AccountId: 011433970860
ContactId: ce173b33-181b-4a7b-b175-9d9875aaa335
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 548030 ms
Total Talk Time (AGENT): 313983 ms
Total Talk Time (CUSTOMER): 174725 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/ce173b33-181b-4a7b-b175-9d9875aaa335_20250523T18:24_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]. Hi, my name is um [PII] and my last name is, and I, my husband has the insurance through you guys, and I was wondering what does it really cover because I had a couple of questions.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Um, can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] I think this number 02064088.
[CUSTOMER][NEUTRAL] I don't know if I have the the correct card or not.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] Can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] And the mailing address and phone number that we have on file?
[CUSTOMER][NEUTRAL] For me or for my husband?
[AGENT][NEUTRAL] Uh, if your husband is the policy owner, it would be what he has.
[CUSTOMER][NEUTRAL] OK, it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, what's the, is the mailing address the same? What's the mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And you said the phone number was one more time cause I think it disconnected a little bit. I got partial.
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] But what would be his number because it would go off of his, what information he put in.
[CUSTOMER][NEUTRAL] Mhm, OK, so his number.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy is a Medlink policy, which means it's secondary gap insurance. So what this does is this helps pay um after your major medical has paid, this helps with co-insurance, co-deductible and co-pays, and I can pull up your
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Full policy to see if, if there's anything in particular that you're wanting to know or are you just wanting to know um some various benefits?
[CUSTOMER][NEUTRAL] It's uh my
[CUSTOMER][NEUTRAL] The just the benefit, I mean.
[CUSTOMER][NEUTRAL] I was recently in the hospital and my husband kind of understood that because I spent the night they were paying me additional, like $1000 or something like that, but I don't know if it's correct or not, so that's why I'm calling you guys to find out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and this is just a verification of benefits and not necessarily a guarantee of payment, but it looks like your policy has an in, uh, I'm sorry, an inhospital deductible. Um, your in-hospital benefit is up to $5000 per covered person per confinement, confinement is um 18 hours or more.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Um, your deductible for in-hospital visits are $0.
[AGENT][NEUTRAL] And were you wanting to know something else? I have outpatient as well.
[CUSTOMER][NEUTRAL] So, no, so basically that means that if I go, I was in the hospital recently.
[CUSTOMER][NEUTRAL] So they will only cover $5000?
[AGENT][NEUTRAL] Up to $5000 per confinement for in hospitals, and that's after your major medical pays. So this helps pick up whatever is left over.
[CUSTOMER][NEUTRAL] After the
[CUSTOMER][NEUTRAL] OK, and then outpatient, how much does it cover?
[AGENT][NEUTRAL] Your outpatient deductible is $500 per covered person per occurrence. So if you go in, so each time you use your outpatient, it's up to $500 per covered person.
[CUSTOMER][NEUTRAL] Only $100 I mean.
[AGENT][NEUTRAL] Per occurrence, also with a $0 deductible.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so basically it just covers whatever I, so let's say I was in the hospital, United, which is my insurance pays for the bill, and let's say they spend $4000 that I'm missing, that is what you were covered, right?
[AGENT][POSITIVE] Yes, if it's within what you have in your schedule of benefits, as long as it's a covered service and your major medical has also paid towards it, this will pick up what's left over. It might not pick up all that's left over, um, but it will help afterwards. But with that being said,
[AGENT][NEUTRAL] If your major medical denies the claim, this policy will not pick up after it. It's only if the major medical has paid any towards any benefits, and this helps cover some of those other benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and so when filing for a claim, you'll want the your primary insurance's explanation of benefits showing what procedures were like what the procedure codes are and what was and what they had paid.
[CUSTOMER][NEUTRAL] So that
[AGENT][NEUTRAL] So that we know what we're picking up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And outpatient means like if I'm gonna get a colonoscopy or something like that?
[AGENT][NEUTRAL] Um, your outpatient, it looks like it does have, um, an ER service or an urgent care facility service. Um, if you were to go into surgery, certain diagnostic tests or an MRI facility is could also be covered. And then it also looks like you have outpatient treatment for mental or emotional disorders as well if you ever needed to use that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and also on your policy, you have an outpatient, I'm sorry, a physician outpatient treatment rider, meaning that if you get treatment in a hospital outpatient facility or a physician office, uh, we help cover that $25 per visit. And again, that's after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's, and that's only how many times a year? 4 times?
[AGENT][NEUTRAL] Um, for that outpatient treatment, it's up to a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So you could go 4 times and your husband can go 4 times.
[CUSTOMER][POSITIVE] OK. Thank you so.
[CUSTOMER][NEUTRAL] Yeah, well, I don't worry, I'm the sick one, he's not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh no no that's always in the hospital.
[CUSTOMER][POSITIVE] OK, OK, thank you so.
[AGENT][NEUTRAL] Was there any other questions you might have?
[CUSTOMER][NEUTRAL] No, that's it, thank you. So they basically what they told them that they would give him $1000 if I ended up in the hospital for overnight, it's not true, right?
[AGENT][NEUTRAL] If you're in the hospital overnight, you should have, as long as your major medical helps cover some of that, this should be able to help cover that because you have inpatient and outpatient benefits.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Um, and real quick, do you all have an online service account with us?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, I think I signed them up recently.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] It's uh I think it's fine.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Uh, I was gonna say because I do see an email on file so if you have that online service center, um, you should be able to if you have any other questions, say and we're closed, um, you can see your policy certificate on there and you can read um it it has it laid out if you go all the way down on your policy certificate if you go down to schedule of benefits that's that's the easiest part to read.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because it tells you your benefits and the amount and then the rest, a lot of it is definitions, um, so you do have that at your fingertips too, um, and you still feel free to call us if it gets confused because it's a lot, um, so we're here to help but in in case you ever have a question and you can't get a hold of us, um, you can, you should be able to access that through the online service center as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, of course.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. You're welcome.
[CUSTOMER][POSITIVE] Have a great weekend. Thank you for your help.
[AGENT][POSITIVE] Have a great weekend, be safe and thank you for calling APL.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Bye.