AccountId: 011433970860
ContactId: f4112642-39c6-4061-affb-5e5d7cdd3e29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1648930 ms
Total Talk Time (AGENT): 486031 ms
Total Talk Time (CUSTOMER): 692615 ms
Interruptions: 10
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f4112642-39c6-4061-affb-5e5d7cdd3e29_20250123T18:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Good afternoon, [PII]. You sound like you have so much joy in hearing your voice. I'm glad to hear someone like you today. How are you?
[AGENT][POSITIVE] Thank you. I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing good. I have to reach out to you guys cause I have a question about some things that I've been held responsible for, and I just thought about my APL um benefits and I said, you know what?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It to tell you about a try, but I am [PII] old and um I'm sorry, [PII]. I'm [PII]. I'm [PII] old and I have to, I guess I felt that at heart, huh. But I'm [PII] and I had to have a mammogram done because my um
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] My primary care doctor, I've had a lumpectomy before back in [PII], that had to be surgically removed. And so my primary care doctor reckoned because I had a lot of scar tissues and lumping that I had a mammogram.
[CUSTOMER][NEUTRAL] So I had a mammogram done and because of my age, the insurance is not covered because it says I was not the, I guess you gotta be [PII] to get one done and because I'm [PII], so it's not covered. And I'm like, should I fight that, but if it was recommended by a doctor because I'm high risk because I had, you know, a benign, I mean, um, you don't have to have it removed and I had, she just.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so, um, I think or wanted to check and see in our coverage, are we reimbursed if we have a mammogram done? If I have the receipt showing what the mammogram was and stuff like that. Could you pull my account up to see if you guys cover that with my service?
[AGENT][NEUTRAL] I sure can. Um, so I'll take a look at your policy and see the coverage for mammograms. Um, may I have your name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] I got married in November, so [PII]'s [PII] It should have been updated. I'm not sure if they updated APO like they updated my insurance. So if it's not, it's probably under [PII]. Thank you.
[AGENT][POSITIVE] OK. Well, congratulations.
[AGENT][NEUTRAL] You're welcome. And uh Miss [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, give me one second. One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that the the.
[CUSTOMER][NEUTRAL] It is I think that it was $900. Hold on.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Alright. 224-425-0.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] 62586.
[CUSTOMER][NEUTRAL] Um, what else did you need? What was it?
[AGENT][NEUTRAL] Um, your, your mailing address and your email address.
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[CUSTOMER][NEUTRAL] The [PII] or do you have the match?
[AGENT][NEUTRAL] Say that one more time, it's going in and out. I missed what you said.
[CUSTOMER][NEUTRAL] Is it the the.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, this one looks like it might be your work email.
[CUSTOMER][NEUTRAL] OK, give me one second. It should be [PII] um [PII].
[AGENT][POSITIVE] Yes, and thank you so much for verifying your information. So all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you have, um, just taking a look at your policies.
[AGENT][NEUTRAL] You have um 123 policies that a wellness benefit could be on, the accident, the critical illness, and the hospital indemnity. So I'm just gonna check those three, check for wellness benefits and let you know if I see some, OK?
[CUSTOMER][NEUTRAL] OK, and then I have.
[AGENT][NEUTRAL] Alright, hold on, oh go ahead.
[CUSTOMER][NEUTRAL] I got a question about mammogram, ambulance, and an auto accident. So I just want to let you know.
[AGENT][NEUTRAL] You said mammograms, ambulance, and auto accident?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Alright, so I'm gonna look through these 3, these 3 policies and look at the wellness benefit and then I can answer those 3 questions for you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yes. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I did take a look at all of your policies. So the accident policy does have a screening benefit, but that's only if a screening is needed due to an accident.
[AGENT][NEUTRAL] Um, in terms of like your mammogram, that would be on your critical illness policy. The policy will pay 70 up to $75 a year, um, each time you get a mammogram, um, but it's 1 per year.
[CUSTOMER][NEUTRAL] OK, so I have to file a claim and what did you say they pay bill then?
[AGENT][NEUTRAL] Um, the max is $75.
[CUSTOMER][NEGATIVE] Are you serious? And that thing is 900 and something dollars. Dang.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so I filed a claim and you guys will reimburse me $75.
[AGENT][NEUTRAL] Right, so either you can file the claim or if you want to give this um
[AGENT][NEUTRAL] Policy information and even our phone number to the providers if you want them to file the claim, it's up to you, um, but yes, you can file the claim for that mammogram under your critical illness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I secondary um insurance, right? That's what it's considered like secondary. OK, so I have them do it, um, that'll save me some.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, the, the, the, um, the auto. I see something on there that says auto.
[CUSTOMER][NEUTRAL] Modification. What did that mean? Auto auto modification or home modification. What does that mean?
[AGENT][NEUTRAL] Let me take a look, and you saw it on your policy?
[CUSTOMER][NEUTRAL] Yeah, on accident. I've seen that on accident.
[AGENT][NEUTRAL] Typically home mod is like if someone hurts themselves they're in a wheelchair and now they need ramps in the home or something like, you know, something, some type of home modification due to that injury or that accident, but um let me just
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEGATIVE] I got in a car accident and um when my car was in an accident. I was involved in a hit and run. I am having to pay out of pocket now for a rental car and I paid almost $1000 within two weeks and it's like.
[CUSTOMER][NEUTRAL] You know, I have the accident if it's been out of, um, you know, modification. I didn't know if it was because I have a police report and I have receipts from the rental. If some of my money can be reversed back because I was involved in the accident, well my car was involved in the accident.
[AGENT][NEUTRAL] Let me take a look
[CUSTOMER][NEUTRAL] Cause I see it says other
[CUSTOMER][NEUTRAL] On the group accident insurance, it says auto and home modification, $1000.01 time. So I want to know what that means.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, uh vacation benefit.
[AGENT][NEUTRAL] If uh accident alterations to their principal residence and or private vehicle to make residents accessible and or vehicle drivable and ridable, resident in a vehicle modification must occur within 13 days after to cover this.
[AGENT][NEUTRAL] Mm OK, so what's the schedule benefit.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So if I don't get the supervisor position, [PII] is going to be above me.
[AGENT][NEUTRAL] I'm out of here.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][POSITIVE] I'm doing good. I just have a quick question. Do you know about the auto and home modification on the accident policies?
[CUSTOMER][NEUTRAL] I haven't had one yet, but I can look at it. What's the policy number? Do you have a policy number?
[AGENT][NEUTRAL] Um, 2, 224-4250.
[CUSTOMER][NEUTRAL] On uh [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm. Wait, what did you say?
[CUSTOMER][NEUTRAL] A [PII]
[AGENT][NEUTRAL] Oh yeah, mhm.
[CUSTOMER][NEUTRAL] [PII] or something like that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So she's, it sounds like she's trying to use the benefit for like car repairs, but this is more so like if a modification needs to be done to the car for
[AGENT][NEUTRAL] Like if they hurt themselves and they're in a wheelchair now or something like that, right?
[CUSTOMER][NEUTRAL] Let me take a look at it. Let me get it pulled up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the modification, it covers um.
[CUSTOMER][NEUTRAL] The benefit covers if as a result of a covered accident, a person requires alterations to their principal residence and or private vehicle to make the residence accessible and drivable, so that any changes done to either their auto or home.
[CUSTOMER][NEUTRAL] Any modification of their auto or home coverage.
[AGENT][NEGATIVE] Right, but it's not like repairs, like we're not gonna fix the damages. This is for like
[CUSTOMER][NEGATIVE] Correct, it's not. No.
[AGENT][NEUTRAL] Wheelchair accessible, I mean, I don't know, I have to think of the.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] But modifications because of the injury.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, modifications either to their home or their vehicle.
[AGENT][NEUTRAL] Right, OK, she's trying to use it for repairs. No. OK, I got it. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, not for repairs, yeah, OK.
[AGENT][NEUTRAL] All right, bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I had to reach out to claims because I wanted to make sure for the modifications if they, if the
[AGENT][NEUTRAL] Policy is speaking of like repairs or if it's more like uh
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] This person, you know, there was an injury and now they can't get in the car, we need to adjust the door or something like that. So that is what it is.
[CUSTOMER][NEUTRAL] Yeah, y'all, splash me.
[AGENT][NEUTRAL] Um, it's not so much for the repairs. This is more so like to make it accessible.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, what's the mean? Like, can you explain it to me?
[AGENT][NEUTRAL] So, like, of course, so the auto part of the modification, even the home modification part, is saying it's not, it's not $1000 for repairs or if something's wrong with the car. It's like let's say you got hurt and your legs are broken, you now need a wheelchair.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You need a wheelchair accessible unit or car, we would, the policy could pay up to $1000 to help you make that transition to get it a ramp in there or whatever you need to make it accessible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not for like repairs or to fix damages, it's to make it.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And accessible unit because of whatever the injury was.
[CUSTOMER][NEUTRAL] OK, I see like some I be saying someone came wheelchair bound and now they need one of those ramps on their van or something, is it up to like something like that.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Right, then you will have up to $1000.
[CUSTOMER][NEUTRAL] But it had, it had been caused by accident. OK.
[CUSTOMER][NEUTRAL] OK, I got you. OK, so that's a no go on that one, but the 75%, $75 I can have the people that did it, call and make that claim, give them my information. And then what about the ambulance? I have to get to the ambulance, but it was um [PII], and I just got the bill not too long ago and opened it up. I hadn't opened it and realized that it was like $400 and something dollars for the ambulance um to go to the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now is that something I can be reimbursed for or what?
[CUSTOMER][NEUTRAL] Cause I see the ambulance grounds or something like that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For the ambulance. Hold on one second. I'm going back to the ambulance.
[AGENT][NEUTRAL] Yes, if you have an ambulance bill, um,
[AGENT][NEUTRAL] For ground, the policy will pay up to $400. Yes, you can, um, you can send the ambulance bill in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so submit that a copy of the um ambulance bill. OK.
[CUSTOMER][NEGATIVE] Alright, so I just wanted to ask first before I did it because some things I submit and you guys don't even cover so I was like pointless do it so now I said I'm just gonna call them to act now. And there was one more thing, um, I'm doing good, what was it?
[AGENT][NEUTRAL] Why am I gonna do it, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said the mammogram, the ambulance, and then the motor vehicle, the accident itself, I think.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, um, one other thing, OK, so I don't know if you can look up, have I gotten the max of my walk-in clinic visit, like, so if I had to go walking and I was sick, I missed work last month and I had to go to a walk-in, and I think it used to be like $35 and they paid it up to 3 times. Did I, did I use the 3 times I had available? Can you see that? It was like, I can't remember.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see which, so that was for, uh, OK, so which policy am I under now? Hold on one second. This is critical illness, I think. This is an accident. Um, that benefit, do you know if it was under your critical illness or your accident? I can look at, well, it's not on, doesn't, I don't see it on accident. Let me look on critical illness.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yes, walking.
[CUSTOMER][NEUTRAL] I'm glad I screenshotted pictures of these papers because I sure ain't got a moment. Hold on. Um, emergency treatment, urgent care, urgent care treatment pays once per day, um, or $100 for two days. I think I've gotten it or unless it doesn't start over every year.
[AGENT][NEUTRAL] Which policy are you looking at?
[CUSTOMER][NEUTRAL] Is that for
[CUSTOMER][NEUTRAL] That's the group accident insurance.
[AGENT][NEUTRAL] This is accident? OK, hold on one second. Let me go to accident.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's an urgent care treatment is on the initial treatment benefit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh so.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said you see it under initial treatment. Hold on.
[CUSTOMER][NEUTRAL] is it?
[CUSTOMER][NEUTRAL] It's the 123, 3rd 1 down on the initial treatment on the group accident and it says $100.02 days.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Physician office, $100. Hold on, and urgent care is right above it? OK, this is it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I'm trying to see, have you guys reimbursed me, um, $100 twice but I'm assuming that they'll pay you $100 you know, only the first two visits, basically not over that and then it does that start over every year is what I was asking.
[CUSTOMER][POSITIVE] I'm sorry about that
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for the physician office, it has to occur within 30 days of the accident, um, payable for up to 3 days per calendar year, I'm sorry, per plan year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Not for the physician office. I'm talking about an urgent care. I was sick. I had a virus. It's an urgent care visit.
[AGENT][NEUTRAL] OK, so urgent care is the same with up to 2 per plan year. Let me see if it's being used. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is for 25 or 24?
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] Oh no. Yeah, yeah, 2, no, what's this? January?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I got to that before [PII]? It was [PII]. It was [PII].
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Your policy is on a plan year, so this would
[AGENT][NEUTRAL] This would all be the same year for now because until September, that's when your your plan uh restarts.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sorry. OK.
[AGENT][NEUTRAL] So, as of [PII], I'm not showing the urgent care benefits have been used.
[CUSTOMER][NEUTRAL] OK, so I got 2 available to file.
[AGENT][NEUTRAL] So you can, you have those too. Mhm.
[CUSTOMER][NEUTRAL] And I'm gonna file it cause I need everything that I sent out.
[AGENT][NEUTRAL] I mean, that's the, that's the truth.
[CUSTOMER][NEUTRAL] OK, so I can, I got 2, if I got 2 urgent care bills, and they're like $35 but regardless, I can just send in what is um the visit paper.
[CUSTOMER][NEUTRAL] That's what I send in? Or will they only send what I pay?
[AGENT][NEUTRAL] Yes, you were sending the um the itemized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And will they only send me what I paid or will I get up to the $200 because I went twice because I had, I was sick twice.
[AGENT][NEUTRAL] Um, it will only pay up to the uh the max of the 200 if it's, if the full 100 is, well, no, that's what the benefit is, so it would be the max of 200.
[CUSTOMER][NEUTRAL] Oh, will it be just up the field.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I'll send the, send the bills in. So I'll do that, the mammogram and the ambulance.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And see what happens. That's all I can do is submit the claim for in the itemized bill. That's right. OK. Thank you so much for your help, sweetheart, and your patience.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] You're very welcome. Oh, you're welcome. That's what I'm here for. Was there anything else I can assist you with today, Mrs. [PII]?
[CUSTOMER][NEUTRAL] No, I said my, my new start for the benefits is September, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so say if I use those two urgent care, that was for [PII]. Say something happens in October, I have two more available because it had, it starts over, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Right, because September begins the plan year again, so you'll have all those benefits available again.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Alrighty sounds good to me. Thank you and you be safe and hopefully are where you are because it's cold where I am.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's, it's, well, it's cold here too. I'm in [PII]. We had some snow and ice and stuff last night. Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yes, no, yes, yes. Did you enjoy it?
[AGENT][NEGATIVE] I mean, I'm from [PII], so I, I don't want it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] See, we from [PII] and we don't want it either, but everybody all excited cause we finally got some some snow.
[AGENT][NEUTRAL] Mm mm. I don't want it. I wanna keep that up there.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Yes, yes, yes. Well, yeah, it's been such a delight to talk to someone like you. Keep your customer service, continue to make a difference, and may God bless you, OK?
[AGENT][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You also, thank you so much. I appreciate you. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You're welcome.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, let me get out of here.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm.