AccountId: 011433970860
ContactId: 00100bb4-2caa-42e0-b28a-0d790085a376
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525989 ms
Total Talk Time (AGENT): 241253 ms
Total Talk Time (CUSTOMER): 217055 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/00100bb4-2caa-42e0-b28a-0d790085a376_20250220T13:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is, uh, [PII]. Um, I'm calling just to check coverages and all that kind of good stuff. I don't know. I've never used this yet, but we got a new insurance and, uh, I'm sitting here trying to find out what, uh, coverage I have, so or what this gap insurance, whatever we have takes care of.
[AGENT][POSITIVE] OK. Well, I can help you.
[CUSTOMER][NEUTRAL] So what?
[CUSTOMER][NEUTRAL] Yeah, what numbers do you need?
[AGENT][NEUTRAL] Well, 1st may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, policy certificate number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02582095
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Alright.
[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] Um, date of birth is [PII]. Mailing address is [PII], and I'm not sure what email you have. It's either [PII], [PII], or [PII] stores.
[AGENT][NEUTRAL] OK, um, actually, did you, when I went to the email, there's not one listed. Did you, did you want me to add one for you or you're OK?
[CUSTOMER][NEUTRAL] Yeah, no, I'd rather just, it's my name, um, just [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's the one I, that's my most frequent. I don't, I only check work when I'm working.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, right, so I have your policy here and all the information provided is a verification of benefits, not a guarantee of payment. So this policy um pays towards your co-pays, your deductible, and your co-insurance after primary. So if you go to the doctors or any, you know, hospital, wherever the providers that you go, if they require you to pay a co-pay for your primary insurance.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You may have to pay that upfront and then once they file a claim with us, you can be reimbursed for that or if there's something still owed to the provider after primary pays, we can pay towards that or both. It just depends on what the paperwork shows after we get the explanation of benefits and everything.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I got you. OK, so I just talked to Cigna. This is the new insurance that you're for, so I just talked to them and I asked them about, um, chiropractor coverage, and she says.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That my copay would be $75 each visit and would you guys pick that up or not?
[AGENT][NEUTRAL] So, um, like I said, it'll be, you'll have to pay that and it could possibly be reimbursed on the back end, but you do have the office treatment, um, in a physician's office. Let me see.
[CUSTOMER][NEUTRAL] Because the chiropractor keeps me from going to see the back doctor.
[AGENT][NEUTRAL] Right. Um.
[CUSTOMER][NEUTRAL] Which back doctors a whole lot more money.
[AGENT][NEUTRAL] Let me double check on this.
[CUSTOMER][NEUTRAL] Sort of a preventive thing for me, yeah, I'm just curious. I'm trying to find out because, um, my old insurance, believe it, you know, I, well, we had a signa through Lucent last time, but we dropped it, you know, the company dropped that now we got it through this and then we got APL here and all that, but I'm just trying to find out my coverages and what it'll do and then you guys also help with prescription too, right?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Prescription cost.
[AGENT][NEUTRAL] Um, let me see if prescription is on here.
[CUSTOMER][NEUTRAL] Because I know the office manager told me to save all my receipts for anything that I might have to pay for on my things and you turn them in and da da da and then you know.
[AGENT][NEGATIVE] It's not a reimbursement plan in that way. This is more so like your services. I don't see any um coverage.
[CUSTOMER][NEUTRAL] Uh, I thought it was like she said, uh, yeah, she said a prescription, she said if you have to pay $5 or $20.25 dollars, save them and then send them in whatever, I don't know.
[AGENT][NEUTRAL] Now your primary may do that, but for your secondary, um, I mean some of them do have um prescription benefits, but this one doesn't, but it has other to other benefits like sleep studies, speech therapy, all of that, which typically is not on here. Um, so I'm not sure which ones.
[CUSTOMER][NEUTRAL] That's strange. I wonder why she would do that.
[AGENT][NEUTRAL] Yeah, there's
[CUSTOMER][NEUTRAL] That's strange why she's, I'm gonna give her a hard time about that one but I don't think we need to have speech therapies and all that.
[AGENT][NEUTRAL] Well, it's probably just all, well, I, I'm not sure it'll, so.
[CUSTOMER][POSITIVE] That's funny.
[CUSTOMER][POSITIVE] No, I just think it's funny that she would have that signed up in there for the company.
[AGENT][NEUTRAL] Um, let me check on this office treatment, um, and the chiropractor. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEGATIVE] No, not at all.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I know my answer. There goes my answer.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So yes, chiropractic services are considered under the physician and you have the benefit, um, which will pay, hold on, let me see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] For outpatient benefits, your policy would pay up to $9100 per calendar year, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Well, that'll take care of all my business for the year.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] I go every couple 2 to 2 to 4 weeks is what I do.
[AGENT][NEUTRAL] Yeah, so whenever
[CUSTOMER][NEUTRAL] So they would have to file file it through Cigna and then file it through U2, right?
[CUSTOMER][NEUTRAL] It's what I need to tell her.
[AGENT][NEUTRAL] Right, so they're gonna
[CUSTOMER][NEUTRAL] The lady at the
[CUSTOMER][NEUTRAL] The you know, the lady that does the insurance at the chiropractor.
[AGENT][NEUTRAL] So they're going to file with primary first Cigna, and then Cigna will apply, and if they have us in their system, they'll automatically bill us second, and then that's where we'll see everything that Cigna has paid, everything that was charged, everything Cigna paid, you paid and what's left over. That's when you can then be reimbursed for the co-pays that you paid or
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the provider can be paid, but however many claims come in, it'll be up to that $9100 per year will pay out.
[CUSTOMER][NEGATIVE] OK, well that, I mean that's fine. I mean, I only see him 2 every 2 weeks is 26 times a year or so that's not that's not, you know, it's not gonna go over that because I know the bill is never more than $67 so.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So on that one.
[AGENT][NEUTRAL] And just keep in mind with this insurance, anytime, anything that the
[AGENT][NEUTRAL] Primary has to pay towards the claim for us to be able to pay towards.
[CUSTOMER][NEUTRAL] Oh, so if they don't have to pay anything, you won't pay anything?
[AGENT][NEUTRAL] Right, anytime if your primary insurance does not apply anything to the claim, like pay anything towards the claim or it says it's not covered or, you know, something like that, then
[CUSTOMER][NEUTRAL] Well, they told me that they pay anything over $75.
[AGENT][NEUTRAL] Right, so I'm
[CUSTOMER][NEUTRAL] They pay, I, you know, it's 75 out of my pocket and then they pay for it.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I'm just letting you know in general, if your, if your primary insurance does not pay towards the claim because we're second to them, we then won't. So if they say this is, this isn't covered, you can't then file a claim with us, you know, just move.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just letting you know because you're new to the insurance.
[CUSTOMER][NEUTRAL] Right, yeah, no, I mean, yeah, yeah, yeah, no, I, no, I know I just got off the phone with them and they told me that it is covered. It's just they, I pay 75% and they pay anything over that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So anything over that they would pay and then I would get my 75 back from you, right?
[AGENT][POSITIVE] Right, you can be reimbursed once.
[CUSTOMER][NEUTRAL] Or the doc or the doctor would.
[CUSTOMER][NEUTRAL] How long does it take to be reimbursed?
[AGENT][NEUTRAL] It could be both
[AGENT][NEUTRAL] 7 to 10 business days.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] I will definitely follow up on it and I thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am, thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] All right thank you bye bye.