AccountId: 011433970860
ContactId: 2a2ba157-733d-4c21-8cb4-f6788e34b2d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514989 ms
Total Talk Time (AGENT): 211669 ms
Total Talk Time (CUSTOMER): 207865 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/2a2ba157-733d-4c21-8cb4-f6788e34b2d1_20250422T15:14_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, this is [PII]. Um, my law firm, um, we have a, a, a group, um, policy with you all, and I'm an individual insured, and I've never utilized, um, the policy because every time I've asked, I've had surgery twice since [PII]. I've been told, I don't even know what you're talking about. I've never heard of this insurance.
[CUSTOMER][NEGATIVE] I'm having to have surgery again and so this time I wanna make sure that if I'm, you know, if it's gonna help pay the deductible or whatever that I'm able to do that, try to log in online and it's not finding me.
[AGENT][NEUTRAL] OK. Do you have a policy number, [PII]?
[CUSTOMER][NEUTRAL] I do, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 020.
[CUSTOMER][NEUTRAL] 32964
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] I do [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, [PII]. Uh, 2 more pieces of information. Um, what is your address?
[CUSTOMER][NEUTRAL] [PII], that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, looks like I've got a a totally different address, uh, [PII].
[CUSTOMER][NEUTRAL] You would. I moved in, yeah, I moved in [PII]. Um, you've got a [PII] address in [PII].
[AGENT][NEUTRAL] OK, so do we want to get that changed?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Let's get that changed real quick.
[AGENT][NEUTRAL] OK, I'm so sorry. Will you give that address to me again?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, OK, we're checking benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let's see what we have.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment. It's a basic outline of your policy. I've got you active in our system, so if they call to verify benefits, we'll tell them that you're active, and then the benefits that are applicable, and these will be after your primary insurance has processed the claim. So any deductible insurance, um, co-pays, this is what would pick up. Um, let me see what your max is.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This outpatient surgery.
[CUSTOMER][NEUTRAL] Uh, no, I'm actually, it's, um, cervical spine surgery and I'm spending one night in the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it looks like for your inpatient benefit maximum it's 4900 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is a deductible for inpatient services, so the deductible has to be met first, which is $2000 then it pays $4900.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let me ask you this, um, two questions. First of all, do I file this myself or do I get the healthcare provider to do it?
[AGENT][NEUTRAL] So, the healthcare provider should be able to file for you, um, especially if they call them verified benefits and know that there would be some type of, you know, this type of benefit that it's payable. So sometimes they won't though. Um, and if that's the case, you'll want to see if you can get the claim from them to file with us, and then you'll have to wait till your primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To file the explanation of benefits from them because we need two pieces of information, the explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I, so I just need to stay on top of them and then make sure that um that um if they won't do it, that I do that. Let me ask you this. Um, is it possible, I had surgery, so I've had like a spate of crap. Um, I had to have a shoulder repair in [PII]. I had a knee replacement in [PII] and now I'm having spinal surgery in [PII]. Um.
[CUSTOMER][NEGATIVE] And so nothing happened with this. I didn't file it. Like I said, the healthcare provider said we don't even know what you're talking about. Is it possible for me to go back at all and, and if I can get the EOBs and what I paid to.
[CUSTOMER][NEUTRAL] To access this.
[AGENT][NEUTRAL] Absolutely, yes. There's no timely filing limit. So you can file those any time. Um, just again, most important thing here is the explanation of benefits and then asking that healthcare provider if they can get, provide you the actual claim they filed with your primary insurance because that's gonna have, yes, exactly, because that's gonna have your diagnosis, it'll have your procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With Blue Choice, OK.
[AGENT][NEUTRAL] It's gonna have all the pertinent information that we need um to process under this plan, so.
[CUSTOMER][POSITIVE] And then y'all would just reimburse me up to the maximum of $4900 minus the $2000 that I've already paid, you know, towards whatever.
[AGENT][NEUTRAL] That is
[AGENT][POSITIVE] That is correct, yes, that's correct.
[CUSTOMER][NEUTRAL] And that's for inpatient what about so when I had my shoulder shoulder surgery done and then my knee replacement, they actually did that as outpatient um is that the same benefit for outpatient?
[AGENT][POSITIVE] It is, it's the same benefit, yes.
[CUSTOMER][NEUTRAL] The same $4900. OK, perfect. Listen, you have been so helpful, um, and so, so to log in when I try to log in online I used my social security number because I don't have a member ID number and it said that I wasn't found.
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] Let me see if I can see if maybe you had set it up before, or let's see, let me check something.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] OK, yeah, I don't show.
[AGENT][NEUTRAL] Oh, I know what it is. Um, looks like we don't have an email address on file for you.
[AGENT][NEUTRAL] And that so what uh what's a good email address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the problem. Let me get that entered real quick.
[AGENT][NEUTRAL] So it's gonna need your email address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK, you should be able to do it now, um, and then I've updated your address, so that's, so you'll use your new zip code for that, your social security number, last name, email, and then you and date of birth, and then you should be able to log in and that's a really great resource to upload any documents you have. That's usually the fastest way versus like mailing it in. So, um, just call her out if you have any.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, in fact it just let me in, yeah, to create an account, so perfect.
[AGENT][POSITIVE] OK, perfect.
[AGENT][POSITIVE] OK, perfect. Great.
[CUSTOMER][POSITIVE] Listen, I really appreciate your help today.
[AGENT][POSITIVE] Oh, no problem. Anything else I can help with, Ms. [PII]?
[CUSTOMER][POSITIVE] That's it. Thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] You too.