AccountId: 011433970860
ContactId: 43b0b96f-80cd-40f5-8c8b-0ae83d530975
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352410 ms
Total Talk Time (AGENT): 210094 ms
Total Talk Time (CUSTOMER): 114745 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/43b0b96f-80cd-40f5-8c8b-0ae83d530975_20250306T16:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, I'm currently new to having APL this year and I just had a question about using the benefits card. Um, I go, I'm currently pregnant and I go to my OBGYN and they're requiring me to pay a pre-labor billing charge. Would I be able to use my APL card for that payment?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'll have to look and see what type of policy you have with us, but I'll be more than happy to let you know how it works. Um, sure. May I have your name and then a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and then on your card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Yes, the inhospital benefit cert number do you want that number?
[AGENT][NEUTRAL] Mhm. Oh, so the numbers are the same, that ML 7 or 8 at the end is different. I just need the numbers.
[CUSTOMER][NEUTRAL] OK, so it's 02584244.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, here we are, and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII]. My mailing address is [PII], and you said my email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I have two emails. So [PII], and I have [PII].
[AGENT][NEUTRAL] Yes, so I am showing the place. I hope that you want to keep that or switch it to your personal or?
[CUSTOMER][NEUTRAL] That's fine. No, I have access to both, yeah.
[AGENT][NEUTRAL] It's OK?
[AGENT][NEUTRAL] OK. And then, so let me see what type of policy you have. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you, so this is a Medlink policy, so it's your supplemental policy, so we pay towards your co-pay, your deductible, and your co-insurance of covered charges after primary. So like if you're um
[AGENT][NEUTRAL] The pre-labor billing, is this like a co-pay or?
[AGENT][NEUTRAL] Are they saying like self-pay and this is what you have to pay upfront?
[CUSTOMER][NEGATIVE] So they, I asked them if they've ran my insurance and they said they did, and because of my deductible is so high, this is what I would have to pay.
[AGENT][NEUTRAL] Oh, OK, OK, OK. So the deductible is not met on the primary, so they're saying the charges might not be covered, so they have that upfront. OK, I got it.
[CUSTOMER][NEUTRAL] Correct, yeah, and it's pre- labor charge, mhm.
[AGENT][NEUTRAL] They have that upfront fee.
[AGENT][NEUTRAL] So I'm hesitant because the question then is, so is the pre-labor charge billed to insurance or this is, this is something you have to pay. That's gonna be, that's gonna make the difference. If they bill this to your to your primary insurance and we process it,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And then um they send it to us and we process it, then it would be just a normal claim like as if it was like a co-pay or deductible, but if this is like a fee or a charge that they're billing direct like billing to you only, then insurance wouldn't be applied.
[AGENT][NEUTRAL] I would ask them.
[CUSTOMER][NEUTRAL] OK, so I would have to find out.
[AGENT][NEUTRAL] Mhm. I will ask them if this free labor billing charge is billed to your insurance or if this is something that you have to self-pay. If this is something you have to self-pay, then insurance is not involved. If it is billed, then it would be just like
[AGENT][NEUTRAL] regular claims, it'll go to your primary insurance and then it'll um come to us, but it sounds like they're saying because of the amount of your deductible for primary, this is kind of like a buffer payment, so it may be self-pay.
[AGENT][NEUTRAL] I'm just thinking it through.
[CUSTOMER][NEUTRAL] OK, and I wouldn't be able to use the card if it's self pay.
[AGENT][NEUTRAL] Right, because they are not going to bill it to insurance, they're just billing it to you as like a buffer payment.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I would definitely find that out.
[AGENT][NEUTRAL] Yeah, so if they say self-pay, then yeah, you'll know, but now you know the difference between the two, so you'll be able to.
[AGENT][NEUTRAL] Know how they're gonna handle it.
[CUSTOMER][NEGATIVE] OK, and there's no way to like get reimbursed since it's like pre-labor charge. There's no way to get like reimbursed for that money afterwards since they're taking it out I guess early.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So basically, if you, if there's a claim and your primary insurance pays towards that claim, then APL can pay towards the claim as second. But if your primary insurance doesn't pay towards the claim, if they say the deductible hasn't been met or, you know, give any type of denial reason, then we as second can't apply to the claim because we're only second to your primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. OK. I will definitely find that out. Thank you so much for that information.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] All right, well, thank you so much for calling APL and congratulations.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][POSITIVE] Alrighty bye bye.