AccountId: 011433970860
ContactId: 3e191cc0-6cf8-45c4-8c9f-7b08fb7f56be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417859 ms
Total Talk Time (AGENT): 185048 ms
Total Talk Time (CUSTOMER): 187762 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/3e191cc0-6cf8-45c4-8c9f-7b08fb7f56be_20250311T21:24_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 [PII], I've um got a membership with you or a payer ID. I um had to visit the emergency room a couple of weeks ago and I wanted to touch base with you to see if there's any coverage that um you guys are providing in relation to um that uh emergency visit.
[AGENT][POSITIVE] OK, I can definitely help you with your coverage and let you know um the emergency room visit or benefits that you have if you have any. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Thank you for that. And Mr. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Let's see uh.
[CUSTOMER][NEUTRAL] Which which uh which number is it from the card? Is it uh the one that says payer ID number, is that what you mean, or?
[AGENT][NEUTRAL] No, um, it should say in hospital or outpatient policy certification number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, so the inhospital one is 0260.
[CUSTOMER][NEUTRAL] 3918 M for Mike, L for Lima, 7.
[AGENT][NEUTRAL] Thank you and I have you here. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII] [PII]. And did you say email as well?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, I'm just waiting for your benefits to populate here.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And you said it was an emergency room visit or were you admitted into the hospital?
[CUSTOMER][NEUTRAL] Uh it's emergency room visit and then I was transferred to the trauma unit at another hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which is just the emergency room, but I didn't stay in the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So for outpatient, the benefit is up to $5000 per calendar year, which does include the hospital emergency room.
[AGENT][NEUTRAL] There is no deductible.
[AGENT][NEUTRAL] Um, so you have two choices. You can either reach out to the hospital and provide them with this, um, policy number and our phone number if they need to verify benefits and let them know you have a secondary insurance and to bill us or you can file a claim on your own.
[CUSTOMER][NEUTRAL] Right, OK, because at the moment I think um they have me down for a $350 copay. I don't know if there might be some other payment, other bills to come in or not, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, I'll, uh, I'll try contacting them and give them that number and they should con they'll contact you, they'll you directly for that. Is that my understanding correct?
[AGENT][NEUTRAL] Right, so they'll bill your primary first primary will apply and then um they'll bill us as second and then um
[CUSTOMER][NEUTRAL] But
[AGENT][POSITIVE] Yes, so that's how it will work.
[CUSTOMER][NEUTRAL] OK. And um uh your, does your plan cover the Delray Medical Center? It's not uh you know, restricted to certain hospitals or anything?
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] Is it, sorry, are you asking if there's, if there's specific hospitals you have to go to?
[CUSTOMER][NEUTRAL] Yes, I'm just making sure that all that for emergency rooms is covered everywhere.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right, for your secondary policy, there is no network, so there's like no in or out of network benefits. Um, that's would probably be more so for your primary. Now, if they don't apply, then we wouldn't be able to, but
[CUSTOMER][NEUTRAL] Right, I see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, OK, yeah, that, that, so some of it was covered with them and then what did you say was the maximum coverage? You had $5000 was it?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm, for your outpatient benefits.
[CUSTOMER][NEUTRAL] And, and what an outpatient counts as emergency room as well, does it?
[AGENT][NEUTRAL] Yes, the hospital emergency room is under outpatient. Mhm.
[CUSTOMER][NEUTRAL] I see. OK. So is that the number that I need because it's, it is slightly different in the numbers for the in-hospital benefit certificate number and the outpatient. So should I give when I call them, should I give them the outpatient benefit uh number?
[AGENT][NEUTRAL] So the numbers there are the same, that ML 7 or 8 at the end is different. You really could provide just the numbers. You don't have to give the ML 7 or 8.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, I see. OK, fine. OK, great. Um, is there anything else I need to know that I'm not asking you a question about because I don't know why I don't know.
[AGENT][NEUTRAL] Um, no, not if you're not if you're gonna give them a call and have them bill us and know that that's all you'll have to do.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEGATIVE] All right, let's say I call them and they say it's too late now, they can't bill you and they send me a bill. What, how do I deal with that?
[AGENT][NEUTRAL] So at that point, you can either mail it to us, you can fax the claim, or you can upload the documents on to our online service center, which is our secure portal.
[AGENT][NEUTRAL] Um, you'll need the itemized bill from the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it would need to have the diagnosis codes.
[AGENT][NEUTRAL] The procedure codes and all of the charges.
[CUSTOMER][NEUTRAL] OK, and then I send that to um.
[CUSTOMER][NEUTRAL] Uh, is there an email address did you mention as well, or is that only, uh, I have to log in and register or something?
[AGENT][NEUTRAL] Well, you'll, you'll need two other things. Did you want the other two things as well?
[CUSTOMER][NEUTRAL] Yeah, go
[AGENT][NEUTRAL] So you also need your Medlink claim form, which can be found on our website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] And you'll also need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so it'd be a lot easier if I can get that pay bill you direct by the sound of it. I'll try that first and then I'll call you again if I get stuck.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it for today. Thanks a million.
[AGENT][POSITIVE] All right. Well, thanks for calling APL and I hope you feel better. Have a good day.
[CUSTOMER][POSITIVE] Thank you, yeah you too thanks bye bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.