AccountId: 011433970860
ContactId: fc7c6212-ff1a-4769-b868-8035deb13e1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 950969 ms
Total Talk Time (AGENT): 225052 ms
Total Talk Time (CUSTOMER): 644615 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/fc7c6212-ff1a-4769-b868-8035deb13e1d_20250110T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, you said [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII], my name is [PII], and I am online trying to just look at my um look at my benefits we've had uh through my company we've had um.
[CUSTOMER][NEGATIVE] A gap coverage uh for some years now and I'm just trying to get the latest policy, uh, download a new ID card and when I went to put in the information for what I have even to just uh to do a uh password reset and I put in both emails that I have, it said it didn't have anything. Then when I went to set up as a new user, it said this account already exists.
[CUSTOMER][NEUTRAL] So I'm not really sure, you know, what is what, but um I was wondering if you could help me.
[AGENT][NEUTRAL] OK, may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, well, I'm not sure which is the which is the actual policy number because I have an old card. um, the card said the policy number says 989603.
[AGENT][NEUTRAL] And that's the benefit certification number?
[CUSTOMER][NEUTRAL] It just says policy slash search and that's on the card.
[CUSTOMER][NEUTRAL] And I have the group, the group number.
[CUSTOMER][NEUTRAL] Here
[CUSTOMER][NEUTRAL] The kids can just.
[AGENT][NEUTRAL] May I have your date of birth, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Don't you know about and it's isn't he accepted whole life insurance.
[AGENT][NEUTRAL] And I do need to verify the mailing address that is listed on file.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have a callback number just in case this call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Absolutely [PII].
[CUSTOMER][NEUTRAL] Uh sorry.
[AGENT][NEUTRAL] OK, and so for the email address, could you verify that that we have on file?
[CUSTOMER][NEUTRAL] This is what I have two. I have the one. I'm the benefits administrator at my job, but I'm, I'm, I'm plugging in as an individual right now. So my personal individual, uh, my personal email address is [PII].
[AGENT][NEUTRAL] OK, that's the one that we do have on file and that's the one that you're entering into the system?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, and it's telling me that you know that that there is when I tried to do the the password reset, it said that that did not exist. We can't find you in the system. And I am on uh [PII].
[AGENT][NEUTRAL] OK, so for that, for you to log into our system, it is secured, that is [PII]
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what, that's where it's at now. I'm looking at it, that's that's where I am and the the actual logo is in the, on the left side of the screen, but it does say secured.
[AGENT][NEUTRAL] OK, and so you went in and you did your username and password?
[CUSTOMER][NEUTRAL] So if I go
[CUSTOMER][NEUTRAL] Uh-huh, I did my username which again let me ask you this.
[CUSTOMER][NEUTRAL] What I don't know is, is my username the same as my email address?
[AGENT][NEUTRAL] It shouldn't be normally it's just the name either you what you entered in. Now if it is your email address that you use then you would enter that. Let me see if I can find what your username is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It looks like this, but what I have to tell you.
[CUSTOMER][NEUTRAL] If you want to stay play.
[CUSTOMER][NEUTRAL] If you want something permanent.
[CUSTOMER][POSITIVE] He's a good guy. He's fun, he's fun.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You know what?
[CUSTOMER][NEUTRAL] Never mind. I, I found it.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] I found it. I went back in my notes and uh on my phone and I found it. Um, let me see if this will let me in, wait a minute.
[CUSTOMER][NEGATIVE] I don't even know why I didn't think to check there first.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][POSITIVE] OK, so there's a password expired and it has to be reset, so I think I'm good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much. I appreciate you. Oh, you know what? Maybe I should be asking you, let me, let me just do this, um.
[AGENT][POSITIVE] You're welcome. You're welcome. Yeah.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Let me just ask you this, uh, what I'm trying to find out is, um, is, uh.
[CUSTOMER][NEUTRAL] Let me put this excuse me, let me put this number in for verification if you don't mind, um, what I'm trying to find out is having um this coverage, um.
[CUSTOMER][NEUTRAL] Having this coverage.
[CUSTOMER][NEUTRAL] I um wanna know what actually the benefits cover in terms of, in terms of like um
[CUSTOMER][NEUTRAL] X-rays, things like that. I'm not sure what it all covers.
[CUSTOMER][NEUTRAL] know.
[AGENT][NEUTRAL] OK. So is there a specific thing that you're needing for me to pull up?
[CUSTOMER][NEUTRAL] So, so when I went to, when I went, I had, this was like uh back in [PII], um, and 20 early part of [PII]. I went to the doctor and I had surgery done first of all. And it looked like it may have covered some portion of that, but I can't even tell what it covered then. Um
[CUSTOMER][NEUTRAL] And um and if by chance it did, my office did accept it or it did not, I have no idea.
[CUSTOMER][NEUTRAL] I have no idea. So, I don't know what the policy covers. I actually have a booklet here that was mailed to me, but it doesn't tell me really specifically what it covers. And so I don't know like if I go to urgent care, I know it doesn't cover doctor's visits, correct?
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] So of course they know how they change, but it's always like.
[AGENT][NEUTRAL] Now are you trying to
[AGENT][NEUTRAL] Look at for the previous year or for this year?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The previous year and or this year cause the coverage to my knowledge, has not changed.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for your office procedure, up until [PII], verification of coverage does not guarantee the payment of the claim. You did have up to.
[CUSTOMER][NEGATIVE] That's his home repair facing foreclosure and need to sell your house back.
[CUSTOMER][NEUTRAL] At cash buyers my end we'll give you.
[AGENT][NEUTRAL] $250 per calendar day for office procedures for outpatient, which is urgent care, emergency room.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see if lab is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 86981.
[AGENT][NEUTRAL] You did also have lab, and that will be covered up on that $250 per calendar day.
[CUSTOMER][NEGATIVE] So, so I presented my card at an urgent care and it did not accept it.
[CUSTOMER][NEUTRAL] I have to go back and get a receipt for that in order to get reimbursed for that or how does that work? You can go ahead, I'm listening. I need to listen. That's what I need to be doing.
[AGENT][NEUTRAL] OK. So if the
[AGENT][NEUTRAL] Oh, it's no problem. So for that we do not accept receipts. You would have to either get the statement from that provider and your primary insurance EOB and you will have to submit that documentation in to us now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Within that statement or the discharge papers, if it doesn't indicate the diagnosis code, you would have to get that from that provider as well.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so that, so I, I'm gonna just consider because by the time I go through all of that, it, you know, it it's like.
[CUSTOMER][NEUTRAL] I can get the EOB from United Healthcare. Um, but the, what I may not be able to get is from the urgent care. That will probably be the issue from the urgent care.
[AGENT][NEUTRAL] OK, so if you contact the urgent care, you can just give them that date of service that you're calling in regards to, and they should give you that diagnosis code for that date of service. If you're not able to get that statement, the explanation of benefit will suffice, but we will need that diagnosis code.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and OK, that, that's fair enough. Um, so.
[CUSTOMER][POSITIVE] Are there any services? So where I go, so let me, let me be very, let me be a little bit more specific and maybe you can help me even better, uh, because you're doing a great job. Thank you so much and I am in. I, I did get in and I was looking trying to um get it um.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Trying to see if I could end up getting, uh, OK, it did, it did drop the policy. Um, yeah, it did drop the policy. What I wanted to find out is I, I have all of this, all of these questions for me started when I started going to my uh orthopedist. I had a surgery back in, back in [PII]. I'm not even dealing with that, uh, cause I don't, how far back can you go, first of all?
[AGENT][NEUTRAL] As long as the policy was active.
[CUSTOMER][NEUTRAL] OK, the policy was act. I mean, but don't you have a certain time frame in order to go back to get to claim to make claims?
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][NEUTRAL] OK, very good. OK, then I'll, I'll pull all those EOBs and see where I sit with that. Um, and I can probably get that also pulled from my doctor's office to do the matching what you're talking about. But, so going to my, going to this orthopedics, I actually, he actually um
[CUSTOMER][NEUTRAL] Um, he actually, uh, does X-rays and everything right there in his office.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm not so sure how that works with the gap coverage.
[CUSTOMER][NEUTRAL] If he does it in his office and not a freestanding facility.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK. So that is considered an office procedure.
[CUSTOMER][NEUTRAL] Cause I got, cause I gotta start that.
[CUSTOMER][NEUTRAL] OK, cause I gotta, I'm gonna start that whole process again, getting checked, x-rays, all that stuff, uh starting Monday, uh, for cause I got another issue going on.
[AGENT][NEUTRAL] OK, so for that, that is up under your office procedure benefit rider, which is also included in that $250 per calendar day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so, um.
[CUSTOMER][NEUTRAL] Yeah, I see where they, they, you did process a couple of claims, but um on the day of surgery, the day when I had the surgery, that one was the one that actually covered uh quite a bit of my um.
[CUSTOMER][NEUTRAL] Of my uh inpatient procedure.
[CUSTOMER][NEUTRAL] Um, but anyway,
[CUSTOMER][NEUTRAL] So all I have to do is present my card to them and they should accept my card, is that correct?
[AGENT][NEUTRAL] It's the provider's discretion if they accept it or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, alright, I'm gonna print up the new card. I'm out here trying to see, um, pull up my.
[CUSTOMER][NEUTRAL] Uh, pull up my account and see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says welcome uh policy contact information notification purposes. Where do I go in here to find and get a copy of my card?
[CUSTOMER][NEUTRAL] I said listen.
[AGENT][NEUTRAL] Is there
[AGENT][NEUTRAL] I think it's up at the top right corner. It's like 3 dots or 3 lines or something like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, on my screen it let me let me go home let me see.
[CUSTOMER][NEUTRAL] Uh, on my screen, wait a minute, it's.
[CUSTOMER][NEUTRAL] OK, let me see, oh here it is available ID card.
[CUSTOMER][NEUTRAL] So let me see if this is it.
[CUSTOMER][NEUTRAL] 22.
[CUSTOMER][NEUTRAL] It says it's starting the
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][POSITIVE] OK, I got it. I got it.
[AGENT][NEUTRAL] OK, and did it give you the correct policy number effective [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Only thing it says, it says um.
[CUSTOMER][NEUTRAL] It only says insured is me coverage individual group number is effective date and then it says the plan the uh mid link select group uh medical supplement, but it does not have.
[CUSTOMER][NEUTRAL] And it gives an in hospitals er number and it gives an outpatient certain number but it doesn't give anything else as far as a group number. I mean as far as um a policy number.
[AGENT][NEUTRAL] The outpatient inpatient benefit certification number is your policy number.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, OK, OK. So what would this be? Go ahead.
[AGENT][NEUTRAL] And is that one that
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] If so, how would this be classified if I go to my doctor's office?
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] I just show them, I just show them this card and, and then what do they do? Cause I used to have one of the hard.
[AGENT][NEUTRAL] They will either contact us.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, cause the card that I have is so old it's actually like a credit card. Do you guys issue those type anymore?
[AGENT][NEUTRAL] What, what are you talking about like it's plastic or something?
[CUSTOMER][NEUTRAL] Yeah, it's plastic.
[AGENT][NEUTRAL] Mm, we sometime we'll issue out new cards but normally since we have the OSC it's just downloaded.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well, I know what to do at this point. I, um.
[CUSTOMER][POSITIVE] Appreciate it. Now I know that I I had I can log in I can get that going and uh I'm gonna print these cards up so I could have them and see what they accept.
[AGENT][NEUTRAL] OK, and did, would you like to verify if that is the correct policy number for this year?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Oh yeah, that is true. um, let me see, one minute, yeah, it says effective [PII].
[AGENT][NEUTRAL] OK, that is it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much. I appreciate it, and then I'll be able to check out the policy and check to see if it's different from the booklet that I have. I think I got this booklet back in 23.
[AGENT][POSITIVE] You're welcome and thank you
[AGENT][POSITIVE] Yes, you should be able to download that um new benefit certification as well.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] OK, alright, sounds wonderful thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thanks you too take care bye bye.
[AGENT][POSITIVE] Thank you bye.