AccountId: 011433970860
ContactId: fca507d1-45f0-4abe-adda-f1715c35b0e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465679 ms
Total Talk Time (AGENT): 144581 ms
Total Talk Time (CUSTOMER): 154495 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/fca507d1-45f0-4abe-adda-f1715c35b0e5_20250527T19:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, I just called a few minutes ago. I was speaking with someone named [PII] and the call dropped.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Is that someone you can connect me with or not?
[AGENT][NEUTRAL] Uh, let me see if she's available and your name is?
[CUSTOMER][NEUTRAL] [PII], we talked 5 minutes ago and I gave her my phone number in case we got disconnected and.
[CUSTOMER][NEUTRAL] I gave you the number and the call dropped.
[AGENT][NEUTRAL] Uh, she probably call back and if she doesn't have the number, what's a good callback number, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you hold on one moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Give me one moment I just send her a message.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And she's heard from bankers need this providers.
[AGENT][NEUTRAL] You're needing a list of providers?
[CUSTOMER][NEUTRAL] Uh, I am, so, uh, I've been on this coverage since February.
[CUSTOMER][NEUTRAL] And when I call uh APL they refer me to multiplan who I've called and they send me a list.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They send me a list of doctors here in [PII].
[CUSTOMER][NEUTRAL] And I've called about 2 dozen of them, but no one has ever heard of ABL or APL or benefits in a card.
[CUSTOMER][NEUTRAL] So, um, I just need some help to find an actual uh provider who is with you guys.
[AGENT][NEUTRAL] Well, we don't have like a network. They can like you can go to a multi-plan provider and most times claims are repriced via multiplan if the provider participates with them. But as far as having a list of providers who accept our insurance, we don't have that information. Uh, the only thing we can suggest is you can have them call our office so we can verify what type of benefits you have with our company.
[CUSTOMER][NEUTRAL] Yeah, I've tried a bunch of that and nobody's heard of you guys so um I'm kind of stuck here.
[AGENT][NEUTRAL] OK, well, if the provider doesn't want to submit the claims, you can be reimbursed any payable benefits. But the only thing we can offer is to provide a call in our office so we can actually give them benefits under the plan.
[CUSTOMER][NEUTRAL] So what do I do? I find a doctor, I pay for it out of pocket, and then submit a claim to you. Is that how it works?
[AGENT][NEUTRAL] Uh, typically when you give your information to the provider, what they would normally do is call our office to verify benefits and eligibility and where to submit claims.
[CUSTOMER][NEUTRAL] Oh boy, OK, so is this my primary or is benefits in a card my primary?
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] I have a policy slash certification number here, is that it?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] That's 02595525.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see. And your date of birth and mailing address?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK, and mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is there an apartment number because I'm showing one in our system.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it could be used as either primary or secondary. The type of medical policy you have with us is a limited medical indemnity plan, so it could be primary or secondary.
[CUSTOMER][NEUTRAL] Uh, OK, cause I had called, uh, my cardiologist's office, so I've been going to for a few years with my previous insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh they called you guys and they were told that ATL is a secondary, not my primary.
[AGENT][NEUTRAL] Yeah, because we don't require any primary insurance explanation of benefits in order to process a claim. So we don't necessarily have to be secondary or primary since it's a limited indemnity plan that don't coordinate benefits with other insurance.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I put a uh claim through with you guys, uh, some weeks ago I went to see a spine specialist here in [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The office visit was $500. I submitted a claim with all the detailed information, and then I got a check for $50. Is that only about how much it covers?
[AGENT][NEUTRAL] For an office visit, yes sir. The max benefit payable is $50 up to $50 per visit and you have a total of 4 visits per year.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, so now for me to find a primary doctor here in [PII].
[CUSTOMER][NEUTRAL] What am I gonna do?
[AGENT][NEUTRAL] Uh, only thing, like I said, we can suggest you give them our information and ask them to call our office so we can verify benefits and eligibility.
[CUSTOMER][NEUTRAL] OK, so they would call [PII]?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh huh, um, OK, well, let me keep trying on that list and uh.
[CUSTOMER][NEUTRAL] See what I can find.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's all, that's all about it. Thank you very much.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.