AccountId: 011433970860
ContactId: db1b07c8-0188-48c8-948e-d826f9c641da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547070 ms
Total Talk Time (AGENT): 311239 ms
Total Talk Time (CUSTOMER): 152843 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/db1b07c8-0188-48c8-948e-d826f9c641da_20250217T15:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yeah. Um, I'm a new policy holder and I just wanted to have an idea of how my coverage works.
[AGENT][POSITIVE] OK. Yeah, absolutely. I'm happy to help. Do you by chance have a policy number?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] I have a group number 80116.
[AGENT][NEUTRAL] OK, do you have anything that shows like a certificate number or anything like that?
[CUSTOMER][NEUTRAL] Mm, it's, well, I have a, it's, I have the, the card, it says insured group num coverage group number, effective date plan med link select group.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] It should have like an in hospital or outpatient cert number I believe on it.
[CUSTOMER][NEUTRAL] Oh yeah, I have, I have a in hospitals benefit certificate number and an outpatient benefit certificate number.
[AGENT][POSITIVE] Perfect, so either one of those will work.
[CUSTOMER][NEUTRAL] OK, so 0258.
[CUSTOMER][NEUTRAL] 674 9 M. like Mary, L like Larry, and the number 7.
[AGENT][NEUTRAL] All right, thank you so much. And then let me get your first and last name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you [PII] and then I just need to verify for security your physical address on file and email address please.
[CUSTOMER][NEUTRAL] Uh, it's [PII] or [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and what else, my phone number?
[AGENT][POSITIVE] Oh just email address I'm sorry.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you. All right, so the plan it looks like you have with us is this plan is a secondary plan. So what this would cover is basically any it basically gaps the bridge between your primary insurance and you paying anything out of pocket.
[AGENT][NEUTRAL] Um, so it's gonna cover like deductible, co-pay, co-insurance that your primary insurance does not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] Is it only for like, like, for example, it's only like in the urgent care in hospitals?
[AGENT][NEUTRAL] Well, that's yeah that's what I was actually, yeah, that's what I was actually gonna check so some of these plans will cover physician's office visits like the fee just going to see your like regular doctor if you had to pay like the $25 copay some of the plans won't cover that and then some of them do not cover the copay. Some only cover.
[CUSTOMER][NEUTRAL] Is that how it works?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Treatment. So for example, if you had to have like physical therapy, they usually bill you for the treatment and office visit. The plan would cover treatment but may not cover the office visit. So let me see if yours is gonna cover any office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause I was trying to look that up on the, on like my login website, but I.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I didn't see anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So physician cover charges do not include on your plan their own medical equipment so that would be like a CPAP machine.
[CUSTOMER][NEUTRAL] Wait
[CUSTOMER][NEUTRAL] I hear you. I'm sorry, I hear you a little far away. You said physician, um, what?
[AGENT][NEUTRAL] Um, these are not covered charges.
[CUSTOMER][NEGATIVE] They're not covered, OK.
[AGENT][NEUTRAL] Correct, so, um, medical equipment.
[CUSTOMER][NEUTRAL] So what was the first one?
[CUSTOMER][NEUTRAL] Medical equipment?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cancer treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Physical therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the doctor's office visit fee is not covered.
[CUSTOMER][NEUTRAL] And the doctor's office visit fee.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Is that doctor's office visit fee, is that the co-pay of like, that's what that means, the co-pay or just a regular fee?
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Correct, it would be the co-pay the fee to go to the doctor's office. It's not gonna be covered.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK, and neither is the physician fee, right? So the first thing you said?
[AGENT][POSITIVE] Correct
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So what is covered?
[AGENT][NEUTRAL] So, you would be covered for in hospitals, any sort of inhospital would be covered. Um, your plan, it looks like you added a treatment. Let me see. You added some other things on here though.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, you actually added an outpatient.
[AGENT][NEUTRAL] Hang on here hold on just.
[AGENT][NEUTRAL] OK, so I take that back. I apologize. You actually added some additional, um, [PII], you added some writers onto a policy, meaning additional options, and so I didn't see those to begin with, so I apologize. So you actually, you actually do have on here office treatment writers so what that means is the physician office treatment benefit.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] We will pay any out of pocket amount for physician cover charges. The benefit maximum is listed on the scheduled benefits page, which is the benefit maximum is 8700 for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that is like that is that would be that that office visit that I had asked about earlier?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Would it be that? OK. So let me ask you.
[AGENT][NEUTRAL] Yeah, because then you added on, go ahead, I'm sorry, uh huh.
[CUSTOMER][NEUTRAL] Uh, no, no, it's OK. I'm just trying to understand. So, um, when I go to the doctor, do I give them this card as well?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Yeah, uh huh, you can explain to them that whoever you have, let's say if you have United Healthcare, you say, hey, this is United Healthcare. They're my primary insurance.
[AGENT][NEUTRAL] And I have APL as a secondary insurance so they should be able to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] They should be able to bill your main insurance first.
[CUSTOMER][NEUTRAL] And then, and then the supplementary.
[AGENT][NEUTRAL] Correct, yes, and then if you have anything additional then they would um obviously let you know at that time, yeah.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah, got it. OK, OK, OK.
[AGENT][NEUTRAL] Yeah, and what I'm gonna do, [PII] actually is email you a copy of the policy certificate because.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][POSITIVE] Yeah, that'll definitely help you because you added durable medical you added medical equipment writer you added a lab facility writer, so those are like additional benefits that you added on and there's a scheduled benefits page included and it'll break down the exact amounts that are covered and it tells you what is and isn't so that'll definitely be helpful for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you so much. Yeah, that would be great.
[AGENT][POSITIVE] Yeah, absolutely, so I send that to your [PII] address on file, so you should get that in a few minutes, um.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Hold on, open it up.
[AGENT][POSITIVE] But yeah if you ever have any questions or concerns as far as using it you can always give us a call.
[CUSTOMER][POSITIVE] OK, yeah, yeah, if anything else I'll I'll call back thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Have a nice day.
[CUSTOMER][NEUTRAL] OK, yeah, I think I already got your email.
[AGENT][POSITIVE] OK perfect
[CUSTOMER][POSITIVE] OK, thanks. Have a nice day.
[AGENT][POSITIVE] You you too bye bye.