AccountId: 011433970860
ContactId: e2eb28ff-b976-48c4-bf19-9a5302cf8f17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1280920 ms
Total Talk Time (AGENT): 677177 ms
Total Talk Time (CUSTOMER): 389803 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/e2eb28ff-b976-48c4-bf19-9a5302cf8f17_20250514T18:59_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hello [PII], how are you doing? Um, I have an issue. I signed up back in September with my company for the gap insurance.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And um I'm, um, this is the first time I'm, I need to use it.
[CUSTOMER][NEUTRAL] And um I never received my ID cards and on the ID cards that my HR provided.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't see a member ID so I'm trying to make an account so I can make a claim.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But um I don't see, well, it, it says they couldn't find the, find me in the system with my last name and social.
[CUSTOMER][NEUTRAL] So that's the main concern there.
[AGENT][NEUTRAL] OK, so you're you you're saying that you believe you are to have a policy with APL, but you're trying to set up your profile in the portal and you're getting an error message saying it can't find you, is that correct?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Correct, based on my last name, um, social, yeah.
[AGENT][POSITIVE] Yes, sir. I can
[AGENT][NEUTRAL] Yes, well I can try and help you with this. What I'll need to do is to pull up your and see if I can locate your information first off. If I do find a policy for you, then I will need to verify several things with you for security purposes first, and then I can try and help you with this, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good.
[AGENT][NEUTRAL] All right, so first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah, Mr. [PII], what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is, do you have an ID card?
[CUSTOMER][NEUTRAL] Uh, yes, I do.
[AGENT][NEUTRAL] OK. And what is your policy number? It depends on the type of coverage you have as to how that may be worded on there, Mr. [PII]. You may say, you may say, excuse me.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, it says the plan says meddling select group meds. I'm assuming a medical supplemental or something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you may see an in-hospital or outpatient number.
[CUSTOMER][NEUTRAL] Have both, either or works?
[AGENT][NEUTRAL] OK. If you'll, yes, because if you'll notice, prior to the letters ML.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Both of those numbers are the same, and that's actually the policy number. The rest of it just differentiates whether it's an in-hospital admission or an outpatient service. So just give me the first part of that number.
[CUSTOMER][NEUTRAL] Everything is the same.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's 02545453.
[AGENT][NEUTRAL] OK, thank you. So one moment, let me get your information pulled up.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And your full social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number and you said the unit is [PII] was correct, is that correct?
[CUSTOMER][NEUTRAL] Yeah, [PII], yeah.
[AGENT][NEUTRAL] OK, thank you and then the phone number that we have 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] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you and lastly your email address and I'm not sure if this is your personal or your work email.
[CUSTOMER][NEUTRAL] It'll be flash.
[CUSTOMER][NEUTRAL] That it's gonna be my personal.
[AGENT][NEUTRAL] So there's
[AGENT][NEUTRAL] This on file is your work email then.
[CUSTOMER][NEUTRAL] Or do you have one on file?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's if it's [PII], yes, that's my work email.
[AGENT][NEUTRAL] Yes, that is what is on file for you.
[CUSTOMER][NEUTRAL] I'd like to switch it over to my work, I mean to my personal if possible.
[AGENT][NEUTRAL] OK, so Mr. [PII], I will be happy to update that for you. You will also still need to contact your HR department, um, to make sure that they have your apartment number or your unit number 34 on file because that did not come over on your enrollment information.
[AGENT][NEUTRAL] We do not have that for you. Just [PII], correct. So I have added that and I'll be happy to update your email address. However, I need to let you know that because of the way we receive your group's enrollment information, if it, if the file comes across with your work email on it, it will override my change and it will also remove your apartment number.
[CUSTOMER][NEUTRAL] What did they put?
[CUSTOMER][NEUTRAL] Oh it's just the address we know.
[CUSTOMER][NEUTRAL] And that's it.
[AGENT][NEUTRAL] That I've added.
[AGENT][NEUTRAL] So I just wanna make you aware of that.
[CUSTOMER][NEUTRAL] So it's best to just leave it alone.
[AGENT][NEUTRAL] Again, I could change it. I can change it.
[CUSTOMER][NEUTRAL] Or it's best to have them change it.
[AGENT][NEGATIVE] And you can set up your profile using your personal email, but I just didn't want you to call back at some point and when if you didn't reach me and spoke to someone else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your apartment number was not on file and your work email was back on file with us. I didn't change it. I just wanted to explain how that process works. So get with your HR department, ask them if there's a way that they can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, first off, they definitely need to add your apartment number and then.
[CUSTOMER][NEUTRAL] Right, just because the way I signed up, it was through [PII], which I'm not really sure exactly what they are.
[AGENT][NEUTRAL] Could change your email to your personal.
[CUSTOMER][NEUTRAL] But that's where all of our insurances are.
[CUSTOMER][NEUTRAL] Book through? I don't know what's the exact terminology.
[AGENT][NEUTRAL] Mm, I, I don't know.
[CUSTOMER][NEUTRAL] So I don't know if there was some kind of cross up in that registration process.
[AGENT][NEUTRAL] Yes, sir, and unfortunately, I'm sorry but I'll be, well, what is the personal email that you want me to change this to?
[CUSTOMER][NEUTRAL] Well, are you, do you have access to my account now?
[CUSTOMER][NEUTRAL] It's OK, I mean, for now we can leave it the same.
[AGENT][NEUTRAL] So you will have to use your working.
[CUSTOMER][NEUTRAL] If there's a if there's a uh a possibility of some kind of.
[AGENT][NEUTRAL] Well, you, OK, so you're OK to use that email to set up your profile, your work email?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, well then I'll leave that alone. OK, so yes, I do have your account information pulled up. I have added your apartment number at least for the time being.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] You should be able to set it up now. Your group does not have a member ID, so as you will see it asks for your social.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Mhm. Yeah, it didn't work with my social either, which is really weird.
[AGENT][NEUTRAL] Let me verify one more screen.
[AGENT][NEUTRAL] OK, let me look at something. Give me just a second.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And repeat your social one more time.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that is correct in our system and date of birth is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So yeah, that's the part that threw me off cause I couldn't, maybe.
[AGENT][NEUTRAL] It was probably
[CUSTOMER][NEUTRAL] Maybe it was looking for my work email.
[AGENT][NEGATIVE] It was, it was. If you on that screen entered all of your information but put your personal email, it would have given you an error message if you put personal instead of work.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Well, the weird thing is I was trying to register, so I would assume that any email input would be the one, but I think there's some sort of like pre-registration to the registration, yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Nice sir for security.
[AGENT][NEUTRAL] No, there's just, it's a security feature.
[AGENT][NEUTRAL] You have to sign up for the portal with the email that we have on file.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] morning
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][NEUTRAL] And my second question is, is my spouse and my son, my, what would you call them, my
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Like add-ons, what's the word that I'm looking for?
[AGENT][NEUTRAL] Your dependents?
[CUSTOMER][NEUTRAL] Dependent
[AGENT][NEUTRAL] Mhm, OK.
[AGENT][NEGATIVE] Now, this policy does not
[CUSTOMER][NEUTRAL] Cause from my end, I see.
[AGENT][NEUTRAL] It's only you and your wife. Your son is not on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or a child.
[CUSTOMER][NEUTRAL] OK, see, here's the thing, yeah, because I'm, I'm not.
[CUSTOMER][NEUTRAL] On my end, this is that my son is a dependent as well as my wife.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] With APL or your primary insurance?
[CUSTOMER][NEUTRAL] With uh APL.
[AGENT][NEUTRAL] Mm, no, sir. Your premium and everything relates to a couple.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah I think
[CUSTOMER][NEUTRAL] Something happened because there's some, a few disconnects here.
[CUSTOMER][NEUTRAL] With its enrollment
[CUSTOMER][NEUTRAL] Oh my God. The thing is, my son was hospitalized uh last month, so I'm trying to um
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Use the, the gap insurance for the, for our balance. That's how it works, right? It's like there's a, a, a remaining balance and as long as it's under what the annual threshold is, that's what you cover, correct?
[AGENT][NEUTRAL] Yeah, this plan is a supplemental policy to your primary insurance, and any information that I provide you, Mr. [PII] on your benefits is a guarantee, excuse me, it's a verification of benefits and not a guarantee of payment. But again, this supplemental policy is designed to help you with your co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the claims are filed with your primary insurance company first and then with APL because we'll have to have a copy of the primary insurance's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on your coverage you have a $3000 per calendar year benefit maximum per covered person for inpatient hospitalizations and then you have a $3000 outpatient benefit max per calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So technically it's 6000 per year but it's 3 per category.
[CUSTOMER][NEUTRAL] Per person.
[AGENT][NEUTRAL] Correct. And office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] What is it, sorry?
[AGENT][NEUTRAL] Office visits?
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] That is not a covered benefit.
[CUSTOMER][NEUTRAL] What about like um
[AGENT][NEUTRAL] How
[CUSTOMER][NEUTRAL] Not the co-pay, but the uh co-pay is what you pay up front and the co-insurance is like what the insurance did not cover. Am I understanding that right?
[AGENT][NEUTRAL] The the uh each of these three cat each of those three categories we look at.
[AGENT][NEUTRAL] Under the under the outpatient benefit or in hospitals benefit we look to see what the primary insurance paid and for coverage services, yes sir, we will pay up to that benefit max on this policy per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] And give me just a second because I was trying to, no, go ahead.
[CUSTOMER][NEUTRAL] Like my understanding is um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, my understanding was pretty much what the hospital, I mean what the insurance didn't cover for the hospital, and then there's like a, a balance. I'm assuming that that's where this insurance would kick in.
[AGENT][NEUTRAL] Correct. Up to that benefit, Max, if, if.
[CUSTOMER][NEUTRAL] Because if there's a part that I owe that is not a copay, correct.
[AGENT][POSITIVE] Correct, that's how this plan works. It helps with that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] That extra up to that benefit maximum.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] That's great.
[AGENT][NEUTRAL] Now, I would, what you will need to do because we do not have your son's enrollment on here, so you would have to reach out. I'm gonna make a note though, give me just a moment.
[AGENT][NEUTRAL] And always present your APO cards, Mr. [PII], along with your primary insurance card when you go for medical services.
[AGENT][NEUTRAL] Because most of the time the providers will file the claims with both of your insurances to just make it a little easier for you.
[AGENT][NEUTRAL] But in the event that they don't.
[CUSTOMER][NEUTRAL] Mm, like when they ask for a primary and a secondary insurance, is that like the type of situation where I would use it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Because if they'll file if take care of it for you, it just makes it easier because when you have to file your own claim, you can do that and you can upload your information into the portal. There's a claim form you would have to fill out and you also have to get itemized bills with diagnosis codes from the providers and also your a copy of your primary insurance's explanation of benefits. So again, it just, it's a little easier to say we'll do it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEGATIVE] So it just gets, it just gets complicated if I have to handle it on my end pretty much.
[AGENT][NEUTRAL] It's, it's, it's a little more lengthy, yes. Not that you can't do it because we have people do it all the time, but um I would recommend seeing if your providers, you know, will file the supplemental policy, and if they don't, then you can call us and we could give you the information on how to go about doing all of that.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, what is your son's name now? I'm just.
[CUSTOMER][NEUTRAL] So how would I explain it to the
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My son's name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what's his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said that he had been in the hospital?
[CUSTOMER][NEUTRAL] Um, yeah, he was hospitalized last month.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Or maybe March, um, yeah, actually, yes, and at the end of March I think into April, let me see.
[AGENT][NEUTRAL] In April.
[CUSTOMER][NEUTRAL] I think he went, he was discharged [PII], I believe.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But he was there from the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually let me see here.
[AGENT][NEUTRAL] I'm just making a general note.
[CUSTOMER][NEUTRAL] [PII], he was there.
[AGENT][NEUTRAL] To the end of
[AGENT][NEUTRAL] March
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, now I do have a user guide for the portal, Mr. [PII], but I, even though you'll probably have no trouble in setting it up your profile now that you know, were you able to set it up? Have you tried yet?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, not yet.
[AGENT][NEUTRAL] OK, well I do have a user guide that I would be happy to send to you they just and I will have to email it to the work email, but in addition to giving you the instructions. OK, on how to set up your profile, it explains some of the different things that you can do within the portal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's fine. I'm at work.
[CUSTOMER][POSITIVE] OK, that would be perfect.
[AGENT][NEUTRAL] OK, all right, so one moment, I'll send you that real quick.
[AGENT][NEUTRAL] The email that you're gonna receive will come from care team at [PII] and I will put APL in your subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, so I have just sent that to you, Mr. [PII]z, so you should be receiving it any moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Make sure you receive it.
[CUSTOMER][NEUTRAL] So I'm gonna have to talk to uh my HR and see what happened on that sign up.
[AGENT][NEUTRAL] Yes, because again, it is.
[CUSTOMER][NEUTRAL] Because on my end, I see it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] There it is AP online service, OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, so moving forward, uh, anytime like I go to a specialist, I'm gonna need some.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe some kind of a uh not diagnostics. What was it diagnostic? Like some kind of like blood work or X-rays, something that would have like a co-pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just be like, here's my, my primary insurance and supplemental, or how would I
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you would just make sure to give them both cards because again, an office visit is not covered. If you receive some type of treatment in the doctor's office, the treatment we could review under your outpatient benefit maximum, or if you had to have lab work sent to, you know, an independent lab facility, that's something that we could review. And then, yes, urgent care, emergency room.
[CUSTOMER][POSITIVE] Award it for them.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Correct. No, that's fine.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Diagnostic testing, things like that, or things that we can look at under this benefit.
[CUSTOMER][NEUTRAL] But if I have an urgent care co-pay,
[CUSTOMER][NEGATIVE] That wouldn't cover because I'll just pay my co-pay.
[CUSTOMER][NEUTRAL] But then if there's any kind of
[CUSTOMER][POSITIVE] Treatment received that has like an outstanding balance.
[AGENT][NEUTRAL] And it depends, yeah.
[AGENT][NEUTRAL] It depends, correct. That, that, that portion of it we could review. And depending on how they, how the urgent care bills.
[AGENT][NEUTRAL] You know, files your claim with your primary insurance, um, but urgent care is something that, yes, we do review, but again, a, a visit charge is not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's perfect that's fine.
[AGENT][NEUTRAL] And, and there's a copy of your policy information in your portal as well, and it explains all the benefits and those amounts, and there's definitions of like what a hospital admission is or.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Any of the outpatient services.
[CUSTOMER][NEUTRAL] OK, perfect. Yeah, that's all, uh, man, I'm really concerned because.
[CUSTOMER][NEGATIVE] I mean the bill is not that high for what the hospital sends us.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But either way I don't want to pay something that should be getting covered, you know.
[AGENT][NEUTRAL] I understand. No, sir. I definitely understand. So I would definitely reach out to your HR department and then they would have to, if the child is supposed to be
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Depending on what the issue was, if the child should be on the policy, they would be obviously the ones that have, would have to reach out to us. We, that would not be something you would be able to do on your own.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, Mr. [PII], are you still there? Oh, I thought I lost you. OK.
[CUSTOMER][POSITIVE] OK, that sounds good.
[CUSTOMER][NEGATIVE] Yes, I'm here. I kind of lost you, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But uh yeah so I'll go ahead and follow the the um user guide you sent me and I'll see what we can handle on our end.
[AGENT][POSITIVE] OK, well, perfect. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That will be it thank you very much.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you. You too. You too. OK bye bye. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.