AccountId: 011433970860
ContactId: 31f050bb-55e9-454f-85e1-86f94d34a7a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402899 ms
Total Talk Time (AGENT): 113721 ms
Total Talk Time (CUSTOMER): 254948 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/31f050bb-55e9-454f-85e1-86f94d34a7a0_20250324T13:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII] in [PII]. How are you?
[AGENT][NEUTRAL] I'm fine, [PII]. How are you?
[CUSTOMER][NEUTRAL] Doing well. Hey, I've got, um, I guess a favor or to see if we could do this or not. I've got a group that we've had for with APL for about 1 year now, and they're coming up for the renewal, and they've fallen below the 5 employees, but they're searching for 2 new hires. Is there any way we could get an exception to keep their program in place because it works very well with their higher deductible plan.
[AGENT][NEUTRAL] OK, so the group has fallen below participation and they're coming up on their renewal. When is their renewal fall?
[CUSTOMER][NEUTRAL] It's a 4 it's a 4-1 renewal. We were hoping that we would have 1/5 by then and we just, uh, there's, I can't guarantee that I'll have it before 4/1 so and I've just gotten there, uh, Aetna rates in and looks like we're gonna be making a change from Anthem over to Aetna just because of the rate factors.
[AGENT][NEUTRAL] OK, and [PII], what group is this for?
[CUSTOMER][NEUTRAL] It's a Vera A V E R A Industrial supply.
[CUSTOMER][NEUTRAL] And I may have a group number for you. Hold on one second, yes, group number.
[AGENT][NEUTRAL] I've got it.
[AGENT][NEUTRAL] I've got it.
[CUSTOMER][POSITIVE] Look at you being so fast.
[AGENT][NEUTRAL] OK, let's see what we have going on here.
[CUSTOMER][NEUTRAL] And then remind me, I have another question for you we got another group that we're gonna bring online it's a new group, but I just had one question when we get this kind of maybe.
[CUSTOMER][NEUTRAL] Finalized.
[AGENT][NEUTRAL] So what I'm gonna have to do, [PII], is I'm gonna have to go to underwriting and ask for the exception.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it'll be probably just.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] A few days before they're able to get a response on that one, but I'll get it as quickly as I can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, um, and the question the other question I had was in these particular situations, uh, yeah, and I've heard it explained a couple of different ways, but kind of had a strategy, and I don't even know if it would work or not. So we've got a new group we're gonna be bringing online, it's called Advanced Valve and instruments, um, they're, you know.
[CUSTOMER][NEUTRAL] A little bit puzzled as to how this works and I've explained to them that, you know, these, these products and plans have existed for decades. The problem had always been the outpatient benefit was very limited in its scope and APL seems to have figured that pitfall out and to, to be perfectly honest, I've never seen anything like what your product does. So the question is, is that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Instead of turning in the APL of secondary insurance, could they obtain an EOB from their primary care and file their claim with APL direct?
[AGENT][NEUTRAL] Um, so if I if I understand your question, so.
[AGENT][NEGATIVE] You don't want them.
[AGENT][NEUTRAL] Assigning the benefits, you want them to file the claim themselves?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. Yes, and here's why, a lot of the providers and especially rural [PII], will sometimes give, you know, cash payment discounts for deductibles, things of that sort. So in that particular situation, I had one come up for me at the end of [PII], where I owed like $3400 and they agreed to settle for $1500. So, under that scenario, if someone had
[CUSTOMER][NEUTRAL] A benefit payable from APL then they could negotiate their deductible exposure down and I didn't know if that was permissible under APL's guidelines or not.
[AGENT][NEUTRAL] No, we're gonna need the EOB.
[CUSTOMER][NEUTRAL] Well, I mean, we could get the EOB that's not a problem, because the, the carrier, you know, the member's gonna get an EOB from the primary care carrier.
[CUSTOMER][NEUTRAL] And I didn't know if there was a claim form and if they could submit the claim form and the EOB into you guys to get direct payment.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] They, they can, they can. Um, so the EOB will be from the major medical carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, it would be from the primary, say for example, Anthem Blue Cross Blue Cross. So they get their EOBN and it shows what per you know, what was applied to the calendar your deductible and then if there were a claim form, could that be sent in and instead of the money going to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, if you, yes, um, you can have the funds assigned to yourself, uh, just have to say that on the claim form, yeah, but that means the employee would be on the hook for anything that's owed.
[CUSTOMER][NEUTRAL] So that is permissible.
[CUSTOMER][POSITIVE] Nice.
[CUSTOMER][NEUTRAL] OK, well, that's uh.
[CUSTOMER][POSITIVE] Exactly, and I mean it'd be, it would be forthcoming because, I mean, nothing happens until you get the primary EOB just like any other secondary insurance and then it has to be submitted to the secondary carrier. So, OK, that's a neat little feature.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, um, but we do have a claim form online that they can, they can use, um, they would just need to make a note of that when they submit their claim because almost everybody we have assigns it to the major medical carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Exactly. So, OK, well, that, that answers my question. And if you could just let me know, I mean, I know it's kind of late in the game, it's kind of almost a 2 minute warning, so to speak, and I'm, I'm down by 5 points. I need to score a touchdown.
[AGENT][NEUTRAL] OK, yeah, um.
[AGENT][NEUTRAL] We'll get this submitted to the exception. I
[CUSTOMER][POSITIVE] I'm glad you got the football analogy, by the way, thank you.
[AGENT][NEUTRAL] [PII], I have 3 boys and a husband who live and breathe OU football. So, yeah, I get it.
[CUSTOMER][NEUTRAL] So, so you know, you know what it's like to be down by 5 or 2 minutes to go.
[AGENT][NEUTRAL] I know what it's like. I know. All right. Well, as soon as we um hear something back, then we'll, we'll let you know, OK?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much and again your name was?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], thank you.
[AGENT][POSITIVE] Alright, [PII], thanks so much for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm. Bye-bye.