AccountId: 011433970860
ContactId: fd5c78f2-cbbb-427b-b55c-009321fa5d17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 970820 ms
Total Talk Time (AGENT): 502226 ms
Total Talk Time (CUSTOMER): 355714 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/fd5c78f2-cbbb-427b-b55c-009321fa5d17_20250522T22:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, sorry, I think uh the drop, uh, the call was dropped or something, or the lady put me on hold, but I never really got a real answer, so I had to hang up and dial again.
[CUSTOMER][NEUTRAL] Um, so I'm calling to verify my benefits, um, uh, just change insurance, uh, companies, and you guys are the new insurance providers for us, and, uh, I do have a few questions, so regarding my, my.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My policy.
[AGENT][POSITIVE] OK, I can help you with your benefits, sir. May I please get your name and your callback number just in case the call drops on us, I'll be able to call you back.
[CUSTOMER][NEUTRAL] Sure. Um my name is [PII], spelled [PII] Last name [PII], spells [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Policy certificate number is 026.
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] 133.
[AGENT][NEUTRAL] OK, let me look that up, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, [PII], can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you, sir?
[CUSTOMER][NEUTRAL] Um, that would be, uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh what else do you need?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] My email address is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then the phone number that you just gave me to call you back on, is that your cell phone number, sir?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me. OK.
[AGENT][NEUTRAL] So you have benefit questions. Um, I will tell you this is a limited, a limited hospital indemnity plan and this is to verify your benefits. It's not a guarantee of payment. Basically, um, if you go into the hospital, you have a hospital benefit one day per calendar year that pays $500.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then if you have to stay in the hospital, you have 30 days per calendar year that pays $50.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, you have.
[AGENT][NEUTRAL] Physician visits, you get to uh.
[AGENT][NEUTRAL] For accident and sickness.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] For surgical benefits.
[AGENT][NEUTRAL] That pays $250.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have outpatient accident and sickness treatment in an ER, urgent care center, physician's office, or for physical therapy that pays $50.
[AGENT][NEUTRAL] Um, you also have diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That pays $100 and then if you have to have a follow-up test, it'll pay $25.
[AGENT][NEUTRAL] Uh, you have an outpatient prescription drug benefit that pays $10.
[AGENT][NEUTRAL] And then if you ever have to go by ambulance to a hospital, it pays $100.
[AGENT][NEUTRAL] Or if you have to be airlifted, it pays $200.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have preventative or elective surgery in a physician's office one day uh per calendar year that pays $250.
[AGENT][NEUTRAL] Uh, if you have a critical illness,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, life-threatening critical illness for yourself, it pays $5000. For your spouse, it pays $2500 and for your dependent child, it pays $1250.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's basically your benefits in a nutshell, um, because it's an indemnity plan.
[CUSTOMER][NEUTRAL] OK, so I do have a couple of questions. Yes, so I went to a doctor last Saturday for consultation. Uh, I don't know if you already have it on file, but um that was the first claim you'll probably have for me. Um, it was, um,
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just, uh, you know, what you call it, just a family doctor, I guess you call it, um, and, um, he also sent me to labs for urine test and blood tests. So I would like to know how much that will be covering, my insurance will be covering out of that.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And um, if, if, uh, because when I, when I, they did call me and they say, well, your insurance, they, they, they don't have a network, so you have to send them the bill so they can pay partial. It's like, well, I never had to really deal with insurances before like this, so I don't know if you guys are confused or I'm confused. I don't know how that works.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir. I understand. So if you went to um the physician's office for accident or sickness, so this for your ER urgent care center physician's office, it has to be for an accident or for sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it'll pay $50.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then your diagnostic.
[CUSTOMER][NEUTRAL] $50 out of that.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And then your diagnostic testing, you said you had lab work done?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look and see what your policy says about lab.
[AGENT][NEUTRAL] Did you get a copy of your policy certificate?
[AGENT][NEUTRAL] Yeah, I know you said you're new.
[CUSTOMER][NEUTRAL] Not really.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you should be getting a copy of your policy and all of the information that I've given to you will be on that policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me get on your schedule of benefits and see if it covers lab work.
[AGENT][NEUTRAL] Give me just a minute while the computer pulls it up for us.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] I don't see that it covers lab work. It does have a diagnostic testing benefit if you had an MRI, a CAT scan, uh, a PET scan.
[AGENT][NEUTRAL] Sleep study.
[AGENT][NEUTRAL] Uh, nuclear stress test for diagnostic, but I'm not showing a lab benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about uh referrals, so they want me to go to the urologist um here in Austin, um.
[CUSTOMER][NEUTRAL] urology, uh Austin urologist, that's what the company or the doc the uh clinic is called. And they did call me today to verify appointment and so, well, I need to call my insurance policy to make sure you guys are in the network if there is any network. um.
[AGENT][NEUTRAL] Right. And
[CUSTOMER][NEUTRAL] Can you remind me on that one? How does that work? Um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can use this policy anywhere. All they have to do is file a claim with us with the that's on your card.
[AGENT][NEUTRAL] Uh, now, if you go to a specialist that's also considered a physician's office visit and it pays $50 for a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 4 days, so I can go to the doctor for 4 days and then it's on me.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Right, and that's still for accident or?
[AGENT][NEUTRAL] 4 days a year. And that's still um considered for sickness or or accident.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So if I go to a urologist, I'll be considered considered automatically like sickness, right? So you guys will pay the $50 or do I have to prove that there's sickness on the urologist visit?
[AGENT][NEUTRAL] Well, that will, that will be based on uh what the urologist, when they send in the claim, they'll have diagnosis and procedure codes on the claim and everything is paid based off of those diagnosis and procedure codes that they submit to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So they're the ones who will be billing you, right? I don't have to forward you any bills or anything, correct? because that's more or less what I understood last time I talked to.
[AGENT][NEUTRAL] You shouldn't have to.
[AGENT][NEUTRAL] Right, you shouldn't have to. They should, they should file your claim for you. Now, in the event that they don't file the claim for you, you can still file yourself, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9 out of 10 times they're gonna file it for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you really
[CUSTOMER][NEUTRAL] Well, is there any other tactics that I can buy to make it better? Because this seems to be very, very basic. I mean, if I get sick, I'm on my own, basically with this, with this coverage.
[CUSTOMER][NEUTRAL] Uh, I wanna know if there's anything better I can do, uh, cause, man, I mean, this is very, very, I mean, I've never seen so very little coverage in any insurance company at all.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Right. So what you'll need to do.
[CUSTOMER][NEUTRAL] And I know it's not your fault, right, giving me the information, mhm.
[AGENT][NEUTRAL] Right, it's, it's got OK so your plan was, was chosen through your employer, so you'll have to go to your employer and ask them if there's any other benefit package that you could get and tell them what you're looking for.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Alright, I'll do that. Thank you so much and um I'll get all that in, can you send me, um, can you send me like an email with the with the policy benefits in a nuts I mean uh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, you're very welcome.
[CUSTOMER][NEUTRAL] In a nutshell, um.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Actually I'm gonna give you a website to go to.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] And you can get your policy certificate, you can get copies of your cards on that website and you can also file your own claims if you ever have to. Let me give you that link to that website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you just let me know when you're ready to write it down.
[CUSTOMER][NEUTRAL] OK, please.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, you're gonna go to [PII].
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] A like Apple Michael, AM public.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, what, what else? [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And when you go in there for the.
[CUSTOMER][NEUTRAL] [PII], like, uh, OK.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII], I got it. OK. [PII].
[AGENT][NEUTRAL] When you go in there for the first time you're gonna sign up as a new user.
[AGENT][NEUTRAL] And then the second option that you choose is you're an individual with a with a uh APL policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] APL
[AGENT][NEUTRAL] Yes, individual with an APL policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if you wanna wait and sign up for it on Monday we've got a brand new online service center that will be um released on Monday if you wanted to do it before Monday you would sign into it but then after Monday you would have to uh set up set it up again because of the new release.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Is it on the same website or is it a different website for the new one?
[AGENT][NEUTRAL] It's the same it's the same website it will just have a different you'd be using your email address for your username and then you would choose your password for this one you have to choose a username and a password.
[CUSTOMER][NEUTRAL] Oh, OK, well I'll wait for Monday so I don't have to redo it again.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right, uh, now, uh, do you see any claims, uh, in my, in my account or in my policy?
[AGENT][NEUTRAL] Yeah, that's up up to you.
[AGENT][NEUTRAL] I did look and I haven't seen that anything has been sent in yet.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well, thank you so much. So if, if because we changed companies and I, I, I gave them the new info for this new company, but maybe they're trying to, to build my old company, which in turn they will probably reject it or send it back.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then they'll bill me for that, right? Um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So how does that work? Do I need to tell them, hey, now you have to build this guys again or or do I forward you the bill to you or how does that work?
[AGENT][NEUTRAL] Well, you can just give them your, your um information for your policy through your card and just ask them to bill us.
[CUSTOMER][NEUTRAL] I think it, yeah.
[CUSTOMER][NEUTRAL] Yeah, I did, and it was Saturday they did wrote down everything and they were like, yeah, yeah, yeah, we, we got it, we're billing the company, but if you don't see anything, I mean they said that they already sent the bill to you guys, so I don't know if they got confused and sent it to the wrong.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Company.
[AGENT][NEUTRAL] Well, if it was just Saturday and they mailed in the claim, then it'll take a while for it to get to us.
[CUSTOMER][NEUTRAL] Oh, OK, they mailed it. Oh, OK. I thought they do it electronically.
[AGENT][NEUTRAL] If they did, yes.
[AGENT][NEUTRAL] A lot of them do, but some of them do still choose to mail them in instead of doing it electronically they um they can mail it and they can fax it or they can um do it electron electronically that's their choice, you know, which way is most convenient for them.
[CUSTOMER][NEUTRAL] All right, I'll wait then.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well, um.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome, sir. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that'll be all thank you so much appreciate it.
[AGENT][POSITIVE] OK, well, you have a wonderful Memorial Day weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Likewise, thank you, bye bye.