AccountId: 011433970860
ContactId: 4503353d-7c18-4af5-8146-5dbd0a052b14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 750190 ms
Total Talk Time (AGENT): 303290 ms
Total Talk Time (CUSTOMER): 348302 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/4503353d-7c18-4af5-8146-5dbd0a052b14_20250313T16:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is uh [PII], and um I was calling about, um, I guess I just have a question really. So my daughter needs uh a procedure done to repair uh like a little hole in her ear.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEGATIVE] What do you call it when I gave the insurance to, when I give the insurance card to them and they said that that part covered and then I give them your guys' information they're saying that they couldn't run the card or or they wouldn't be able to do it. I would have to pay for the full amount uh for the facility which was like, like 4000, uh, I wanna say it's like 4800 bucks.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I, if I pay for that, can, can I submit the claim to you guys or how can I find out you guys will cover a certain dollar amount?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, actually I can help you. We'll just look at your policy and see what your businesses are.
[AGENT][NEUTRAL] Can I get your name and your policy number?
[CUSTOMER][NEUTRAL] The, the policy number which, so my name is [PII].
[CUSTOMER][NEUTRAL] And then is it is that the group number you're asking for?
[CUSTOMER][NEUTRAL] Or the payer ID number.
[AGENT][NEUTRAL] It may say
[AGENT][NEUTRAL] It may say inpatient or outpatient cert number.
[CUSTOMER][NEUTRAL] Uh, OK, there's, uh, there's one for in hospital and then one for outpatient.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it doesn't matter which one to give you.
[AGENT][NEUTRAL] Either one of those numbers will work.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so it's uh 017317.
[CUSTOMER][NEUTRAL] 13 M as in Mike L as in Larry 7.
[AGENT][NEUTRAL] OK. Let me look that up real quick for you.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK [PII], I'll need for you to verify your policy for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] I'm sorry you broke up. What did you say?
[AGENT][NEUTRAL] Your date of birth, please?
[CUSTOMER][NEUTRAL] Oh yes, uh [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, oh, you might have the [PII], and then, uh, phone number is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And then my email will be uh uh [PII].
[AGENT][NEUTRAL] OK, thank you very much and then if our call gets disconnected, is the phone number that you just gave me a good number to call you back on?
[CUSTOMER][POSITIVE] Yes, the [PII], yeah, because you sound, I'm, I'm not gonna lie, you sound a little choppy here and there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, sorry, sorry about that. We must have a bad connection. Um, OK, so the way your policy works is it's a supplemental insurance policy.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To verify your benefits, it's not a guarantee of payment. Um, your primary insurance is billed first.
[AGENT][NEUTRAL] And the explanation of benefits from the primary is sent in with the claim to show if you've paid any deductible co-pay or co-insurance, um, the policy only helps with deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if your daughter goes inpatient, which is gonna be 18 hours or more.
[AGENT][NEUTRAL] There's a $3000 benefit for calendar year to help with the the deductible co-pay or co-insurance.
[AGENT][NEGATIVE] Once that $3000 is exhausted, then there will be no more benefit for the rest of the year for inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when you're saying it.
[AGENT][NEUTRAL] And then you also have an out out.
[CUSTOMER][NEGATIVE] Sorry, you're breaking up.
[AGENT][NEUTRAL] Yes sir, go ahead.
[CUSTOMER][NEUTRAL] No sorry you broke up you were about to say outpatient.
[AGENT][NEUTRAL] I was gonna tell you, you
[AGENT][NEUTRAL] Yes, you also have an outpatient benefit per calendar year of $1500.
[CUSTOMER][NEUTRAL] Alright, so I just gotta find out if it's uh inpatient or outpatient.
[AGENT][NEUTRAL] And that also goes towards deductible.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right, the best thing to do is give them when you go.
[CUSTOMER][NEUTRAL] All right, cause, cause.
[AGENT][NEUTRAL] When you go in to have the procedure done, give them your major medical insurance and this card to give them both of them.
[CUSTOMER][NEUTRAL] So that's what I did. So I went to the my ENT specialist because.
[CUSTOMER][NEUTRAL] Um, when we had to do the reconstruction of the year, um, you guys cover the hospital portion and my insurance covered the other, so I was trying to, I, they have both cars and I asked them if they ran on both, and they're saying my as of right now what I would have to pay right away would be the, the facility which is like 4800.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, um, the remaining what I would owe is for the doctor side which was like $900 and something dollars and they said that's after they ran my insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So and I, and I asked them about did you check with with you guys to make sure and they said that they couldn't and I was like oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was trying to ask them if they can send me the information of um you know the facility so I can contact them if they have reached out to you guys about it but I.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You know my daughter's been, you know, she has, she has this pain in his left ear when water hits it. I'm just trying to get this done and I guess my thing was like if I pay the.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][MIXED] The 4000 do I submit the claim to through you guys to see, I mean like you said, you said it doesn't sound like it can't cover at all but still something better than nothing that's how I'm kind of looking at it and then um.
[AGENT][POSITIVE] Correct. Right.
[CUSTOMER][NEUTRAL] But um do I need to find out if it's an inpatient or outpatient but if it's if it's the year I have to assume that's an outpatient procedure, correct?
[AGENT][NEUTRAL] I'm not sure. It depends on your doctor, you know, if they're wanting to keep her overnight for observation or something like that and they keep her in the hospital, then that would definitely be inpatient.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, so this is, this is not gonna be an overnight. So they told me, I don't, I mean, for something so expensive, the doctor's like, oh, it takes 20 minutes to do. I was like, you mean like in and out because I've never been in the hospital where it's 20 minutes.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Wow
[CUSTOMER][NEUTRAL] I was like, like that's, that's a lot of money for.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Um, I'm just trying to make sure I cover my bases. Uh, I mean, I've already been collecting quite a bit of the money, but I wanna see if I can try to recoup some of it concerning, you know, I use you guys one, you know, I mean that was the whole point. That was the whole point of purchasing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, I agree with you um like I said, you'll just have to give them the cards if they do not file the claim for you or check on benefits for you, then you will have to file the claim yourself.
[CUSTOMER][NEUTRAL] OK, and then what would you if I had to claim do it myself, do I need to get a receipt? What do I need to get from the from the facility?
[CUSTOMER][NEUTRAL] So I can make sure I pass it along to you guys.
[AGENT][NEUTRAL] You'll need to get an item.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You'll need to go to our our you'll need to get the itemized statement from the facility.
[AGENT][NEUTRAL] And then you'll also need the explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What do you mean explanation? like what do you mean?
[AGENT][NEUTRAL] Explanation of benefits is after the insurance, the primary insurance has paid their part.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] They have something called an EOB explanation of benefits to show what they paid and what uh procedures they paid for, so that will need to be sent in along with the itemized statement and the claim form.
[CUSTOMER][NEUTRAL] OK, so the explanation for my primary and I my statement from the facility and then a claim form from for you guys.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, but I'll get the claim form from you guys when I call, right, or?
[AGENT][NEUTRAL] Yes, um, now you.
[AGENT][NEUTRAL] Well, you, you can do it two different ways if you sign up for our online service center.
[AGENT][NEUTRAL] You can file the claim online.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and let me give you that.
[AGENT][NEUTRAL] Uh, address to go to so you can sign up it's.
[CUSTOMER][NEUTRAL] Oh well I'm, I'm actually driving right now. Would that, would it be on the back of my card?
[AGENT][POSITIVE] Secured
[AGENT][NEUTRAL] Yes, it should be on your card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Secure OK I see what it says.
[AGENT][POSITIVE] Secure. Yes, if you sign up for that online service center you'll be able to do it through there and the claim form will be available for you there.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, and of course if I have any troubles I can always give you guys a call, right?
[AGENT][POSITIVE] Absolutely, yes, and we'll help you walk you through it.
[CUSTOMER][NEGATIVE] Alright, alright, well, it, I mean, I'm not gonna lie because of the facility people that really don't wanna help me out. I've been waiting for just a breakdown of what it cost to get it done and it's been two weeks.
[CUSTOMER][NEGATIVE] And they said they were gonna send it to my email and I still haven't received it.
[AGENT][POSITIVE] Mm, I'm so sorry. Gosh.
[CUSTOMER][NEGATIVE] Uh, at this point I just don't want to see my kid and I just don't wanna.
[AGENT][NEUTRAL] Yeah, I would, I would keep calling them until they do.
[CUSTOMER][POSITIVE] Yeah, all right, well thank you for your time. I do appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, it's no problem at all. I'm glad I was able to help you and maybe get some clarity for you.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Do I still, I mean, is, uh, the outpatient, uh, the outpatient, is it still at [PII] or do I did I already use it?
[CUSTOMER][NEUTRAL] For so far this year.
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Let me check and see if you've used anything for the year of [PII].
[AGENT][NEUTRAL] I'm showing that you have not used anything for the year of [PII] that's been submitted to us so far.
[CUSTOMER][POSITIVE] Alright, alright, well that's good news on my end because I don't remember going myself or the kids. Everything's been routine lately.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] All right, well,
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK, you're so welcome. I hope you have a wonderful day and I hope you.
[AGENT][POSITIVE] Your daughter's procedure goes well for you.
[CUSTOMER][POSITIVE] Thank you so much take care.
[AGENT][POSITIVE] You're welcome. You take care too. You thanks for calling APL.
[CUSTOMER][POSITIVE] Alright thank you bye.
[AGENT][NEUTRAL] Bye-bye, [PII].