AccountId: 011433970860
ContactId: 21ecc37b-ad82-4a79-9592-ec2d8a0d2820
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 727460 ms
Total Talk Time (AGENT): 261106 ms
Total Talk Time (CUSTOMER): 304066 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/21ecc37b-ad82-4a79-9592-ec2d8a0d2820_20250102T20:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, [PII]. Happy New Year. My name's [PII].
[AGENT][NEUTRAL] Hey [PII], how are you doing today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Good, thank you. I have a question.
[CUSTOMER][POSITIVE] I work for Food for the poor. I have APL. Thank [PII] for APL.
[CUSTOMER][NEUTRAL] Um, just a general question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But do, do, um, I'm pretty sure I need to go get an X-ray of my knee.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, I understand that if I go to in-network with my insurance, uh, to urgent care, it's $100 pay and with my insurance, the X-ray is free.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I go to the hospital.
[CUSTOMER][NEUTRAL] Um, do you guys cover, like, do you, I, I don't think you reimburse for the 100 for the.
[CUSTOMER][NEUTRAL] For the uh
[CUSTOMER][NEUTRAL] Urgent care, right?
[AGENT][NEUTRAL] Um, I would need to take a look at the plan type that you have with us, [PII]. Do you by chance have your policy number?
[CUSTOMER][NEUTRAL] Sure, what would you like the APL policy number?
[AGENT][POSITIVE] Uh-huh, yeah, that would be great.
[CUSTOMER][NEUTRAL] OK. I have the in-hospital outpatient. I guess it would be outpatient, right?
[AGENT][POSITIVE] Yeah, that'll work, yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. uh 018.
[CUSTOMER][NEUTRAL] 669-83 [PII] number 8.
[AGENT][NEUTRAL] OK. Let me just bring this up here. Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then for security, I will need to verify please your date of birth and then address.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. I have two addresses, one where I live and one postbox. Which one do you want? I think the post box you have.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, it looks like we have your PO box on file.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Alright, thank you for that. And then your email address looks like it is a work one. It's um [PII]. Is that still a good email for you?
[CUSTOMER][NEUTRAL] Yeah, they changed it around a little bit yeah I think we could still get it but uh should I give you the new one?
[AGENT][NEUTRAL] Yeah we can update it for sure if that one's not um up to date, let's update it.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] What it is is [PII], which is uh it's [PII], so it's a [PII] and then [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And then the at sign lower case all the rest lower case [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you repeat that to make sure I gave it right?
[AGENT][NEUTRAL] So it's doctor and then [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, [PII] [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Correct, and I don't know if lower upper case matters, but it's the capital D on the last name B on the first name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the rest are all lower case.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So let's see here.
[AGENT][NEUTRAL] OK, so yeah, looks like the plan that you have with us is a secondary plan.
[CUSTOMER][POSITIVE] Right, correct, yes.
[CUSTOMER][NEUTRAL] It's a backup plan.
[AGENT][NEUTRAL] So yeah, let's see.
[CUSTOMER][NEUTRAL] And I have the the insurance I have is uh UMR is United um United Healthcare Company.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so on the plan, it looks like um it does cover any sort of treatment or that you would have to have in an office, so that would include an X-ray.
[AGENT][NEUTRAL] Um, it looks like
[AGENT][NEUTRAL] Even if you did it in a hospital, it would still fall under outpatient.
[AGENT][NEUTRAL] Um, inpatient is just defined as far as being admitted and then being there for 18 hours or longer. So your plan max for the calendar day, it's not even a year on this, it looks like $500.
[CUSTOMER][NEUTRAL] Is that, yeah, but I, uh, my question, hon is.
[CUSTOMER][NEGATIVE] When I give $100 if I go to urgent care and I give $100 do I get that back? That's like my co-pay for that's for walking in the door. Do you get me?
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] Yes, so this would reimburse the co-pay, co-insurance deductible, yes, correct.
[CUSTOMER][NEUTRAL] It would?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do I get it, it, it would reimburse the copay. Wow, for, for a hospital or urgent care?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I believe the only thing it may not cover is just, let's see.
[CUSTOMER][NEUTRAL] I think probably just surgeon care, huh?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] That's interesting.
[AGENT][NEUTRAL] OK, so the only thing under the physicians charges that are not covered.
[AGENT][NEUTRAL] Would be
[AGENT][NEUTRAL] Any sort of office visit fee.
[AGENT][NEUTRAL] But any sort of treatment or services supplied or recommended by a physician and an outpatient facility, which would be like an urgent care would be covered.
[CUSTOMER][NEUTRAL] OK, can you speak like I'm [PII] old? Are, are you saying that the
[CUSTOMER][NEUTRAL] $100 co-pay will be reimbursed for sure or you don't know or we don't know or no.
[CUSTOMER][NEUTRAL] That's what I'm after, hon.
[AGENT][NEUTRAL] Is the $100 the fee that your insurance is that the fee for the office visit? Do you know?
[CUSTOMER][POSITIVE] Yeah, urgent care, yeah, correct, yes.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Under the.
[AGENT][NEUTRAL] Policy certificate, it says that the office visit fee is not covered. So based off of that, I would deduct that it would not be covered if that's the fee itself to go to the urgent care.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Right. OK. Makes sense.
[CUSTOMER][NEUTRAL] All right, um, yeah, I don't remember it being covered in the past and that would make sense, um.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] And then, uh, so the hospital outpatient, would that be the same? Do you know? Are you not sure? Um, I wanna be sure. I wanna have a solid answer, you know?
[AGENT][NEUTRAL] So under outpatient covered charges.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It would be covered because I don't see anything. It says covered, you know, under the just not the exclusions. I don't see anything about a hospital listed.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is there any way you can verify that? Because you don't.
[CUSTOMER][NEUTRAL] I, I wanna be 100% sure, not just because of omission, like something that's not written down, you know?
[AGENT][POSITIVE] OK [PII], I'm happy to get somebody else on the line to go over this with you. Do you mind holding for just a few moments?
[CUSTOMER][NEUTRAL] I don't mind, but if it's it's like maybe a supervisor, somebody that might know.
[CUSTOMER][NEUTRAL] 100%, you know, like, um.
[AGENT][POSITIVE] Absolutely, yeah, not a problem. Is uh the [PII] a good call back in case something happens?
[CUSTOMER][POSITIVE] Yeah, thank you, and you've been very helpful. What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, thanks, [PII].
[AGENT][NEUTRAL] You're welcome. One moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Thank you for calling APL. My name is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] in customer care. How are you?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][NEUTRAL] Hey, I'm good. I have an insured on the line. Her name is [PII] Doctor and she has some questions on her meddling plan. I'm wondering if you could help her with.
[CUSTOMER][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] It is 01866983.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Alright, and specifically what she's asking for is she was asking about like outpatient cover charges and she wanted to know if her copay at an urgent care facility would be covered.
[AGENT][NEUTRAL] Um, I told her that physician's office visits are not covered. And then she was asking about a hospital. Um, she wasn't really confident in my answer, so then she had asked to speak to somebody else, so.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, that's OK. I mean, look, I'm new so I may him and hall a little bit. I read the policy, do the best I can do, you know, so, uh, no, no, no worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][POSITIVE] All right thanks here she comes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hi, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, hello. Hi, this is [PII] with APL claims department. How are you?
[CUSTOMER][POSITIVE] Oh hi I'm good thank you how are you doing? I'm good. I understand you have some questions in regards to your policy and urgent care benefits and office visit benefits.
[CUSTOMER][NEUTRAL] Uh, urgent care or hospital. Let me explain. Um, I need an I need to go for an X-ray of my knee, OK? Um, and what I found out so far was that, um, through my insurance, I have to pay $100 in that network at urgent care just to get in the door and the X-ray is free, that, that I understand. My question was, would I get reimbursed by.
[CUSTOMER][NEUTRAL] APL for the.