AccountId: 011433970860
ContactId: eb7392bc-7605-4924-8f19-630ed40d5088
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 723820 ms
Total Talk Time (AGENT): 322694 ms
Total Talk Time (CUSTOMER): 339538 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/eb7392bc-7605-4924-8f19-630ed40d5088_20250113T20:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII], and I, hello?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, ma'am. I'm here.
[CUSTOMER][NEUTRAL] OK, hi, so what can I give it to you? I have a question about my um policy or insurance. This is my first time. I'm a new member of uh American Public Care multi plan.
[CUSTOMER][NEUTRAL] Um, I had made a, uh, appointment for tomorrow for well woman checkup with one of the gynecologist that I found on the provider network. Uh, how do I verify that how much is gonna be a charges for that?
[AGENT][NEUTRAL] OK, so you're new with APL and you have a question on your benefits for an office visit that you have scheduled for tomorrow?
[CUSTOMER][NEUTRAL] Office visit, yeah, I have an office visit tomorrow for well woman checkup and uh um the medicine that I'm taking, I want them to prescribe it because before I was with a different insurance company.
[CUSTOMER][NEUTRAL] And that's the one the doctor I was using it so.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEUTRAL] How can I verify how much will be my, my charge for tomorrow's visit?
[AGENT][NEUTRAL] OK, so, um, first off, I need to get you, I can answer some of your questions for you, but first off, I will need to get your name again. I didn't understand your name initially. I'm sorry.
[CUSTOMER][NEUTRAL] OK. My name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[AGENT][NEUTRAL] I'm so sorry. Will you spell the last name for me one more time, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, Ms. [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, yes, ma'am, I have it. Thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Uh, it says policy slash certificate number is 02502546456.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][POSITIVE] Good thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so give me just a moment, Ms. [PII], while my, your information is loading for me.
[CUSTOMER][POSITIVE] Yeah, sure, not a problem. Thank you.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so first off, Ms. [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your date and I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII], I mean [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, [PII] mhm.
[AGENT][NEUTRAL] OK, thank you and lastly your email address?
[CUSTOMER][NEUTRAL] It's [PII], my first name and last name together, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you so much. So one moment.
[AGENT][NEUTRAL] Moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the diet is.
[AGENT][NEUTRAL] It's still loading your information this message, so please bear with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, to be.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That for you.
[AGENT][NEUTRAL] OK, so Ms. [PII], on your policy that you have with APL, this is not a major medical plan. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] And your policy with us does not have a wellness.
[AGENT][NEUTRAL] Office visit benefit on here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This, this is only for accident and sickness.
[AGENT][POSITIVE] That you have benefits.
[CUSTOMER][NEUTRAL] Oh, I see. So how about, um, how about like I selected as a wellness, but how about, how does that considered because I'm taking some medications, uh, and I need a doctor's prescription to write it down for my monthly medicine. Does that consider under any of the thing or it's still consider?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] That is the reason.
[AGENT][NEUTRAL] On this, well, on this benefit.
[AGENT][NEUTRAL] OK, I'm sorry, on this plan.
[AGENT][NEUTRAL] For a physician's office visit that's related to accident or sickness.
[AGENT][NEUTRAL] Do you have a benefit of $100 per day maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your outpatient prescription drug benefit on this plan is $20 per day.
[AGENT][NEUTRAL] And a maximum of 15 days per calendar year per covered person.
[CUSTOMER][NEGATIVE] I don't understand. So when I visit them and uh they're gonna write it down for monthly, it's gonna charge for $40 a month for.
[AGENT][NEUTRAL] Now, this would, this benefit only pays on pre excuse me, a prescription drug benefit on this plan is $20 per day.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And a maximum of 15 days per calendar year.
[CUSTOMER][NEUTRAL] Wow, 20 even with the regular thing it's 20. So what happen if I go to tomorrow the visit for the woman or whatever this doctor write it down, um, for just for the prescription, uh, that I can get it from any.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ja
[CUSTOMER][NEUTRAL] Drug like Walgreens or CVS.
[CUSTOMER][NEUTRAL] Uh, do I need to pay $20 per day?
[AGENT][NEUTRAL] No, ma'am, we, this plan would only pay.
[CUSTOMER][NEUTRAL] $20 per day. OK, makes sense. OK, for 15 days, yeah, OK. 15 days.
[AGENT][NEUTRAL] $20 per day. Yes, ma'am, and a maximum of 15 days per calendar year. Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] For calendar year.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] Oh, OK. Um.
[AGENT][NEUTRAL] Again, that's because this is a limited benefit plan. It's not a major medical. Mhm.
[CUSTOMER][NEUTRAL] Limited that ma'am because I was with Kaiser before so it's a huge difference for me to understand I was with Kaiser Permanente for more than 20 years. OK, um, so, OK, I got that point. I'll check it out, but how about for the
[AGENT][NEUTRAL] Yes. Yes, ma'am.
[CUSTOMER][NEUTRAL] For the uh the visit that if I'm gonna do that uh I, I understand it's not considered under the plan, so whatever they charge, I will just give it to them that's how it works or how does that work?
[AGENT][NEUTRAL] Well, you would, yeah, I mean, you would have to discuss that with them um this method to find out about, you know, any payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cause I called them and they said, call you guys.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, ma'am, but we don't determine patient responsibility and that type of office visit for a wellness benefit is not covered under this policy.
[AGENT][NEUTRAL] So that would be something that they would have to work out with you, you know, on your payment.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] I see, I see.
[CUSTOMER][POSITIVE] OK, OK, let me make a call to them then. Thank you so much. Mhm.
[AGENT][NEUTRAL] OK. You're welcome. And is there, and I can see that you did set up your profile in our portal.
[AGENT][NEUTRAL] Where you can have access to your information online. So just so that you're aware, there is a copy of your policy in the portal that has all of your benefit information in there as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I just logged it. I'm gonna check it there, uh, so where do I check all the, all the information in the profile or uh?
[AGENT][NEUTRAL] Yes, ma'am, once you log in, yes, ma'am, when you log in, you would just go under my coverage and where you see your policy number, you can click on that and then you should see a little uh PDF icon.
[CUSTOMER][NEUTRAL] Hold on, so.
[AGENT][NEUTRAL] And that way you can download a copy of your policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Network provider access your provider important message my application no, I, I see my, I'm on multi plan provider porter.
[AGENT][NEUTRAL] And you're logged
[AGENT][NEUTRAL] Are you
[AGENT][NEUTRAL] Oh, no, ma'am. No, I'm talking about our portal at APL where you set up your profile at [PII].
[CUSTOMER][NEUTRAL] OK, oh, I think I need to check it that one. I'm not sure. Did I set up that one? You see that I set it up already that one then I need to log on to that.
[AGENT][NEUTRAL] Yes, ma'am, I do know. I can provide you the um website that you would go to to sign in. I can also tell you.
[CUSTOMER][NEUTRAL] OK. What is that?
[AGENT][NEUTRAL] Your username, so your portal website is secured.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK. [PII]?
[AGENT][NEUTRAL] And your uh-huh, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the username that you created, it's your first name and the first letter is capitalized, everything else is lowercase and then the numbers [PII], so [PII] is your username. Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you, yeah, that's OK.
[CUSTOMER][NEUTRAL] And password. I'll do forget password.
[AGENT][NEUTRAL] Yes, ma'am. I could because we don't have access to that, so you would just have to reset it if you don't remember what it was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see. OK.
[CUSTOMER][POSITIVE] Mm, OK, I'll go with that one then. OK, thank you so much for your information. I'll appreciate your time.
[AGENT][POSITIVE] OK. Were you, absolutely. Yes, ma'am. You're very welcome. So, can I help you with anything else today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it for today. Mhm. Thank you.
[AGENT][POSITIVE] OK. Well, thank you again for calling APR and I hope that you have a very nice evening, Miss [PII].
[CUSTOMER][POSITIVE] OK thank you ma'am.
[AGENT][NEUTRAL] Uh-huh. Bye-bye