AccountId: 011433970860
ContactId: 1a7c45b3-91b3-4b52-ab91-e7e2917b392a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 948380 ms
Total Talk Time (AGENT): 289447 ms
Total Talk Time (CUSTOMER): 294333 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/1a7c45b3-91b3-4b52-ab91-e7e2917b392a_20250212T16:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? Um, my name is [PII] was a Bammer. I have, I have coverage under my wife for the gap insurance, and, um, I'm not a provider. I, I know, I understand that this is a line for providers, but the thing is that, um, I, I provided my numbers, uh, the, the, the.
[CUSTOMER][NEUTRAL] Uh all the numbers for the coverage and everything to my uh provider for a sleep apnea study and um apparently they were not able to reach you. I don't know if there's any way for you to try to be um to, to call them, uh, and, and see if I have the coverage or not, or I can check if I've got coverage, yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And I apologize, your name is again?
[CUSTOMER][NEUTRAL] My name is [PII] and the last name is gonna be Long, [PII]
[CUSTOMER][NEUTRAL] The coverage is under my wife.
[AGENT][NEUTRAL] OK, and Mr. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, I have a group number. Is that good for you?
[AGENT][NEUTRAL] No, sir. On the card, uh, do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you see a policy certificate or at the bottom in hospital or outpatient benefit certificate number?
[CUSTOMER][NEUTRAL] Yes, I I'll give you the outpatient benefit certificate number is 01685.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] 8 ML 8.
[AGENT][POSITIVE] OK, thank you so much. And a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[AGENT][NEUTRAL] OK, and verify your date of birth and mailing address.
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[AGENT][NEUTRAL] OK, and you said the provider stated that they called us to verify if it's sleep apnea, uh, uh-huh.
[CUSTOMER][NEGATIVE] Yeah, I punch it. They, they couldn't reach it. They couldn't reach. They said that it was ringing and, and nobody picked up. I just, you guys just picked up on the first try, so maybe they dialed the wrong number or something like that.
[AGENT][NEUTRAL] It could be, um.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Or they can just call again and verify, but give me one moment to pull up your plan.
[AGENT][NEUTRAL] If it doesn't work the first time, try, try again.
[CUSTOMER][NEUTRAL] That's what I will say.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Give me one moment just pulling up your policy.
[AGENT][NEUTRAL] And as far as the sleep apnea study, is it going to be in an outpatient facility or a hospital or in a doctor's office?
[CUSTOMER][NEUTRAL] No, it's outpatient.
[AGENT][NEUTRAL] Outpatient? OK.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is gonna, um, you said in an outpatient facility like a hospital?
[CUSTOMER][NEUTRAL] No, they apparently they sent uh a device to my house. It's a new thing.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Give me one moment. I wanna, I'm gonna check with an examiner to see if it's covered because some services at home, like it's considered home health is not a covered place to service on the plan, um, but give me one moment to double check with an examiner. Do you mind holding for a moment?
[CUSTOMER][POSITIVE] Not a, not a problem. Thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEGATIVE] They smell like strawberries.
[AGENT][NEUTRAL] I swear.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] If your baby mama.
[CUSTOMER][NEUTRAL] For calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. I have a quick question for you.
[CUSTOMER][NEUTRAL] Hey [PII], how you doing?
[AGENT][NEUTRAL] I'm here. I'm hungry. I wait for lunchtime. I need to eat.
[AGENT][NEUTRAL] But, um, under the, well, under the gap gap, Metlink policy as far as sleep apnea, the insured is saying that uh they would have a machine taken home and want to know if that's covered. And for what I understand, like taking a machine home, that is not covered, but taking it back to the doctor's office for review could be covered under lab benefits, but they don't have a lab writer, so I just want to double check and see if that's covered or not.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] That smell like strawberries.
[CUSTOMER][NEUTRAL] I don't think it's covered, but I don't wanna lie to you. What's the policy number, [PII]?
[AGENT][NEUTRAL] 1685558.
[CUSTOMER][NEGATIVE] I don't know cause I'm gonna ask Miss [PII] because I had processed the claim. I had one was at home and I think I denied it.
[CUSTOMER][NEUTRAL] And she told me I'm supposed to pay, but let me make sure cause I don't wanna lie to you.
[AGENT][NEUTRAL] Yeah, cause I, I couldn't remember. I know [PII] had told me something before, but
[AGENT][NEUTRAL] I forget.
[CUSTOMER][NEUTRAL] Hold on, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I didn't get anybody, but um.
[CUSTOMER][NEUTRAL] I don't, I don't wanna tell you yes and I don't wanna tell you no, then we process the claim and it's not processed, but I'm trying to reach out to [PII] or [PII] to verify if it's covered or not.
[CUSTOMER][NEUTRAL] But um the the policy, I'm looking at it, don't.
[CUSTOMER][NEUTRAL] It says that it's covered uh in like the facility itself, but
[CUSTOMER][NEUTRAL] I wonder, would it be at home, like home should be covered if it's covered under the outpatient facility charges.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] For home health?
[CUSTOMER][NEUTRAL] And they have it.
[CUSTOMER][NEGATIVE] Not for home health for sleep apnea. Home health is not covered for sleep apnea.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, yeah, I mean.
[AGENT][NEUTRAL] I couldn't see anything in the policy as far as sleep apnea. I don't know. I just think it wouldn't covered because it's not covered place of service. And I know I wrote a note because I thought that like if they have a machine, they do sleep apnea machine at home and then go back to the doctor's office for a review, then it could be covered if they had a lab benefit.
[CUSTOMER][NEUTRAL] It's at home.
[AGENT][NEGATIVE] But this insured doesn't have a lab benefit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, these people need to stop having sleep apnea.
[CUSTOMER][NEUTRAL] No, why they send it home though? They just, I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm texting um [PII].
[AGENT][NEUTRAL] Is she here today?
[CUSTOMER][NEUTRAL] Uh-huh, but it looks, she red though.
[CUSTOMER][POSITIVE] It's just a good movie.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] Then the caller called back after we received the claim and it was denied.
[AGENT][NEGATIVE] No, there was no claim. He said that the provider tried to call us uh to verify benefits, but they just got, uh, there was no answer, and he was like, well, I called and I got it on the first ring. I was thinking just, and he, I think he want us to call them.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Did they call the right number? Do we don't call people? Well, we can call them on the call. I do let them call them on a conference call to verify their benefits. I do do that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] Like if it doesn't work the first time.
[AGENT][NEUTRAL] Call again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't think they called cause there's too many people on the phone.
[CUSTOMER][NEUTRAL] So this week.
[AGENT][POSITIVE] It says she's great you know.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] It says she's green now. Yup, she's good.
[AGENT][NEUTRAL] Yeah, it's showing green.
[CUSTOMER][NEUTRAL] But I text her, I text [PII] and I text [PII] to make sure, look, somebody gotta give me the answer.
[CUSTOMER][NEUTRAL] This is why you look, this make you miss Miss [PII].
[AGENT][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Cause, of course.
[AGENT][NEUTRAL] Because she went.
[CUSTOMER][NEUTRAL] She would have knew, she would have known.
[AGENT][NEUTRAL] That's the 2nd time this week someone mentioned about Ms. [PII].
[CUSTOMER][NEUTRAL] Just me, do you have a policy number?
[AGENT][NEUTRAL] Had a pro or I call web TPA and they was like, oh, I miss Ms. [PII]. I said, oh, she retired. She said, oh, she just was the Swedish person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She was.
[CUSTOMER][NEUTRAL] I told her that the policy doesn't have the lab writer. She asked what the policy number was.
[AGENT][NEUTRAL] Who, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because I don't think it's covered.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Is what I'm glad you called me so I can help you because I'm processing the self-insured claim with multiple pages.
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] It's a hate process and insured, uh, submitted claims. They never submit all what we need.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mmm, never. And they have submit.
[CUSTOMER][NEGATIVE] Stuff and want us to pay it and be upset about it.
[CUSTOMER][NEUTRAL] She takes it back.
[CUSTOMER][NEUTRAL] Oh, it's not covered. [PII] said it's not covered.
[AGENT][NEUTRAL] I don't think so. What did [PII] say?
[CUSTOMER][NEUTRAL] Yeah, Miss [PII] texting, she must be texting me something long.
[CUSTOMER][NEUTRAL] Some
[CUSTOMER][NEUTRAL] Do they have a lab I don't know ma'am.
[CUSTOMER][NEUTRAL] That's what [PII] asks about the lay rider.
[AGENT][NEUTRAL] So I don't think it's covered. I'll, I'll tell him.
[CUSTOMER][NEUTRAL] Yeah, it's not covered if they don't have to lay rider.
[AGENT][POSITIVE] All right. Well, I appreciate you so much.
[CUSTOMER][NEUTRAL] Oh, it took so long, cause I don't know.
[AGENT][NEUTRAL] No, no, you're good. I need to know, um, just in case we get another call because that sleep apnea is kind of tricky.
[CUSTOMER][POSITIVE] OK. Well, have a good day. Get you something to eat.
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] I am trying to figure out maybe [PII]'s or something, right.
[CUSTOMER][NEUTRAL] Talk to you later.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] Uh, Mr. uh, [PII], thank you so much for holding. I apologize for that delay. Um, I, I just want to double check with the examiner to see if it's covered, but, um, under the plan, sleep apnea is not covered.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Because it's not performing a covered place of service so it wouldn't be covered under the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] Do you still want, uh, do a conference call with the provider and explain it to him, or you can have them give us a call back either way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it's not gonna change. Uh, if it is not covered, it's not covered. So I'm gonna have to pay my part. OK. All right. Thank you for the information.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] I appreciate you waiting and thank you so much for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.