AccountId: 011433970860
ContactId: eac7b986-3fb6-4b43-844e-52104e43a8f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565419 ms
Total Talk Time (AGENT): 260090 ms
Total Talk Time (CUSTOMER): 231285 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/eac7b986-3fb6-4b43-844e-52104e43a8f6_20250610T14:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I just had a couple of questions about my plan, um, and, and what they mean and um how to use them.
[AGENT][NEUTRAL] OK. Do you have one of your policy numbers and I can help you look at your plans.
[CUSTOMER][NEUTRAL] Um, I do. I have one, OK, so I think I signed up through Aflac.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Um, we're American Public Life, uh, we're not affiliated with Aflac.
[CUSTOMER][NEUTRAL] I'm just confused because I have this thing that I got in the mail.
[CUSTOMER][NEUTRAL] That's American Public Life, but I signed up for supplemental insurance through Aflac, but then I got this.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, do you
[CUSTOMER][NEUTRAL] But maybe this is for my insurance through work, um, OK, so do you want the in hospital benefits certification number?
[AGENT][POSITIVE] Yeah, that'd be great.
[CUSTOMER][NEUTRAL] It's 025594-24 [PII].
[AGENT][NEUTRAL] OK. And what was your first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And then what is your address and your email address?
[CUSTOMER][NEUTRAL] My email address is my [PII]. My address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so yes, this is through your work. Um, this is like a secondary insurance. So, once your primary insurance processes claims, this policy can come in and help pick up whatever's left over. So if you have like a deductible, co-insurance, co-pay left over from your primary insurance, this plan helps pay that.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is this the gap, as it's called?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh, OK. OK. I understand that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, OK, well, let me ask you a few questions, um, that can just help me use this moving forward because.
[CUSTOMER][NEUTRAL] Uh, I am pregnant right now and I will be giving birth in August. Can this help at all? I am giving birth in a hospital. Um, I already paid my OBGYN for the birth, and my insurance covered quite a bit of that, um, but can I use the gap for that at all? Or is this just for the hospital? Do I have to bring?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My card to the hospital, um, all these things.
[AGENT][NEUTRAL] Yeah, so, um, got your policy pulled up and anything I quote is not a guarantee of payment. It's a basic outline of your plan. So when you go to the hospital, yes, bring your card for your inpatient stay when you go deliver, um, typically you'll stay like 2 to 4 days depending on what type of delivery you have. Um, so,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For that inpatient stay, there is a benefit that pays whatever's left over from your primary, we will pay up to $6000 for the hospital charges.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So that, that would be for your hospital charges. And then if you have any kind of like office visits between here and, you know, between now and then or even after, you have $1000 per calendar day for outpatient hospital charges, and then also any treatment or procedure rendered in the doctor's office. Just not the actual office visit itself. But if they do an injection or they want to do lab work or something in the office.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] This pays up to $1000 per day after your primary processes.
[CUSTOMER][NEUTRAL] Um, OK, and how would I claim that if I never gave this, like I went to the hospital for an ultrasound and they, um, charged me $200 after insurance. Can I claim that?
[AGENT][NEUTRAL] Yes, so it was done in the hospital.
[CUSTOMER][NEUTRAL] It was done in the hospital.
[AGENT][NEUTRAL] OK, um, so yes, you would need the primary explanation of benefits from your primary insurance. Um, is that Aetna or Ford or?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Ahmed
[AGENT][NEUTRAL] AMed, OK. So you need the explanation from AMed and then you'll need to submit the claim information for that date of service. So that's usually gonna be like it it's a claim that shows you had an ultrasound and what the diagnosis was.
[AGENT][NEUTRAL] So you might see if you have a portal, is there a portal you can get on for your hospital?
[CUSTOMER][NEUTRAL] Uh, yeah, um, both for the hospital and for the, uh, insurance.
[AGENT][NEUTRAL] OK, so I would get on the portal and see if you can find like an itemized bill for that day or something that shows the services rendered and then what the diagnosis was and submit that along with your primary explanation of benefits from AMed.
[AGENT][NEUTRAL] That can be done through our portal, um, by fax or by mail.
[CUSTOMER][POSITIVE] OK, all right. That sounds awesome. Um, and then if I bring this to the hospital, could that help in at the time of my birth, or I'm still gonna have to go through this process afterwards?
[AGENT][NEUTRAL] Uh, yeah, I would bring your card to the hospital, um, because they should be able to verify the benefits that I just, we just talked about. Um, so, um, I would just tell them, you know, I have a secondary gap policy that will pick up some after my primary processes, so can they please call and verify the benefits and we'll tell them what benefits you have.
[CUSTOMER][NEUTRAL] Like it's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I was reading through the packet that I have and um it does say some things about. What about my baby after my baby is born? Is there any coverage for him?
[AGENT][NEUTRAL] Um, so you'll want to talk to your employer, um, because I believe that should, that should be a qualifying event to add the baby to the policy if you'd like to, um, but you'll want to check with your human resources to see about adding the baby. Right now, it's just you on the policy, so it just covers you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I had another question and I forgot. Oh, my name is spelled wrong on my card and I see it on the letter and I don't know where the mistake happened because I think my name is spelled correctly on my insurance card, but um.
[CUSTOMER][NEUTRAL] Can I fix that?
[AGENT][NEUTRAL] Oh yeah, I see that it has two eyes. Is it just supposed to be [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] 02 Ns, OK, not two [PII], OK.
[AGENT][POSITIVE] OK, yes, I'll get that corrected for you. Um.
[AGENT][NEUTRAL] And then we can send out a new card.
[AGENT][NEUTRAL] OK, I'll correct that and send out a new card and then um do you want me to send you some information about how to log on to our website and stuff? Um, that's really the easiest way to submit claims because you can just upload them, upload the documents to our website, they'll go straight through.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you send me through an email?
[AGENT][NEUTRAL] Yeah, I can send it through email unless um we can walk through it right now if you have time or I can send it through email.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You can just send it through email, um, I'm pretty familiar with insurance procedures, so I think I can take it from there.
[AGENT][NEUTRAL] OK, I'll send you the information on how the link to our new website and how to set it up, um, and then I've got your name changed and we will get out a new card.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you. I really appreciate that.
[AGENT][NEUTRAL] OK. Anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] Um, that's really all. Thank you. I really didn't understand the gap and now I do. It's really helpful. Thank you.
[AGENT][POSITIVE] OK. OK, awesome. All right, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye, you too.