AccountId: 011433970860
ContactId: 00b04a24-466f-451f-a1b4-e8f8a3b7030e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 517070 ms
Total Talk Time (AGENT): 272226 ms
Total Talk Time (CUSTOMER): 179922 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/00b04a24-466f-451f-a1b4-e8f8a3b7030e_20250115T17:18_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] Yes, hello, my name is [PII]. I'm an, I'm an employee and I'm going to be having a procedure on the [PII], and I just need to know.
[CUSTOMER][NEUTRAL] I need to understand how this service um.
[CUSTOMER][NEUTRAL] Helps me or works with my situation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm getting different, my, my insurances are getting different information. I have different information, so I am totally lost as to how APL when it pays, what it pays, and what it doesn't pay. So I need to understand APL.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, well, I'll be more than happy to assist you with your policy. And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Uh yes. My my contact number is [PII].
[CUSTOMER][NEUTRAL] 3630.
[CUSTOMER][NEUTRAL] Policy number, I don't know my policy number.
[CUSTOMER][NEUTRAL] I don't have my policy number.
[AGENT][NEUTRAL] OK, I can search the policy with your um social. I can try to search it with your first and last name, whichever you prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My social is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate here. Hold on one moment.
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] OK, and [PII], I have your policy here. I just need you to verify your last name, your date of birth, mailing and email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My last name is [PII], first name is [PII], um.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Address is [PII]. Address is [PII].
[AGENT][POSITIVE] Thank you for that and then just your email address.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you need my work email or my personal email?
[AGENT][NEUTRAL] Um, let me see which one.
[CUSTOMER][NEUTRAL] Cause I don't know which one you have. My work email is [PII].
[AGENT][NEUTRAL] Actually, hold on one sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] pardon me.
[AGENT][NEUTRAL] That's OK. So there's actually no email address on file, so we don't have to verify the email. Um, if you'd like to add one, we can, but your um
[AGENT][NEUTRAL] I'm waiting for the benefits and everything to pull up here. So this is your Metlink policy. So we apply to your co-pay, your deductible, and your or your co-insurance after your primary insurance, which this policy, hold on one moment, I'm flipping through screens.
[CUSTOMER][NEUTRAL] Let let me, let me get something to write on. So you, how do you apply, how does this apply? Say what you just said right now.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So your Metlink policy pays towards co-pays?
[AGENT][NEUTRAL] Deductibles,
[AGENT][NEUTRAL] And co-insurance after your primary insurance. So anytime you have um like when you go for your procedure, give them your primary insurance information and then you'll give them your APL card or I can give you the policy number and our phone number to to call us to verify. So they're gonna bill your primary first. If primary makes you pay a or requires you to pay a co-pay, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All of that would be paid upfront so the service can be done and then on the back end you can be reimbursed for that. Um, if there's something still owed to the provider after primary has paid what they pay for their policy, um, we can pay to the provider as well, um.
[CUSTOMER][NEUTRAL] OK, so let me give you an example.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a procedure coming up.
[CUSTOMER][NEUTRAL] And then I'm getting a really weird comment from one of the doctors, OK? So I'm having a procedure coming up on the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, the facility is telling me that I need to pay.
[CUSTOMER][NEUTRAL] $2,296 for the procedure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The doctor is saying I have to pay $811 and then there's an anesthesia that I can't get an amount of what I'm supposed to pay them. So I'm still pending that info.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What I'm being told is that.
[CUSTOMER][NEUTRAL] From the doctor.
[CUSTOMER][NEUTRAL] Only one claim from either facility will be paid, and whoever applies files first gets paid.
[AGENT][NEUTRAL] So they probably called to verify the benefits, but yes, that's true, because you only have $2550 to use for the entire year. So if someone filed a claim that's $2000 or $2000 you know, and it takes that balance, then yes, that would only be able to be applied to one claim, but if a because we process them as they come in, so they
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They just kind of lump that all into one, but I mean, yes, that is true. If it depends on how the claims come in. If a big claim comes in and your max is applied to it, then any claims after would be denied because you've already met your max. But if a claim comes in and it Go ahead.
[CUSTOMER][NEUTRAL] OK, because.
[CUSTOMER][NEUTRAL] Less, and it, go ahead, go ahead.
[AGENT][NEUTRAL] But if a claim comes in and it's less, then of course you have more of your balance to use the other claims, so they just lumped all that in together.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if the uh.
[CUSTOMER][NEUTRAL] So can you explain that again to me? I'm sorry.
[AGENT][NEUTRAL] You have a calendar year max of $2550 that you can use for your outpatient expenses.
[AGENT][NEUTRAL] So if you have a claim that comes in and it's 2000.
[AGENT][NEUTRAL] $500 you only have $50 left to pay out on claim. So that's why they're saying only one would be paid because they know the price, so they know it's more than the $2550.
[AGENT][NEUTRAL] But if you have a claim that comes in that's $50 well then you have $2500 left. So it depends on what claims come in, their amount, and how it comes in if it because we process it as it comes in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they come in, OK, OK, alright, it's because I was told that only one claim per day could come in per one claim could be sent in.
[CUSTOMER][NEUTRAL] Per procedure would be paid.
[AGENT][NEUTRAL] Well, now that part I.
[CUSTOMER][NEUTRAL] Didn't
[AGENT][NEUTRAL] That part, no. The, the only, the only stipulation is you have $2550 to use for the year. They can send in 20 claims, but we're not going to pay after that $2550 is met.
[CUSTOMER][NEUTRAL] Yeah, I think. Yeah.
[AGENT][NEUTRAL] You see what I'm saying?
[CUSTOMER][NEUTRAL] OK, and my deductible doesn't need to be met first. It can, it's gonna be paying prior to the deductible.
[AGENT][NEUTRAL] Well, for your American so, so don't confuse your primary with your secondary. Your primary charges it, your secondary helps pay it. So the deductible, that's your primary, we can help pay that, but there's no deductible on your policy here with APL. So it depends on the provider. If they say you have to pay the copay and deductible or, you know, upfront to get the surgery or the procedure, then you will have to pay it upfront and then on the back end.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we can, you know, reimburse or pay up to that 2550.
[CUSTOMER][POSITIVE] I see. OK. All right then. Thank you. That clears everything up for me. Thank you so much.
[AGENT][NEUTRAL] You sure? Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.