AccountId: 011433970860
ContactId: 24e2f4db-ba1a-4bed-b575-6b21e24bbb24
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329390 ms
Total Talk Time (AGENT): 119393 ms
Total Talk Time (CUSTOMER): 183291 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/24e2f4db-ba1a-4bed-b575-6b21e24bbb24_20250514T16:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling AP I'm sorry, good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, yes, how are you? How are you doing? I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Uh, it's [PII], and your name is?
[CUSTOMER][NEUTRAL] My name is [PII]. How are you doing?
[AGENT][NEUTRAL] I'm fine, Ms. [PII]. And how may I assist you today?
[CUSTOMER][NEUTRAL] I was calling because I'm OK, I'm having a situation. I really don't understand too much of it, but maybe you can help me out. Um, I'm having surgery on [PII] because I have thyroid cancer and um I'm doing it with UH, which is the UM hospitals here in [PII].
[CUSTOMER][NEUTRAL] And they're calling me now, uh, telling me that I have a bill that I guess I have to pay before surgery for 4,757. I guess my insurance is not covering it, but I do have gap insurance. I was just wondering, do you guys, would that, would I be able to apply my gap insurance towards that?
[AGENT][NEUTRAL] Uh, what is your policy number, Ms. [PII]?
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEGATIVE] I'm just lost in the past when it comes to this.
[AGENT][NEUTRAL] No, I understand.
[CUSTOMER][NEUTRAL] OK, so my, I have a group number.
[AGENT][NEUTRAL] Uh, are you looking at the card?
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the card right now, so it just gives me the group number and then it goes in hospital.
[AGENT][NEUTRAL] At the bottom, do you see it? Yeah, what's that in hospital or outpatient number?
[CUSTOMER][NEUTRAL] OK, the number in hospital is 02583622 M as in Mary, L as in Larry 7.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] And then supposedly it's gonna be in the hospital. I will have to stay overnight, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After the surgery.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] I also gave them this information when they just called me now. They were like, oh, I don't know what the gap insurance is, or I don't know what America public life is, and I don't know if they, if like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, the hospital takes it. I'm like, well, it's like an additional insurance that I have in case my medical insurance doesn't cover my gap will jump in, but
[CUSTOMER][NEUTRAL] They said they were gonna reach out to you guys.
[AGENT][NEUTRAL] OK. And Ms. [PII], uh, verify your date of birth, mailing address and the email address, please.
[CUSTOMER][NEUTRAL] Uh, it's [PII]. My address is [PII], um.
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. Give me one moment. And you said that um you're gonna have this uh you have the service center or scheduled to have it performed, but the primary is not paying?
[CUSTOMER][NEUTRAL] I'm scheduled.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I'm scheduled to have it [PII].
[CUSTOMER][NEUTRAL] I guess they're calling now to ask for payment and I'm like that's a lot of money.
[AGENT][NEUTRAL] OK, because with this policy is secondary, we only pick up if primary pays, meaning if they apply any amounts towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And they can give us, I was, well, you say you try to get our information, they can give us a call and we can verify this is your secondary insurance.
[CUSTOMER][NEUTRAL] Well, they said they were gonna do that. They said they were gonna do that and they would get back to me on Friday, but I just wanted to like.
[CUSTOMER][NEUTRAL] Jumpstart it
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Like, see, I'm pretty sure they're gonna cover something, but I guess they're just looking for a payment first. I have no idea. I'm lost when it comes to like insurances and really don't understand this.
[AGENT][NEUTRAL] No, no, I understand. Typically, if you give them your primary and your our information is secondary, after you have the service, they will follow with your primary first, and then your primary will send them an EOB and from there they will need to submit the billing and the EOB to us since we're secondary, so we can process the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm guessing what it was is that they never had you guys as my secondary. They only had my first medical. They just now I just forward them my, my insurance card from you guys, so maybe they'll work on that and then they'll get back to me or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hopefully,
[CUSTOMER][NEUTRAL] Or they'll send it to you guys
[AGENT][NEUTRAL] Because most providers, if they call, we can verify the secondary coverage and how the policy works, and most times they would just file the claim after you've had the service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Alright, so, and if, and if it's inpatient you guys covered to like how much?
[AGENT][NEUTRAL] OK, um, not a guarantee of payment. This is just verification of your coverage. For inpatient, you have a benefit max up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect OK perfect thank you so much I really appreciate it. I'll just wait for them to get back to me on Friday after I guess they speak to you guys.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yes, ma'am, and thank you for calling [PII]. You have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.