, you know, I pay a lot of co-pays when I went to uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK. When I went to say uh therapy, physical therapy.
[AGENT][POSITIVE] Yeah, and that's exactly what this is supposed to help with. Mhm.
[CUSTOMER][NEUTRAL] OK, and, and is there like a uh uh.
[AGENT][NEUTRAL] Let me see. I will double check. A lot of our policies do have a physical therapy benefit, but I'm gonna go ahead and just get your policy pulled up and check that for good measure. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there's no timely filing limit either, so your policy has been active since the beginning of this year, [PII]. So if you've had to receive any sort of medical treatment that has not been, uh, filed any sort of claims with us, you can still file those claims. There's no deadline that you have to worry about getting that information to us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All [PII], give me just a moment. Let me take a look here.
[AGENT][NEUTRAL] OK, yes, so under your outpatient benefit, physical therapy performed in a physical therapy facility is covered.
[CUSTOMER][NEUTRAL] Uh, let me ask you one more. What about, uh, uh, mental, mental health, uh, like therapist.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEGATIVE] Like, like grieving.
[AGENT][NEUTRAL] Sure, um, let's see.
[CUSTOMER][NEUTRAL] G
[AGENT][NEUTRAL] So it does say, well, that's mental or emotional disorder. Um, let's see. Mental health, unfortunately.
[CUSTOMER][NEUTRAL] I'm talking about like Greek because I lost a [PII], not, not, not so much uh I had lost a [PII] 6 months ago and I, I did go to one person, but I didn't, uh, the co-pay was a little bit expensive, so I was like, wait a minute, I, uh.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm so sorry you have to deal with that. Um, OK. Well, I think it would really depend on where it's at, what kind of facility, um, cause some of them could be considered a specialist, which, if that's the case, that is covered. Um, but I don't, there's no specific, um, nothing specific for that kind of therapy, like counseling or something like that. Um, there's nothing specific for that. But treatment in certain
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Facilities are covered so I would, um, wherever you choose to go like for example if they would consider themselves a specialist, which I think that would be more along the lines of like a psychologist um because I've gone to I've gone to like an actual psychologist before for that kind of thing um and that that would be considered a specialist so.
[AGENT][NEUTRAL] In which case that pays up to $50 per visit, which hopefully would help with that a copay.
[CUSTOMER][NEUTRAL] OK, I'll, I'll, I'll check it too, but I'm, I just never knew. I've been going to physical therapy and the insurance pays a certain portion, but then also insurance pays certain person then I had a, a, a night, you know, I had the copays. I'm like, yeah, I, it, it's costing me too much, you know, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, absolutely, and that's what this is supposed to help with, right, so let's see, [PII], if you would like, um, I can of course first of all send you a copy of this policy if you don't have it already, um, it's very easy to read, it does not have, it's not a bunch of jargon or anything, I promise, um, but it does go through, uh, what is and is not covered dollar amounts, frequencies, things like that and then I can also, uh, help you set up an account on our website.
[CUSTOMER][NEUTRAL] Cause I'm retired now, so.
[AGENT][NEUTRAL] If you would like to do that as well, that's typically going to be the easiest and quickest way to get claim information to us. Do you have access to a uh desktop or a laptop computer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Awesome OK
[CUSTOMER][NEUTRAL] I mean, I got a uh
[CUSTOMER][NEUTRAL] Let me go and
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] There you, I'm about to, I'm about to, uh.
[CUSTOMER][NEUTRAL] I know it's gonna take me a while to.
[AGENT][NEUTRAL] Sure, um, it's you don't have to right now this second, um, just that I just ask because, um, the website doesn't really have much support for mobile devices, uh, so if you were to upload claim information it would have to be done on a desktop or a laptop computer, um, and then let's see, so.
[CUSTOMER][NEUTRAL] It may be quick for me
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I, I'll do it on the computer.
[AGENT][NEUTRAL] Sure, so to set up an account, uh, the information that you enter to set it up does have to match what we have in our system and I don't currently have an email address on file for you so what would you like that email uh account to be?
[CUSTOMER][NEUTRAL] Yeah, I do it on the computer.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, let me go ahead and get that added and of course that's going to be the email that you enter when you go to uh create the account and whenever you're ready I can give you that web address.
[CUSTOMER][NEUTRAL] Is it, is it uh secured?
[AGENT][NEUTRAL] Yes, yes, that's it.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the one.
[CUSTOMER][NEUTRAL] Yeah, I was OK. I, I never even, I had this insurance before and I'm, and it, it was in the mail. I just never.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] No, I know what you mean, yeah, but again there's no timely filing limit, so it's not like you have to worry about getting things to us within a specific time frame.
[CUSTOMER][NEUTRAL] OK, well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, a matter of fact, I got my I have an appointment.
[AGENT][NEUTRAL] All right, I know that was quite a bit of information.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I'm sorry, I cut you off.
[AGENT][NEUTRAL] No, no, no, you're perfectly fine, go ahead.
[CUSTOMER][NEUTRAL] No, as a matter of fact, I have an annual appointment, uh, uh, Thursday and then I, I supply this information to them as well.
[AGENT][POSITIVE] Absolutely and again if there's any confusion they've not maybe they haven't heard of us or they're not sure how it works or what's covered uh encourage them to give us a call just on the same number that you called we talk to providers all the time so we can explain the policy and hopefully clear up any confusion.
[CUSTOMER][NEUTRAL] In my in my primary.
[CUSTOMER][NEUTRAL] And this is, this is, this is like along with my regular insurance to my employers is uh this is gap.
[AGENT][POSITIVE] But the secondary, yes, so this, it kind of works hand in hand with your primary.
[CUSTOMER][NEUTRAL] Right, got it, got it, OK.
[AGENT][NEUTRAL] Yes. Did you want me to email you this policy?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] OK, um, you just want me to send it to this BellSouth email?
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] Alrighty I will go ahead and send that now. Did you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] No, you help me out. You help me out. You hear me out a lot.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Glad to hear it. If you need anything else, don't hesitate to give us a call back and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You as well thank you you have a good one.
[AGENT][POSITIVE] Thank you, bye bye. You too. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.