AccountId: 011433970860
ContactId: 19a08459-23e2-4445-b93c-e128805930c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509600 ms
Total Talk Time (AGENT): 239204 ms
Total Talk Time (CUSTOMER): 214098 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/19a08459-23e2-4445-b93c-e128805930c1_20250502T20:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing?
[CUSTOMER][NEUTRAL] I'm good um I have an insured on the phone that is calling to see how um.
[CUSTOMER][NEUTRAL] Her benefits work.
[CUSTOMER][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] Yep, I was having a whole conversation with myself. I'm sorry, um.
[AGENT][POSITIVE] I was on mute. I can definitely help her with the benefits. May I have the contact number and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh, the policy number is 26087997.
[CUSTOMER][NEUTRAL] Her callback number is [PII].
[CUSTOMER][NEUTRAL] Her name is uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And she wants to know how her benefits are. OK, I'm ready.
[CUSTOMER][POSITIVE] Mhm. All right, thank you. Here she is.
[AGENT][NEUTRAL] Oh wait, hold on.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] I had too many zeros. Thank you, sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's OK, thank you, and here she is.
[AGENT][NEUTRAL] All right. OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, hello, how are you?
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm, I'm fine. I'm with the um care team and I'll be helping you with your benefits. So you're just wanting to go over the benefits for your policy, she was saying?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, hold on one moment. I'm just waiting for the benefits to populate here. And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] And that's for the uh Min 9 gap insurance, right?
[AGENT][NEUTRAL] Yes, that's what, yes, I'm looking at those benefits. Mhm.
[CUSTOMER][NEUTRAL] I just wanna make sure I'm in the room.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for your inpatient, so the policy is broken down into inpatient and outpatient. Um, so inpatient, anytime you're admitted into the hospital, the policy will pay up to $7000 per person per calendar year.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The same for your outpatient expenses, outpatient expenses, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Includes the emergency room, urgent care, outpatient surgeries, um, occupational therapies, you can even do sleep studies, um, speech therapy, um, there's a lot of different
[AGENT][NEUTRAL] Treatments in the emergency room and the urgent care, um, that's all considered outpatient, and the policy will pay up to $7000 per calendar year for that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, I had a question about where it says, in, in the area where it says separate inpatient and outpatient benefits. It says benefits payable under the policy are limited to eligible health benefit plan, deductible, co-insurance, and co-payments that covered person incurs under the other medical plan or, and then it goes on to explain inpatient management. So my question to the, uh, to the young lady that, that she transferred me to you was
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I have to go see a, uh, a specialist, right? And my, under the major medical plan, my specialist co-pay is $70.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Does that mean that you guys cover that $70 co-pay?
[AGENT][NEUTRAL] We could, um, yes, so we pay towards the copay, deductible and co-insurance after your primary insurance. So when you give your specialist your primary insurance information, give them this Medlink card as well, so that they'll go ahead and build primary, primary will apply, they'll then give the explanation of benefits, so we can see what you paid, what they paid, what's left over.
[AGENT][NEUTRAL] If something's owed to you as a reimbursement, we can reimburse you. If something's owed to the providers still, we can pay them or both. So it just depends on the paperwork that comes in.
[CUSTOMER][NEUTRAL] Oh, because, you know, when you go to the doctor's office and you have a copay on your major medical plan, they want that money right away, like before they even see you. So how would that work? Would I have to submit like a reimbursement request for the, for the co-pay?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Exactly, so
[AGENT][NEUTRAL] So you would make the payment, you would make the payment to them so that you can be seen and then they
[AGENT][NEUTRAL] You, you need to give them your insurance card when you give them your major insurance card. Then filing the claim is billing. So once you pay the copay and they bill everything to primary, again, we ask for the explanation of benefits so we can see what you paid and then you can be reimbursed or we can pay the provider or both. So yes, that's how the reimbursement happens once they file the claim with us.
[CUSTOMER][NEUTRAL] So the reimbursement is handled directly with the provider? Do I, or do I also have to go like on your portal somewhere and submit a request to be reimbursed for the co-pay?
[AGENT][NEUTRAL] Mhm. There's no such thing, there's no a request for reimbursement. When you, when the claim is filed and we see that you paid something, your policy can reimburse you. So there's no request. Your provider is going to file a claim, you have the option to file the claim as well, but if you provide them with your insurance information, that's for them to file the claim.
[AGENT][NEUTRAL] And then once they file the claim, that's how the reimbursements happen or if they still are old payment, they can be paid as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right. Um, another question I had was, if I am enrolled in the major medical plan through my employer, and my son has his own individual, he's my dependent, OK? And he has his own health care plan with An better through the marketplace.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I were to add him to the Medlik 9 gap insurance.
[CUSTOMER][NEUTRAL] Would you cover him the same way, even though he's in a different healthcare plan?
[AGENT][NEUTRAL] He wouldn't be able to, so this, so your, your Medicare, I'm sorry, not Medicare, your Medlink policy is second only to the Florida Blue. So unless he's enrolled in the Florida Blue policy, he wouldn't be able to use this policy.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh yeah, that's not happening because
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] My employer only covers me. They won't cover anything for my dependent.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] His policy, his part of the medical, medical policy will be close to $700 a month, so that's, that's a lot.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I guess I have to keep shopping around in the marketplace for a better plan for him.
[CUSTOMER][NEUTRAL] Um, OK, so the, the claim happened, um, directly through the provider. I don't have to submit a claim as long as I provide them with the, with the card, with the information before the appointment.
[AGENT][NEUTRAL] Yes, and just let them know that you have a secondary insurance and a second to your Florida Blue and just give them the insurance card and on the back of the card is our phone number, and usually they'll just call us to verify the benefits and then they'll know how to handle the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, thank you very much for your help.
[AGENT][NEUTRAL] Alright [PII].
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] You have
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL [PII]. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye