AccountId: 011433970860
ContactId: c65e21bd-8d82-4283-bd43-75a4d6cd3d69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551559 ms
Total Talk Time (AGENT): 307567 ms
Total Talk Time (CUSTOMER): 189358 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/c65e21bd-8d82-4283-bd43-75a4d6cd3d69_20250527T17:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um, I'm calling because I have a question about, uh, my coverage, and I was a little confused as to how I, um, as to how I access like the actual plan because it wasn't in um the my benefits in the card like it wasn't in that portal.
[AGENT][NEUTRAL] OK, so you have some questions on your benefits and then about accessing your information online as well?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with?
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] Thank you and do you know your policy number with APL?
[CUSTOMER][NEUTRAL] The policy number is 024.
[CUSTOMER][NEUTRAL] 88561
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address, please.
[CUSTOMER][NEUTRAL] Yes, it's [PII], and that's [PII], and my zip is [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][POSITIVE] OK, thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] Um, the email I have for this account or just any email?
[AGENT][NEUTRAL] Uh, the email that we would have on file for you.
[CUSTOMER][NEUTRAL] Uh, I think it's [PII] I think.
[AGENT][NEUTRAL] OK, yes, thank you very much. OK, so that's all the information I need to verify now Miss [PII], I can see that you have set up your profile before in our portal called the online service center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, do you still remember?
[CUSTOMER][NEUTRAL] So like where would I access that?
[AGENT][NEUTRAL] OK, so you would go to [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK, the one on the card, not the my benefits in the card portal.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. OK, so, so this one, OK.
[AGENT][NEUTRAL] So, mhm, mhm. And that'll be, that portal, you, you have access to your ID cards, um, your policy certificate is in there. And if you don't remember your username that you set up, I can provide that for you.
[CUSTOMER][NEUTRAL] OK, yes, please do, cause I didn't even, I didn't know I was looking in the wrong portal.
[AGENT][NEUTRAL] OK, so it's
[AGENT][NEUTRAL] [PII]
[AGENT][NEGATIVE] And the rest of it's all gonna be lowercase. The next letter is OH [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Altogether.
[CUSTOMER][NEUTRAL] OK, so, so COH and then [PII], OK.
[AGENT][NEUTRAL] Correct, altogether, but the [PII] is the only letter that is [PII].
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] Got you. OK. And then would I just, what I just need to like reset my password?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, now, yes, ma'am, because we don't have access to that. So if you don't remember what that was then yes ma'am, you would just need to do forgot password or reset password or how it's forwarded to create a new one,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, OK, so you told me that you told me the portal told me my username. So do you know, um, would you be able to tell me what the copay is for like um.
[CUSTOMER][NEUTRAL] I guess she's getting like a primary care provider, cause that's really what I, I mean, I'm trying to find now.
[AGENT][NEUTRAL] OK, so now this plan is not a major medical plan. So this plan is a limited benefit plan that pays specific amount for certain services, so there's not a co-pay on this policy. For a physician's office visit, if it's related to accident or sickness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] The benefit on this plan is $50 per day and a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $50 OK.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] So then how is that different from a co-pay?
[AGENT][NEUTRAL] Well, your co-pay is what you would pay going towards, this is what this benefit pays.
[AGENT][NEUTRAL] This is what we pay.
[CUSTOMER][NEUTRAL] Oh what you got and then the copay would be the balance. OK, got you.
[AGENT][NEGATIVE] Right. There's not a co-pay on this. There is no co-pay on this plan. So whatever you, whatever their
[CUSTOMER][NEUTRAL] Got you. OK.
[CUSTOMER][NEUTRAL] Got you. OK, so it's basically.
[CUSTOMER][NEUTRAL] The $50 from whatever the office visit is.
[AGENT][NEUTRAL] Hypothetically, this is just an example. The theoretically, if your visit cost you, if they billed you $100 for your visit and we were able to approve the claim, the maximum that we would pay on that would be the $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you. OK, OK, so, OK, that's easy, easy math.
[AGENT][NEUTRAL] And then we would
[AGENT][NEUTRAL] And you have 4 days per year, yeah. I mean, that's just, you know, an example to try to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Simplify how to understand it.
[CUSTOMER][POSITIVE] Yeah, yeah, no, I got it. It's, it's essentially a 50 $50 discount. It's like how my mind is processing it.
[AGENT][NEUTRAL] Mm, OK. Uh, it's, it's, well, you could, I guess you can look at it like that. But again, it's just
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] If that's easy, but for you that way, um, but yes, that is what this benefit would, would pay if approved.
[CUSTOMER][NEUTRAL] OK, OK, and then what does the, um, how long does the, the approval take?
[AGENT][NEUTRAL] For a doctor's office.
[AGENT][NEUTRAL] Uh, there's no prior authorization. Oh, you mean for us to review a claim once it's been received? It's typically 7 to 10 business days.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Could be sooner, but that's just an approximate depending on if we receive all of the information that's required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So once I
[AGENT][NEUTRAL] 5 to 7 business days, probably, more accurate.
[CUSTOMER][POSITIVE] OK, alright, so 5 days, 5 to 10 days. I'll say 5 to 10 days. Um, OK, I think you, I think you'd answered everything for me.
[AGENT][NEUTRAL] Yeah, just me.
[AGENT][NEUTRAL] OK. Well, all right then.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh wait, you know what, I do, I, I do have one more um question. So when I was in um I was in [PII] last week and I didn't see American public life like in the list. So what is like the actual plan called?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, because it's not a major medical plan, this is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it doesn't have like a major medical code like a plan A or B, you know, it doesn't have any of those. It's just a limited benefit hospital indemnity.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] OK, so I would just have to ask them, do they take it or not? OK.
[AGENT][NEUTRAL] Yes, ma'am. And then just present them your card. Most providers will call to verify, you know, eligibility and get benefit information for the type of service, um, and we'll also file the claims for you, but in the event that if a provider doesn't file the claim, you can always file that and you could call us back if that need arises and we'd be happy to explain how to do that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, well you've been super helpful I appreciate it.
[AGENT][POSITIVE] Well, you're certainly very welcome and it was my pleasure speaking to you today, Ms. [PII]. So again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, I am all set. I'll take it from here.
[AGENT][POSITIVE] OK then, well thank you again for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Yeah