AccountId: 011433970860
ContactId: 216e3977-4196-4e48-8a02-c42b8c6cdbc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2547860 ms
Total Talk Time (AGENT): 831878 ms
Total Talk Time (CUSTOMER): 658160 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/216e3977-4196-4e48-8a02-c42b8c6cdbc1_20250203T19:17_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, good morning, [PII]. My name is [PII], and I'm calling regarding the um the check the status of my claim. I have a policy number and reference number.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to help you with your claim status. Um, just for my notes, can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, and then um I can, you said you had the policy number?
[CUSTOMER][NEUTRAL] Yes, it's um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02578396
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And Ms. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Favor
[CUSTOMER][NEUTRAL] [PII] and um [PII].
[AGENT][NEUTRAL] And then just your email address.
[CUSTOMER][NEUTRAL] And what else do you need?
[CUSTOMER][NEUTRAL] Oh, that's [PII].
[AGENT][NEUTRAL] All right, thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, would this be the claim that was, it looks like it was received on [PII]?
[AGENT][NEUTRAL] It's only, OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh. Right.
[AGENT][NEUTRAL] Alright, so the claim finished processing on [PII]. Um, I have a claim number for you, but it was denied requesting the itemized bill with the charges.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] Diagnosis.
[CUSTOMER][NEUTRAL] Why is that? That's the
[CUSTOMER][NEUTRAL] That's the itemized itemized bill from the hospital.
[AGENT][NEUTRAL] OK, hold on one moment. Let me take a look at the um document.
[CUSTOMER][NEUTRAL] Why is that
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment, I'm just waiting for all the pages to come up.
[AGENT][NEUTRAL] OK, so the bill that you submitted, yes, this is an itemized bill. This is not the version that we're asking us. So the reason why on this bill, it only shows like on the columns here, you'll see where it says procedure code.
[AGENT][NEUTRAL] Or, um, so those are the codes for the treatment that was done. What we're asking for is the hospital's version of this bill. So the hospital has a version and then they create your bill from that version. The hospital's version is called a universal bill.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So a UBO4.
[CUSTOMER][NEUTRAL] Hold on, you.
[CUSTOMER][NEUTRAL] UO Universal Virgin?
[AGENT][NEUTRAL] Universal Bill.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] That has the charges, it has the diagnosis code which gives the medical necessity for the treatment of the procedure codes that we see here. So then we can pay out or provide the decision.
[CUSTOMER][NEUTRAL] So universal bill version, right? Can I, is that right? the title of the.
[AGENT][NEUTRAL] So you would just give the hospital, so you would just give the hospital a call and um ask them for a universal bill for date of service [PII] for your insurance claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, what, what feature is gonna be different from this, the bill that I sent?
[AGENT][NEUTRAL] So again, so your bill has like you see, it has like a column for procedure code. Procedure code is just the treatment that was received. In order to process a claim, we have to say why that treatment was needed, which is the medical necessity, the diagnosis code, correct. So that is why we're asking for the charges, the diagnosis code and procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that is gonna say.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. Um, I'll, I'll request it. Oh, is there anything else?
[AGENT][NEUTRAL] No, that's the only, um, let me double check, but that's the only denial, yes, that's the only denial reason.
[CUSTOMER][NEUTRAL] Unit
[AGENT][NEUTRAL] And any time
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Anytime you file the claim, just make sure you have that version and you shouldn't have this problem anymore.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, um, so where should I send it to?
[CUSTOMER][NEUTRAL] The updated version. Can I send you by email?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Um, you can, you can mail it, you can fax it, or you can send it to us electronically.
[CUSTOMER][NEUTRAL] For male.
[CUSTOMER][NEUTRAL] Oh email by email?
[AGENT][NEUTRAL] Um, that email through our online portal, the online service center. Are you familiar?
[CUSTOMER][NEUTRAL] No, what's the address what address?
[AGENT][NEUTRAL] So, sure, so the online service center is our secure portal. So that's where you can go to file claims, get your um policy documents.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. Uh, could you give me the website address?
[AGENT][NEUTRAL] Sure, let me know when you're ready.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Oh, so you're gonna go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] So, [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I see. Mhm, yes.
[CUSTOMER][NEUTRAL] Uh-huh. [PII]. Yeah, I, I, I'm in, yeah, I'm in.
[AGENT][NEUTRAL] Oh, you're there, OK. So then once you go there on the top right corner, you'll see where it says sign in.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Click there.
[CUSTOMER][NEUTRAL] OK. Oh, I need to register, right?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm, so you'll click on new user.
[CUSTOMER][NEUTRAL] Oh, OK, uh, individual.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. I'm an individual and then follow those prompts there where it says Social Security number or member ID make sure you put your full social in there.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I don't need the dash for the social number when I input, right?
[AGENT][NEUTRAL] No, you don't have to.
[AGENT][NEUTRAL] Put the dashes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Well, actually,
[CUSTOMER][NEUTRAL] I was trying to
[CUSTOMER][NEUTRAL] I mean, I, I put all information for the new user, but the, the new user was found with the information it it's that.
[AGENT][NEUTRAL] Wait, say that, say that, you said no user was found?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, hold on. So that just means something's not matching, let me, because it's linked with our system. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So I'm gonna do it on my side.
[AGENT][NEUTRAL] Trying to see what the differences are. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. So something's wrong somewhere. For the
[AGENT][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I'm just going through it to see what's wrong, what's wrong in our system so I can correct it so that it's the same as what you're entering.
[CUSTOMER][NEUTRAL] So, let me
[CUSTOMER][NEUTRAL] OK, so let me, let me, I mean, actually I used my social number, but let me try the member ID this time. Could you, could you give me my
[AGENT][NEUTRAL] The only number that goes in that field is your full social.
[CUSTOMER][NEUTRAL] But is that social number or member ID?
[AGENT][NEUTRAL] Right, but we don't have a member ID.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] That and why it's not working with my social number.
[AGENT][NEUTRAL] And our sy
[AGENT][NEUTRAL] So, so that's why I'm trying to go through the information that I have here so that you can let me know if it's incorrect, so that you can then re-enter it and it should match.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so you, so the last name was correct. So the social that we have on file is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Did you say [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, that's not mine.
[AGENT][NEUTRAL] OK, so it's the social that's incorrect.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So, what, what do you have again? Social number, what do you have?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's weird, the weird, I, I, I don't even know this number.
[AGENT][NEUTRAL] OK, so sometimes the files come over from the employer with the socials in incorrect spaces, so this does happen, I can correct that for you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what should the correct social be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment. That's all the way wrong.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEGATIVE] So there's a few different places in here that I have to update this to, so hold on one second for me. And then once I update it and save it, you'll be able to, but that's what was wrong. We clearly had the wrong social on here and you were entering the right one, so it said it didn't match.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, hold on one second. So I'm just gonna place you on a brief hold. I have about 2 more screens to go through and then, um, I'll be back on the line with you to go through it and make sure you have access, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So I updated everything and I tried it and I was able to get to the uh next step. So let's try it together. Um, can you either refresh the screen or or um come back out or out and back in, sorry.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Well, actually, yeah, I, I actually, I'm, I'm able to go to the next step, so.
[AGENT][POSITIVE] You did it? OK, good.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so once you create the username and password, um, and you put your phone number down there, it's going to send you a text message to verify, and then everything will populate there for you on the dashboard and you'll see a um like a pop-up button that says upload documents. Um it may say file a claim, and that's what you use to start the claim to upload the documents you send in.
[CUSTOMER][NEUTRAL] OK, um, so once I finished the register, so it, uh, to uploaded the document, so, uh, could you tell me again what exactly section should I go to from the website?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To file the claim?
[CUSTOMER][NEUTRAL] Uh, no, updated the document.
[AGENT][NEUTRAL] Wait,
[CUSTOMER][NEUTRAL] Updated documents.
[AGENT][NEUTRAL] Yes, to send in the updated documents, you're asking me where to go, right?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] Uh-huh. So, once you, so where are you in the signing process? Are you, have you verified and everything?
[CUSTOMER][NEUTRAL] Yeah, actually I.
[CUSTOMER][NEUTRAL] Yeah, I just filled out uh all information for create my account but uh actually regarding the password, they, uh, suggest a strong password which it, which I don't wanna use it. I wanna make up my own, but it doesn't let me input it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It doesn't let you use your, wait a minute.
[AGENT][NEGATIVE] Oh, I don't think I'm gonna.
[CUSTOMER][NEUTRAL] OK, wait a minute, give me one second, let me try again.
[CUSTOMER][POSITIVE] Oh, I think that now I can, I can get it. Yeah, I can, I can do it, yes.
[AGENT][NEUTRAL] You see, you got it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I just uh mm.
[CUSTOMER][NEGATIVE] Oh my God, it doesn't. Give me, give me one second, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, I successfully um finished my re registration.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me log in. So.
[CUSTOMER][NEUTRAL] Yes, now on the page. So where which section should I go to to upload the documents?
[AGENT][NEUTRAL] Um, do you see anywhere that says file a claim?
[CUSTOMER][NEUTRAL] Um, there's
[CUSTOMER][NEUTRAL] Oh, uploaded, yeah, uploaded files under my claim.
[AGENT][NEUTRAL] Yes, you'll click on that option and then that's where you go to start uploading, um, you know, whatever files you're wanting to send.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. And then once I uploaded, uh, the documents you request,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Could you tell me, uh, how, how, how, what, what's gonna, what percentage uh it can cover for the
[CUSTOMER][NEUTRAL] Uh, the ballet?
[CUSTOMER][NEUTRAL] Covers
[AGENT][NEUTRAL] Well, wait, so you're saying like from what you're filing for, what would, what would it cover?
[CUSTOMER][NEUTRAL] I mean, yeah, what you can cover, how many percentage you can cover it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Was it like a surgery or what was being done?
[CUSTOMER][NEUTRAL] Yeah, it was, it was a surgery, it was surgery.
[AGENT][NEUTRAL] So for, um, well, first for the call, again just for the call, the information provided is a verification of benefits, not a guarantee of payment. For inpatient surgery, um, the policy would pay up to $500.
[CUSTOMER][NEUTRAL] Up to $500?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And let me see if there's if that's a per day. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the big, big policy. Hold on one second.
[AGENT][NEUTRAL] OK, so for your, um, I'll just read it from the schedule of benefits because the other screen, it's, it's reading differently. So on your documents for your um policy, for hospital admission, the policy will pay up to $1000 per day with a max of 1 day per calendar year, so that one day that you're the first day that you're admitted.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But then after that for confinement, the hospital will pay up to $300 per day with a max of 30 days.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I think it sounds it sounds like that's for hospitalization, but I, I'm asking about surgery.
[CUSTOMER][NEUTRAL] Surgery doesn't, doesn't take a day, right? It's just one day surgery.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, but I'm OK, so your policy doesn't cover surgeries.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I was just giving you asked me for your, you asked me for the coverage, so I was just letting you know what was on there, but yes, in terms of surgery specifically, there is no um coverage for the surgeries.
[CUSTOMER][NEGATIVE] At all, not at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Are you serious?
[CUSTOMER][NEUTRAL] What kind of insurance doesn't cover at all for surgery?
[AGENT][NEUTRAL] So this is a hospital indemnity policy, so it's a limited medical policy.
[CUSTOMER][NEGATIVE] I mean, you, you, it's limited for everything. It sounds like there's no coverage at all.
[CUSTOMER][NEGATIVE] I mean, it's, it's basically, um, it's surgery. Um, I paid the $20,000 and you cover nothing? What kind of health insurance is that?
[AGENT][NEUTRAL] This is a, this is not like a Blue Cross Blue Shield or Cigna or Aetna. It's not major insurance. It's a limited medical policy. There are other coverages like for the doctor's office, urgent care, emergency room, but in terms of
[CUSTOMER][NEUTRAL] OK, then could you tell me, um, actually, uh, uh, probably my doctor's
[CUSTOMER][NEUTRAL] Office and um they, they, in the, in the middle of the plane for the fee.
[CUSTOMER][NEUTRAL] Or other exam and stuff. So could you tell me the status of that clean?
[CUSTOMER][NEUTRAL] Other than this surgery?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] This is the only claim that we've processed. There's no other claim. They haven't filed it with us yet.
[CUSTOMER][NEUTRAL] No, actually they filed it.
[CUSTOMER][NEUTRAL] I confirm with them, from the Polo to Medical Foundation.
[AGENT][NEUTRAL] So like on the page that lists all the claims that we've processed for you, there's literally only one line and that's the claim that we just went over, that we're going over now. There's, there's nothing else here.
[CUSTOMER][NEUTRAL] Or maybe then just finish the claim process.
[CUSTOMER][NEUTRAL] with the lately, but maybe last within 2 or 23 months.
[CUSTOMER][NEUTRAL] Since November. Could you, could you tell me the history?
[AGENT][NEUTRAL] I don't think, so I don't either. I don't understand the question. We don't, there's only one claim here.
[AGENT][NEUTRAL] Like we don't
[CUSTOMER][NEUTRAL] Uh, not in the past? You, you don't see anything the claim history already has been processed since last November?
[CUSTOMER][NEUTRAL] Under my name, I mean.
[AGENT][NEUTRAL] OK. Let me go out and go back in. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when I go to our screen that lists all the claims we've processed for you, there's only one claim here, and that's the claim that was received on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Whether it was received.
[CUSTOMER][NEUTRAL] Oh, maybe they, they, uh, I mean, the other stuff is not from um myself, it's from the all the doctor's facility.
[CUSTOMER][NEUTRAL] So then it should be the different category?
[CUSTOMER][NEUTRAL] Even if it's under my policy, um, this one, the surgery, it, I claimed it by myself.
[AGENT][NEUTRAL] That's not how our systems work, ma'am. If you, it doesn't matter if you processed it now or
[CUSTOMER][NEUTRAL] But the other claim.
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] 1985, it would be listed on this list with all the claims we've processed for you.
[CUSTOMER][NEUTRAL] Cause when I spoke with other persons from claim department, it was about, uh, I think 3 weeks ago, she, she, she was able to give me the uh the few different claim um process status at the time, which was my other uh doctor.
[AGENT][NEUTRAL] 2 or 3 years ago, you said?
[CUSTOMER][NEUTRAL] No, no, no, 22 weeks ago.
[AGENT][NEUTRAL] And they were able to give you claims that were processed with APL.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so there's
[CUSTOMER][NEUTRAL] Yes, the first.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, she gave me, uh, under my policy what claim is uh was uh on the process at the time. She gave me a few different transactions.
[AGENT][NEUTRAL] Was it with APL or was it another type of insurance that you have? Because other than this call?
[CUSTOMER][NEUTRAL] But I think that that
[CUSTOMER][NEUTRAL] I, I only, no, I only have, I only have this one.
[AGENT][NEUTRAL] OK, I, I'm not sure other than
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Hold on, Ms. [PII]. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute now, what?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Plumber Park.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So I was looking around, but I figured out what was going on. So your policy is with Business Workers of America, so they do have an employee line who helps with claims and things like that. So they may have claims for you that they have not sent over to us yet, um, but I can give you the number and transfer you over to a representative to check on those claims if you like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, could you transfer me to them?
[AGENT][NEUTRAL] Sure, um, before I transfer you, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you so much.
[CUSTOMER][NEUTRAL] So, um, hold on, so hold on, hold on, um, so regarding the
[CUSTOMER][NEUTRAL] Surgery. So basically, there's no coverage at all for surgery?
[AGENT][NEUTRAL] Um, let me
[CUSTOMER][NEGATIVE] So even if I even if I uploaded the, the document you request, so there's anyway, it's not gonna be work.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Is that right, or there's some coverage?
[AGENT][NEUTRAL] Um, I'm going back to your benefits. Hold on one second so that I can make sure I'm quoting it correctly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, under your schedule of benefits, it only has hospital admission, confinement.
[AGENT][NEUTRAL] Um, the outpatient accident and treatment benefit, which is for emergency rooms, urgent care, the physician office, and then like physical speech or occupational therapy.
[AGENT][NEUTRAL] And then the outpatient accident and sickness treatment.
[AGENT][NEUTRAL] Um, it also includes the emergency room urgent care, so the difference between the two is one is only in reference to if an accident happens, the other is accident and sickness.
[AGENT][NEUTRAL] But that's the only coverage that this policy has.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So what, so it's uh my surgery belongs to the same name.
[AGENT][NEUTRAL] Were you admitted into the hospital? Like, were you there for a few days or did you go home the same day?
[CUSTOMER][NEUTRAL] Same day.
[AGENT][NEUTRAL] Um, so that'll be outpatient.
[AGENT][NEUTRAL] So, no, not for, not for the
[AGENT][NEUTRAL] Not for the benefits that's selected for this policy. Um, if it was inpatient and there was an admission, then yes, it could have been a payout for that or a confinement, but since it was outpatient, there's no outpatient surgery on this policy.
[CUSTOMER][NEGATIVE] So there's no meaning to upload the documents.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Correct. After seeing this, yes, ma'am, that's correct, because I mean,
[AGENT][NEUTRAL] I, I mean, I was still upload it because there, I'm not, I'm not an examiner, so there could be things that they, they could still use and be able to make a payout or it could be denied for non-coverage. So I would still send it just.
[AGENT][NEUTRAL] In case there is something that could be paid out.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so, so regarding the policy, so did you say it's it's uh I have a coverage for urgent care?
[AGENT][NEUTRAL] Yes, um, you have.
[CUSTOMER][NEUTRAL] An emergency?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So any, any facility with the urgent care and emergency has cover, will be covered. Is that correct?
[AGENT][NEUTRAL] Right, um, urgent care or emergency room, yes, you have coverage if something, if it was just like, I hope it doesn't happen, but like a car accident or something, you can use that treat that um those benefits and then you also have
[CUSTOMER][NEUTRAL] Well but
[CUSTOMER][NEUTRAL] What about it's not from the car accident, just that uh uh just sickness and go to emergency or urgent care treatment.
[AGENT][NEUTRAL] Yes, you have regular um urgent care and emergency room benefits as well. You have accident and then you have accident and sickness.
[CUSTOMER][NEUTRAL] How many percentage would be covered?
[AGENT][NEUTRAL] There's no percentages, that's major insurance. So for emergency room, the policy would pay up to $300 per day, with a max of 2 days per calendar year.
[AGENT][NEUTRAL] For urgent care, it would pay up to $50 per day with a max of 3 days per calendar year.
[CUSTOMER][NEGATIVE] That's insane. What kind of emergency charges only 20 to $300? You know, they're, they're gonna charge at least $1000 for visit emergency.
[AGENT][NEUTRAL] So you may wanna, you may want to reach out to um where I'm getting ready to transfer you to and let them know that you'd like to see other options for plans and try to get one that meets your needs more. This is not one that you would need.
[CUSTOMER][NEUTRAL] OK, just, just, yeah, transfer me to them.
[AGENT][NEUTRAL] OK, and before I transfer you, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] All right. Well, thank you for calling APL and hold on one moment while I get a representative for you, OK?
[CUSTOMER][NEUTRAL] OK.
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