AccountId: 011433970860
ContactId: 2072630e-ade8-4346-a597-96b225f14d95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312880 ms
Total Talk Time (AGENT): 105839 ms
Total Talk Time (CUSTOMER): 130792 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/2072630e-ade8-4346-a597-96b225f14d95_20250218T21:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, how you doing? Um, I had a question about an upcoming appointment that I'm going to have. I want to know if you guys are gonna cover the, you know, the deductible that they're quoting me.
[AGENT][NEUTRAL] OK. I can verify benefits for you. And your name is?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK. And do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02.
[CUSTOMER][NEUTRAL] Um, 519-567.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Um, [PII], sorry.
[AGENT][NEUTRAL] Oh, you're fine. And your date of birth and email address?
[CUSTOMER][NEUTRAL] [PII] and and emails [PII].
[AGENT][NEUTRAL] OK, it shows a different email address. I'm assuming if it's your um email to your employer.
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you say you wanted to know if the procedure is covered?
[CUSTOMER][NEUTRAL] It's yeah, it's the appointment. Well, so I'm going to [PII] for ENT appointment and they estimated that it's gonna be $608 deductible. Now would that, would that mean that if I were, I mean, I, I, I just told them that I have secondary insurance. I haven't had the appointment yet. I'm just asking in the future if that's the, that's $68 I'm being quoted in my deductible, would that be covered under the secondary insurance? Would you guys be covering that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me see if.
[AGENT][NEUTRAL] It's under your plan. Give me one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] We have to have a full EEG going when the patient dies.
[AGENT][NEUTRAL] Uh, well, under your policy, it does cover treatment performed in the office, but not the office visit and not a guarantee of payment, just a verification of your coverage. You have an outpatient benefit that pays up to $2,025 per calendar year of what your primary applies towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] So it wouldn't cover the appointment or could cover a procedure?
[AGENT][NEUTRAL] It covers procedures in office, just not the visit itself. So if you have, let's say, um, they charge for an office visit and then they charge for lab, the lab could be covered, just not the visit itself.
[CUSTOMER][NEUTRAL] So it says professional charges for ONT for ONT is alandroscopicy.
[CUSTOMER][NEUTRAL] Flexible diagnostic and then an office consultation, so the office consultation would not be covered, but the the laryngoscopy would be covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Mm. And that's not, and, and you're saying that's not, um, and that's not 100% either, even the laryngoscopy.
[AGENT][NEUTRAL] Well, we can't give a guarantee of payment. We can only verify coverage. So it depends on how the primary insurance process the claim, if they apply any amounts towards deductible, co-pay or co-insurance for those procedures, that's what we pick up and pay.
[CUSTOMER][NEUTRAL] Oh wait, if the if the primary insurance pays for some of you won't pay for any of it?
[AGENT][NEUTRAL] Not for the visit, we only pick up what they apply towards deductible, co-pay, or co-insurance for those procedures, not the visit.
[CUSTOMER][NEUTRAL] So the, OK, so I got a so I got an estimate they said the primary insurance will pay.
[CUSTOMER][NEUTRAL] Well, well, well, my, yeah, so, so it's estimated charge was $427. The my charge without you guys is $247 for the for the procedure. You would be covering the $247.
[AGENT][NEUTRAL] I can't give you, yes, we're gonna pay the 247, but if that is applied towards deductible co-pay or co-insurance, then that could be covered under the plan as outpatient.
[CUSTOMER][NEUTRAL] Supposedly.
[CUSTOMER][MIXED] This is so retarded. OK, fine. All right, I appreciate it. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mm