AccountId: 011433970860
ContactId: 0b35f1f1-3d5a-40ac-9ace-ce49e6800cbc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604559 ms
Total Talk Time (AGENT): 261267 ms
Total Talk Time (CUSTOMER): 262393 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/0b35f1f1-3d5a-40ac-9ace-ce49e6800cbc_20250324T16:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII], and I have, uh, your card, and I know we had it for last year and I had surgery and I'm just wondering if you guys can help me out with the, the bill.
[CUSTOMER][NEUTRAL] And I, I, I don't know, uh, the card that I have in my hand, it says the effective date was [PII], but I know we had also the same coverage for um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] and that's last year when I had my surgery in November.
[CUSTOMER][NEUTRAL] And I'm not too sure what you need or what I need to to ask you or you know or give you or whatever.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I'll be more than happy to help you um locate the policy and and give you an update on it. Um, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Well, I think
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided on this call is a verification of benefits, not a guarantee of payment. And so, um, that old policy number there, may I have the policy number that you have? It'll get me to all of your policies.
[CUSTOMER][NEUTRAL] Yeah, sure, sure, it's 02296247.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] problem.
[AGENT][NEUTRAL] OK, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah, so the uh date of birth is [PII]. The email is [PII].
[CUSTOMER][NEUTRAL] And what was the other one you had to?
[AGENT][NEUTRAL] The mailing address.
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so, um, your active policy number is 230.
[AGENT][NEUTRAL] 44297.
[CUSTOMER][NEUTRAL] 230
[CUSTOMER][NEUTRAL] 424297. OK.
[AGENT][NEUTRAL] Now, what was the date of your surgery?
[CUSTOMER][NEUTRAL] Uh, that was on the [PII], uh, I'm sorry, not [PII], um, it's [PII]. Sorry.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][POSITIVE] Yes, yeah, that's correct.
[AGENT][NEUTRAL] OK, I was just making sure depending on the date of service, um, which of the two policies you need to file for. So yes, it would still be under this active policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and then in, was it like an outpatient surgery or did you have to be admitted?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, it was, uh, it was for, um, a hernia, and so they brought me in and they did the surgery and then I went home later on that night.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so that's the outpatient surgery. So, for your outpatient benefits, the policy will pay up to $1500 per calendar year.
[AGENT][NEUTRAL] Um, this policy has been active since [PII], so there's no timely filing, so you can file your claim at any time or you can give um your ID card to the provider and have them file after they file with your primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, which, which one is easier?
[CUSTOMER][NEUTRAL] Is it easier for for me to just give it to the primary or or the um because the primary uh well I don't know so the primary, so is that the hospital I give it to?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] No, so hold on one second, let me go to your, um, I'm waiting for the new policy to come up, or the active policy because I went to the old one. Hold on one second.
[AGENT][POSITIVE] And then my system's kind of taking its time here, so I apologize.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so we are 2nd to Cigna.
[AGENT][NEUTRAL] So Cigna is your primary insurance. So,
[AGENT][NEUTRAL] The to me it would be easier to give my ID card and have the provider file the claims, um, but that's up to you.
[AGENT][NEUTRAL] Do you know if the, well, it's [PII].
[CUSTOMER][NEUTRAL] Oh, so I,
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So I give, I so I give that to Cigna, the information to Cigna, and they process it, is that what you mean?
[AGENT][NEUTRAL] No, no, no. So, OK, so whatever your doctor's office is, when you, after you get your services done, they're going to bill Cigna first because they're primary. Cigna is gonna pay based on their policy and then they'll send the explanation of benefits and the, you know, payment or whatever to the provider. At that point, if there's anything left over or if let's say you have to pay a co-pay or a deductible out um the
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's what it is, yeah.
[AGENT][NEGATIVE] So the second after Cigna sends everything back, then the provider is supposed to send all of that to us because we're 2nd.
[AGENT][NEUTRAL] So then we'll, we'll have the explanation of benefits from Cigna so we can see what you paid, everything that was charged, if we need to reimburse you, we can. If there's something still owed to the provider, we can do that too, or both, um, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If that's just your prefer it depends.
[CUSTOMER][NEUTRAL] Cause I, yeah, because I have it I have the uh the um.
[CUSTOMER][NEUTRAL] Like the, the breakdown for the surgery and stuff like that, and it says my balance is $1000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So is that something that like I send that to you or I talk to AdventHealth and then they send you the information?
[AGENT][NEUTRAL] Right, it goes to primary first and then it comes to secondary.
[CUSTOMER][NEUTRAL] OK, so I contact AdventHealth and then tell them to forward it to you. Is there like a, a particular group or name or or anything that I have to give them? So because I, I haven't done this before so I'm just wondering.
[AGENT][NEUTRAL] Who
[AGENT][NEUTRAL] No, it's fine. I just want to make sure I understand to give to who who the like the doctor's office.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well, yeah, the, the hospital where, where I had this done because it looks like that's they're the ones that are billing me, you know, they say it's not a bill, but there is, yeah, go ahead.
[AGENT][NEUTRAL] Right, OK, so you
[AGENT][NEUTRAL] So you would just reach out to the billing department. I don't know if, so when you went for the services, did you give them your APL card?
[CUSTOMER][NEGATIVE] No, I didn't because I didn't have it on me at the time. They told me not to bring anything, so I just, I didn't bring anything I paid with, I think it was even my wife's credit card, so I didn't have anything on me, so.
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Yeah, so just call the billing department and let them know, hey, I have a secondary insurance. This is my policy number. It's been effective since this date. Here goes their phone number. You can call them to verify benefits and to help with claims, and that's it. At that point, they'll call us, we'll let them know they can fax it, or, you know, how to mail it, however they want to send the claim in, and we'll take it over from there, but it's easier to let them do it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, I, I agree because I have no idea what I'm doing. So do I, so I just give them like the, the APL and then I, I give them my name and the, the 2304297 number for the policy number and the group is the group number still the same? The 21302?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, it's still the same. They won't need that though. Um, they, they really just need, they'll probably either ask you for a copy of the card or they'll just ask you for that policy number and our phone number.
[CUSTOMER][NEUTRAL] Yeah, oh, OK, and the phone number is the one that that I just used to call you, right? that [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um um OK.
[CUSTOMER][POSITIVE] And OK, so let me, let me do that. I, I'll get a hold of them and and then um have them reach out to you guys um and I appreciate your help because I had like I said I haven't done this before so um.
[CUSTOMER][POSITIVE] That's perfect.
[AGENT][POSITIVE] Well, you are very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, I think you actually answered all my questions, so that was, uh, again, perfect. Thank you very much.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APL. If you think of anything or need any more help, just let us know, OK?
[CUSTOMER][POSITIVE] OK, will do. Thanks again.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too bye.