AccountId: 011433970860
ContactId: 29d53829-eeaa-4ded-b377-c11708c45373
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372109 ms
Total Talk Time (AGENT): 146709 ms
Total Talk Time (CUSTOMER): 201749 ms
Interruptions: 2
Overall Sentiment: AGENT=2.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/29d53829-eeaa-4ded-b377-c11708c45373_20250507T17:29_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, this is [PII]. How are you doing?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Doing fine as well, thank you. Um, this is a quick question. While I'm a doctor, it does not mean I know all types of insurance, and by that I mean you have one of your policies, I guess, uh, GA Insurance, and I've never used GAP insurance before, so my question is this I guess we have an HMO policy, a new one through my wife, that is a $4000 deductible, I guess per member and $8000 per family. So I'm going to be going for physical today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the office has already indicated to me it could cost up to $518.
[CUSTOMER][NEUTRAL] So how does that work if we have a high deductible HMO plan?
[CUSTOMER][NEUTRAL] There's a $500 bill for the physical. Is this something that once the HMO, it's a Harvard Pilgrim plan, denies that or says we're responsible for it? Do we then submit that to you to see if it's covered? Like I said, I've never dealt with gap insurance, so this is a first for me. How would we handle that if there's even potential coverage?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me do this. Let me pull up your policy so I can see what type of policy you have and then I'll be able to give you specifics because there's different types of secondary. Um, so let me just see what you have.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, got it. You want outpatients?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, you wanna, you want a group number an outpatient benefit number? What number do you need from the card? I'll see if I can read it on my bifocals work that is.
[AGENT][NEUTRAL] Um, well, first
[AGENT][NEUTRAL] OK. May I have a good contact number just in case we're disconnected and then the outpatient policy er number.
[CUSTOMER][NEUTRAL] OK, I'll give you my number. It's my wife's policy, but since I'm the one calling, it is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and then the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But that was not a side to you. I just got back from the gym, so still trying to catch my breath.
[AGENT][NEUTRAL] Oh, it's OK.
[CUSTOMER][NEUTRAL] 57 for a reason.
[CUSTOMER][NEUTRAL] Um, the outpatient benefits er number is 02613028 M as in Michael, L as in Lambda or Lima, and then the number 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] Sure, like I said, I just want, I don't wanna submit claims and waste time and effort anybody's if it's something that.
[CUSTOMER][NEGATIVE] Wouldn't be worth it.
[AGENT][NEUTRAL] Exactly. OK, so I have you here. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] OK, it should be under the policy is under my wife [PII]. I'm the spouse, obviously. My date of birth is [PII]. Did you say you need our address?
[AGENT][NEUTRAL] Yes, sir, just the mailing address.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So there's two things.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So since we're 2nd, if your primary doesn't apply, we can't apply. So, we will have to see how
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You can't CANT you can't.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Because we're second to them, so if they don't apply.
[CUSTOMER][NEUTRAL] How does that
[CUSTOMER][NEUTRAL] Oh, so if the HMO says I'm responsible for the physical, due to the high deductible, then you would not cover that.
[AGENT][NEUTRAL] Right, it is, so what I'm trying to say, so it depends on what your primary does. If they are um like making you pay this to have the services done, then once you pay it and the claim is filed, then you could be reimbursed for that.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, or something still owed to the provider.
[CUSTOMER][NEUTRAL] Oh, so
[CUSTOMER][NEUTRAL] OK, can you explain that? I know this sounds silly. Like I said, this is not my forte, so they would build this through our insurance.
[CUSTOMER][NEUTRAL] They submit the bill to our insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] If the insurance, so how would this be not paid? How would this be paid? horrible grammar, I apologize. So explain this so one's gonna understand, OK.
[AGENT][NEUTRAL] So if, if
[AGENT][NEUTRAL] If your primary insurance does not apply to the claim, if they don't pay anything to the claim, we can't.
[AGENT][NEUTRAL] If they do, then we can because we're second to them, so we can't, if they don't, we can't because we're 2nd.
[CUSTOMER][NEUTRAL] OK, so if they pay, let's say they pay $300 for the $500 exam, I don't think they're going to, we could then build that $300 to you and then you might reimburse us.
[AGENT][NEUTRAL] If they, so the exam is 500 and they pay 3, so.
[AGENT][NEUTRAL] You should give your provider our information, the card, so that they can automatically bill primary. Once that remaining 200 or, you know, for the example, the 200 comes back, they're gonna automatically bill us for that 200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so that is where the gap would be. You would cover what was not what you would cover the residual, OK.
[CUSTOMER][POSITIVE] They've got both the insurance. I was just trying to understand it myself. Well, I know that you've had this answered this question many, many times for people like me, so thank you for the courtesy. Hopefully, I won't get too used to this.
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Well, it's good to have it. At least you have it and I'm sorry.
[CUSTOMER][POSITIVE] Alright, you have a nice month day coming up.
[CUSTOMER][NEUTRAL] No, no, finish your thought.
[AGENT][POSITIVE] Oh, I was just saying, well, at least, I know you didn't want to use it, but now you have it, so I was glad to have it and hopefully not need it, but now you do, so I'm glad it's here.
[CUSTOMER][POSITIVE] Fair enough.
[CUSTOMER][POSITIVE] Yeah, and I was gonna say have a nice Mother's Day.
[AGENT][POSITIVE] Oh, thank you very much. Well, was there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Nope, like I said, hopefully I won't have to try to figure this out too much, which means I'm staying healthy, so thank you. I really appreciate all the help you gave me.
[AGENT][POSITIVE] You're very welcome and I hope you have a great weekend and thanks for calling APO.
[CUSTOMER][POSITIVE] You got it bye bye.
[AGENT][NEUTRAL] Bye bye.