AccountId: 011433970860
ContactId: 3e15e408-0790-4d03-b9cc-0398ec211c74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436670 ms
Total Talk Time (AGENT): 158949 ms
Total Talk Time (CUSTOMER): 177374 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/3e15e408-0790-4d03-b9cc-0398ec211c74_20250228T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL speaking. May I help you?
[CUSTOMER][POSITIVE] Uh hi, good morning.
[CUSTOMER][NEUTRAL] Uh, OK, I had a question. Should I give you the group number maybe to start?
[AGENT][NEUTRAL] Uh, is it in regards to, are you a group admin?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um, my question is I'm going to have a procedure equivalent clinic and they're not gonna pay.
[CUSTOMER][NEUTRAL] For a quiet amount of of from an uh an amount that I would like to know if this is covered by you guys or not.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Uh, 10, the, um.
[CUSTOMER][NEUTRAL] I don't know I had the group number.
[AGENT][NEUTRAL] OK. Do you have a copy of your card in front of you?
[CUSTOMER][NEGATIVE] No, I don't, I don't have it and I looked for it and I couldn't find it.
[AGENT][NEUTRAL] OK, uh.
[AGENT][NEUTRAL] OK. Uh, what's your social?
[CUSTOMER][NEUTRAL] OK, that's Social Security. Hold on one second, I don't know if I.
[CUSTOMER][NEGATIVE] Oh [PII], I'm sick today.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My hold on let me try it.
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But it's under my husband, the, the insurance and a dependent.
[AGENT][NEUTRAL] And what's his name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, spell the last name for me, please. I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address for me, please.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] [PII] and the address [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling to verify if a procedure is covered?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And this is gonna be in an outpatient facility like at an ambulatory surgery center or hospital?
[CUSTOMER][NEUTRAL] In the hospital.
[AGENT][NEUTRAL] OK. Well, under your policy, uh, we are secondary. We do help with primary insurance deductible, co-pay or co-insurance for services performed outpatient or in hospitals. Um, so it kind of depends on if it's covered by your primary as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it could be covered under the policy if it's performed in an outpatient facility.
[CUSTOMER][NEGATIVE] I don't understand.
[CUSTOMER][NEUTRAL] OK, it says.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So I had to call the main insurance first?
[AGENT][NEUTRAL] Uh, I would say you can verify with to see if it's covered, but with this policy, it's a secondary supplemental plan, and it helps with your primary deductible co-pay or co-insurance up to your max benefit. So it has to be covered by your primary in order to be covered by our company and it has to be in an outpatient facility or inpatient.
[CUSTOMER][NEUTRAL] OK, I
[AGENT][NEUTRAL] So if it's in an outpatient facility, that is a covered place of service for your policy, but it also has to be covered by your primary.
[CUSTOMER][NEUTRAL] OK, I'm writing that down so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I had to go. OK, this is going to be in Cleveland Clinic and they are sending me a letter saying that.
[CUSTOMER][NEUTRAL] My responsibility is going to be 2300.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I need to call the insurance to find out why I'm paying that correct it and whatever that's the insurance don't pay you guys pay.
[AGENT][NEUTRAL] Up to your max benefit you have with us for outpatient. Uh, did you give Cleveland Clinic your information with us as secondary?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So I had to give them the insurance, OK, I'm gonna call them to get that.
[CUSTOMER][NEUTRAL] US as secondary.
[CUSTOMER][NEUTRAL] Insurance correct?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. Just give them your um policy number and our phone number that way they can call and verify benefits and then they will know after primary insurance has processed the claim to also submit it to us as secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry I'm writing that down because if not I forget.
[AGENT][NEUTRAL] OK, that's fine. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, OK, so I'm gonna do that. I'm gonna call that it has to be impatient and what is the other that you said impatient.
[AGENT][NEUTRAL] Inpatient or outpatient, because the policy, if it's
[AGENT][NEUTRAL] Performed in like um a doctor's office or clinic is not a covered place of service for your policy with us. So we only cover services outpatient or in hospital.
[CUSTOMER][NEUTRAL] And what is outpatient?
[AGENT][NEUTRAL] Outpatient is ER urgent care, ambulatory surgery center, MRI or imaging center.
[CUSTOMER][NEUTRAL] OK, that is outpatient. OK, this is going to be uh like outpatient then it's, it's um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's one
[CUSTOMER][NEUTRAL] The surgery.
[AGENT][NEUTRAL] OK. So that, and if it's in a hospital or a surgery center, then it would be considered outpatient.
[CUSTOMER][POSITIVE] Outpatient. OK, perfect. OK, thank you very much for your help. OK, thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] You too OK thank you bye bye.
[AGENT][NEUTRAL] Bye.