AccountId: 011433970860
ContactId: 1d2735c1-7497-41d1-8452-99e16e0abf81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306630 ms
Total Talk Time (AGENT): 161287 ms
Total Talk Time (CUSTOMER): 92051 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/1d2735c1-7497-41d1-8452-99e16e0abf81_20250529T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I have a question about the, the insurance.
[AGENT][NEUTRAL] OK, can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] 02520736
[AGENT][NEUTRAL] Alright, let me look that up for you, [PII].
[AGENT][NEUTRAL] And can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address and phone number that we have on file, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then phone number.
[CUSTOMER][NEUTRAL] Oh sorry, [PII].
[AGENT][POSITIVE] OK, thank you so much and what questions did you have?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I was told this is like a gap insurance so we're trying to see, I'm trying to go to counseling and they're saying um the first sessions all go towards deductible. Is that anything that you guys help with? Um, I don't, I'm not sure how this works.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so this is secondary gap insurance. So, um, when filing a claim for this policy, you will need to have an explanation of benefits or EOB from your primary insurance showing that they paid partial. Um, typically if your primary insurance denies it, this one will deny it as well. This policy does help towards co-pay, co-deductible, and co-insurance, and let me see what benefits you have.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Typically
[AGENT][NEUTRAL] And it looks like
[CUSTOMER][NEUTRAL] This is would be for out of network.
[AGENT][NEUTRAL] Um, so this one won't be in or out of network. Um, we just have, um, like maximum benefit numbers or amounts, and, uh, we don't follow a specific, uh, PPO or anything like that. It'll go based off of your primary insurance, um.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like the policy that you have is related to a sickness or accident.
[AGENT][NEUTRAL] Um, and this is just a verification of benefits and not a guarantee of payment. You have an inpatient benefit maximum of up to $4000 per calendar year.
[AGENT][NEUTRAL] And an outpatient benefit maximum of up to $4000 per calendar year as well. And that's what this policy covers.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So it's on
[CUSTOMER][NEUTRAL] And it's only 4000 once, whether in or out, it's not 8000, it's 4000 total, whether it's in or out, is that correct?
[AGENT][NEUTRAL] Right, it's per calendar year, mhm.
[CUSTOMER][NEUTRAL] Whichever way, so it's just for, so it'll pay $4000. So if I went to a counselor and they send me and they billed me 30, they build insurance 350, when the, when, when the insurance company sends me back the EOB for $350 then I would submit that to you and ask you to to see if you would reimburse that. Is that how it works?
[AGENT][NEUTRAL] Right, so what happens and it, it doesn't have to be a reimbursement, um, you shouldn't have to pay out of pocket. That depends completely on the hospital or who you go see. Um, you should be able to file a claim or whoever you go see can file a claim on your behalf as well. Um, they will need whenever you get.
[CUSTOMER][NEUTRAL] At the same time,
[AGENT][NEUTRAL] Um, it's one or the other, so either you will file a claim or they will file a claim.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if they filed the one to, to United Healthcare, they could also file one to APR at the same time.
[CUSTOMER][NEUTRAL] So that way I'm trying to figure that out.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Right, but um it will get denied until we get the um explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] In in most hospitals, um, when they call to verify we do tell them that this is secondary, um, and I believe when you gave them the card or when you give them the card they will know they typically ask which one is secondary, and they know to build the primary first and that this one will need the primary explanation of benefits. So if you do see a denial, um, we typically will give you the denial reason. It could just be that we need more information or that EOB. It doesn't mean that the whole claim is denied necessarily.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, that helps me a little bit. Thank you so much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] I'll do it thanks.
[AGENT][POSITIVE] Alright, thank you for calling APL [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye.