AccountId: 011433970860
ContactId: 3c37f5c7-7677-41ef-a6d6-2017595cdc27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489209 ms
Total Talk Time (AGENT): 210025 ms
Total Talk Time (CUSTOMER): 277927 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/3c37f5c7-7677-41ef-a6d6-2017595cdc27_20241230T21:22_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] Um, yes, I am calling to, uh, check and see, um.
[CUSTOMER][NEGATIVE] I was told I needed to speak to y'all about what what um you'll cover as far as um my husband it's not a wellness visit it is a.
[CUSTOMER][NEGATIVE] Visit that he has to make because he has to have blood work done um this insurance is new and I don't know why I can't get my head wrapped around it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But evidently I'm not the first person evidently that doesn't get it, but, but, but the doctor's office told me that I would have to call y'all and um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's a doctor we've seen for years and like I said this is new insurance for us so I just have to see if um.
[CUSTOMER][NEUTRAL] See if they're in your network or not or what what we need to pay them or what we don't so um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What do you need first?
[AGENT][NEUTRAL] So I can help you with your policy. Um, well, 1st may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, my name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my, my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] OK, policy is 025673992.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify um the member's first, well, I'm sorry.
[AGENT][NEUTRAL] Well, hold on one second.
[CUSTOMER][NEUTRAL] The employees
[AGENT][NEUTRAL] Oh, you're on here as well. Can you just verify your date of birth and the mailing address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII] and our mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So you're wanting to know how your policy is applied and if it covers blood work?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah I mean well he's got to have lab work done um because it it's time, but.
[CUSTOMER][NEUTRAL] Our, our doctor that we usually see, I didn't know if she's, if they're in or out of the network and what uh.
[AGENT][NEUTRAL] So there's 2 things.
[CUSTOMER][NEUTRAL] When I talk, OK, OK.
[AGENT][NEUTRAL] So you have a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, which is a limited medical policy. So it covers like hospital admission, confinement, um, if you have any accident or need surgery because of an accident or sickness, but then you also have the outpatient benefits and diagnostic testing. So under outpatient benefits, there is a physician office benefit in which the policy would pay up to $50 for each physician office visit 4 times a year.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh huh uh huh.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's where the um
[AGENT][NEUTRAL] The office visit will come into play. So, but the, but the policy would only pay up to the $50 for that visit. In terms of in or out of network, you do have the PPO um policy with Multiplan. Now because Multiplan is a different company, we don't have access to their list of providers, but I can give you their number and transfer you to a rep so they can, do you have your doctor's um NPI number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] No, I don't know what that is and.
[AGENT][NEUTRAL] See, so this, to be honest, the easiest thing to do would be to give our phone number this [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Give that number to your provider and have them call to verify the benefits, but I can also give you multiplans number so they can call and see if they're in network. They're making you do the legwork.
[CUSTOMER][NEUTRAL] Well she told me that she told me that um that that they they couldn't call y'all so I I know it's all confusing believe me um but it.
[AGENT][POSITIVE] Yeah, Is call all the time. They just need your name and date of birth, and, and that's how we, you know, let them know what type of benefits you have and we can go.
[CUSTOMER][NEUTRAL] But I just called I just called multi plan and they told me I needed to call y'all so.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] So let's call them together cause I don't know why they're giving you the runaround, but I can definitely help you. Hold on one moment.
[CUSTOMER][NEUTRAL] To find a provider, well, I mean I know we have limited whatever and I know there's that huge deductible but and he shouldn't have this insurance for too long but he's gotta go and I, he's got an appointment Friday so I thought well I'll call and see what we need to pay.
[AGENT][NEUTRAL] So as far as benefits, so anything with this policy, you're not paying anything upfront, like there's no this isn't like a Aetna or Blue Cross Blue Shield to where you have like a $25 co-pay or something like that. This is all done on the back end, so you'll give them the ID card with the policy number and then once everything is done, they'll file the claim and that's where we come in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] But for the in or out of network, um, I can call multiplan for you, but they're gonna ask for the NPI that's your it's kind of like your doctor's ID number.
[CUSTOMER][NEUTRAL] OK, well, at this point, it probably doesn't matter whether they're in or out of network because he's got to see that doctor anyway because it's, it's it's blood work that he has to have done about every 6 months because he's got thyroid disease and um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she also has to see him because he does take Ambien at night, so.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] I, I guess what I'll do is I'll just give, we'll give them all the information and then go from there as far as the claim, but, but, um, uh, I don't think it matters until maybe the next appointment because we might have to change to a different doctor, um, and I can call them so.
[AGENT][NEUTRAL] You do.
[CUSTOMER][NEUTRAL] They would be able to tell me who's in and out of the network if I call the um.
[CUSTOMER][NEUTRAL] The multiplan number which number is that the 1-800?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I can't read that number 884-699-93 is that the
[AGENT][NEUTRAL] It sounds like you hold on one second, let me see, multi-plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I have 804571403.
[CUSTOMER][NEUTRAL] OK, all right, I've got that on this one, OK.
[CUSTOMER][NEUTRAL] Alright, it says to locate a provider gee, that's right in front of my face there. I'm so sorry this is all I don't.
[AGENT][POSITIVE] Oh, you're totally fine. That's what we're here for.
[CUSTOMER][NEUTRAL] This is through his temp service and it and when I read it I was I've never I've always handled our insurance but this was just all.
[CUSTOMER][NEGATIVE] Confusing to me.
[AGENT][NEUTRAL] Confusing. It's OK, that's what we're here for.
[CUSTOMER][POSITIVE] OK, alright, and uh, well thank you so much for your help, but I'll, I'll, um, I'll let them deal with it with filing the claim, and I'll help them after that so I think that'll, it'll be fine.
[AGENT][NEUTRAL] Alright, well, again, all the information provided was a verification of benefits, not a guarantee of payment. And [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, but thanks so much for your help.
[AGENT][POSITIVE] You're very welcome. Well thanks for calling ATL and I hope you all have a merry Christmas, a happy new year.
[CUSTOMER][POSITIVE] Well, you're fine. I, I'm surprised I didn't say that. So happy new year to you too, OK.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] All right bye bye.