AccountId: 011433970860
ContactId: d7746173-bcfd-425f-8ddc-35649a84c2c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611349 ms
Total Talk Time (AGENT): 267027 ms
Total Talk Time (CUSTOMER): 252118 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/d7746173-bcfd-425f-8ddc-35649a84c2c4_20250616T21:03_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. Um, I'm calling for two reasons. I guess the first reason is, um, I got this car for my husband's, um, job insurance, and I really don't understand how the coverage works. Can you explain that to me?
[AGENT][POSITIVE] Yes, ma'am. Do you have a phone number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] So, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number 02634418.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And the policy is in your name, correct?
[CUSTOMER][NEUTRAL] Uh, well, this card has my name, yeah, insured, but it's through my husband's employer.
[AGENT][NEUTRAL] Hold on just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And who do you work for?
[CUSTOMER][NEUTRAL] I computer village.
[AGENT][NEUTRAL] OK, this policy is in your name through your employer.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] And what else did you need?
[AGENT][NEUTRAL] Um, I noticed we don't have an email for you. Do you have an email address you would like to give us?
[CUSTOMER][NEUTRAL] Sure. It's [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. And what was that address again? I don't think we have it correct in the system either. [PII].
[CUSTOMER][NEUTRAL] [PII]. It should be correct because I just received this card in the mail a couple of days ago.
[AGENT][NEUTRAL] OK, we have [PII]. So, is it Terrace or street?
[CUSTOMER][NEGATIVE] Oh, no, it's terrorists.
[AGENT][NEUTRAL] OK. That's what I was, I knew something wasn't correct.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you for catching up.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And then it's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'll get that changed from street to terrace for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII]. And you wanted to know how this policy worked?
[CUSTOMER][NEUTRAL] Correct, yes. I need more information.
[AGENT][NEUTRAL] OK, I can help you with this. This policy coordinates with the primary insurance?
[AGENT][NEUTRAL] Whatever your primary insurance applies to your deductible co-pay or co-insurance only, we pay up to certain amounts depending on what services you have, so it coordinates with your primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So, for example, I just went to my primary and I had a deductible of $60. Actually, not the primary. I went to um
[CUSTOMER][NEGATIVE] A specialist and I had a deductible of $60. So, but how do I go about that because they wouldn't accept this card they say I have to pay out of pocket.
[AGENT][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] So how does that coordination work?
[AGENT][NEUTRAL] It depends on how they file the claim. Now, if it's just a simple specialist office visit code on there, it's not office visits are not covered.
[AGENT][NEUTRAL] But if you have any services done in the doctor's office, now that would be covered. But the actual office visit itself is not covered. Like if you have any lab work in the doctor's office, injection or anything like that, and that would be covered, but not the actual office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK, so how do I know what's covered and what's not covered? Like how, how do we check on that.
[AGENT][NEUTRAL] You should have gotten a copy of your policy or should be getting a copy of your policy in the mail, or you can go online.
[AGENT][NEUTRAL] And look at the.
[CUSTOMER][NEUTRAL] Yeah, I was trying to set up my account online.
[CUSTOMER][NEUTRAL] But it, it's saying like my information.
[CUSTOMER][NEUTRAL] It's it's not affecting my information cause I put my last name.
[CUSTOMER][NEGATIVE] I put my Social Security didn't work, and then it's asking for my member ID.
[CUSTOMER][NEUTRAL] The member ID is not the same as the.
[AGENT][NEUTRAL] Remember I
[CUSTOMER][NEUTRAL] Policy number, right?
[AGENT][NEUTRAL] Let me look up and see if you have a member ID number.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I'm not showing a member ID. So it's asking for the member ID number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, too long. Well, it's just have to leave it empty as well, so.
[AGENT][NEUTRAL] Yeah, I would just try, I would just try leaving whatever you don't have to put in empty.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Because they did change the website, so whatever, just put in what you have to put in and see if that'll work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that makes sense. Now, let me ask you another question. Um, so let's say like tomorrow I'm gonna get, I'm gonna go get some um lab works and X-ray.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If, if any of those services are covered, how, how do I go about it? How do I do it? Like how do I, I mean,
[AGENT][NEUTRAL] OK. If you, uh, if they will file the claim for you, you can give them all your information and they can file the claim for you, but if they don't take your insurance, your GA policy, then you can file it yourself.
[AGENT][NEUTRAL] We would need an itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That has a procedure code and diagnosis code and the charges on it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we would need your explanation of benefits from your primary insurance, so we'll know what was applied to your deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK. OK. So, ideally they will
[AGENT][NEUTRAL] But while you're at the doctor's office?
[AGENT][NEUTRAL] Just tell them that you need something that has the.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Procedure code, diagnosis code, and charges. Cause most of the time they, they'll put the procedure codes on there, but they will not put the diagnosis code on there.
[CUSTOMER][NEUTRAL] OK, so if, if, if they don't do the claim, I have to pay for it. I had to, uh, uh, in advance and then you reimburse me, is that it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, I understand. And the next thing is I'm trying to sign up for my account online, but it's saying that it's not recognizing my any of my information. Do you, can you check, is my birthday correct in your system? [PII].
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] asking for my last name, my email, and my date of.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] That's probably the problem. Let me put your email in and then try that again, OK? Since we don't have one for you. Hold on just a second. Let me get it entered for you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] And that was YET.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Wow. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if it's in.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, we have your email address in, so you can try that now.
[AGENT][NEUTRAL] Because everything has to match by what's in our system.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Oh yeah, yeah, complete your account set up. Yeah, I think so. I think it's working now. Perfect. OK. OK. So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, it was that email address then.
[CUSTOMER][NEUTRAL] So when I go to my doctor, I tell them I have like a gap insurance that should be able to, to, to cover.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That picks up your deductibles, co-pays, or co-insurances.
[CUSTOMER][NEGATIVE] The bad just not.
[CUSTOMER][POSITIVE] Deductible copay, deductible and points. OK, perfect. Thank you. Thank you so much.
[AGENT][NEUTRAL] Copay or co-insurance.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, I think that's it.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] Thank you, Ms. [PII], for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm, bye-bye.