AccountId: 011433970860
ContactId: 53abad53-9663-4e2c-96d5-c4ecd25dd035
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643760 ms
Total Talk Time (AGENT): 246688 ms
Total Talk Time (CUSTOMER): 236419 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/53abad53-9663-4e2c-96d5-c4ecd25dd035_20250603T17:39_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'm hoping I'm getting myself really confused, but I'm an an employee and um I'd like, well, can I give you my group number and verify myself so you can pull up my coverage.
[AGENT][NEUTRAL] Sure, you're calling from the group or you have an individual policy?
[CUSTOMER][NEUTRAL] Uh, both, but so I'll speak for myself, the individual policy.
[AGENT][NEUTRAL] OK, and may I have your name and your policy number?
[CUSTOMER][NEUTRAL] [PII] and it's 24214.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] We just spoke earlier. OK. Hi.
[CUSTOMER][NEUTRAL] Oh, OK, good, thank you. I thank you. I'm surprised I got the same person. Uh, I don't know. I spoke to two people there, so one of them I got hung up on, so I don't know were you the one that that I get to the end of the conversation with?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And, um,
[AGENT][NEUTRAL] Mhm. I'm, I'm [PII]. Um, yeah, hey.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh hi [PII] sorry thank you.
[AGENT][POSITIVE] It's OK. You're welcome.
[CUSTOMER][NEUTRAL] Um, I called
[CUSTOMER][NEUTRAL] I called UnitedHealthcare again just to make sure it fell under durable medical equipment, and they said we have a separate section just for hearing aids. They don't consider it a DME. They said it's got its own coverage. So now I'm going back to APL to see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] How that works because you said it's durable medical equipment, they said that that's not in their opinion, durable medical equipment, but we have coverage.
[AGENT][NEUTRAL] Right, so let me um hold on one second because my computer froze when you were given the policy number. Let me um get this back up. Hold on one second, I'm sorry. But basically your United Healthcare policy and your APL policy, we work together, but there
[CUSTOMER][POSITIVE] OK thank you OK.
[AGENT][NEUTRAL] Each policy has its own coverage. So it might be one thing for UnitedHealthcare. It could be covered for UnitedHealthcare and something that's not covered on your secondary because there's two, there's two different policies and two different sets of coverage. So I can double check.
[CUSTOMER][NEUTRAL] No, I understand that, yeah.
[AGENT][NEUTRAL] Um, for you just so we can get some clarity. And can you repeat that um policy number for me?
[CUSTOMER][NEUTRAL] Yeah, cause
[CUSTOMER][NEUTRAL] Sure 24214.
[AGENT][NEUTRAL] Oh, this is the group number. OK, hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and since it's a new call, I just need you to um verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII] and address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], do you mind if I place you on just a brief hold? I'm just gonna pull up the, um, actually it just came up. I might not have to use hold. Just trying to get to the claim so I can see the.
[AGENT][NEUTRAL] Let me see, hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so you wanted to know if the hearing aid is covered. Oh, you talk with [PII] also, OK.
[AGENT][NEUTRAL] Yes it's a lot.
[CUSTOMER][NEUTRAL] I got disconnected one time so I didn't get very far, yeah.
[AGENT][NEUTRAL] So we're just trying to see if hearing aids are covered on your policy.
[CUSTOMER][NEUTRAL] Yeah, because I, I, they don't, they don't necessarily, she said that they don't they don't fall under UHC section for DMEs. They have their own section in the policy, so they have their own benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She said so DMEs for them are other types of devices and she read off the list and I don't remember what they were but I know that you I just it's very important because I don't wanna get stuck with the, you know, a bill that I didn't know so I'm trying to figure it out beforehand.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, OK, and I think we, because I don't see any notes on here from me, so I think we probably spoke about someone from the group. I just remember your name, um, but I'm pulling.
[CUSTOMER][POSITIVE] Oh, it's easy to remember.
[AGENT][NEUTRAL] So I'm pulling up the um policy benefits now and just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Do you mind if I place you on just a brief hold so I can go over your um policy and the benefits?
[CUSTOMER][POSITIVE] Sure. Sure, thank you. And I do have a diagnosis and a procedure code if that helps.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Um, she put it in the notes, but I don't need it for the coverage because we don't go by the codes.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let's see how this works. Let's see.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. OK, so for the definite answer, you do have durable medical equipment on your secondary policy. So, um, your policy pays up to $4000 a year for outpatient expenses. So whatever claims come in this year, including for the hearing aid, it'll all will pay out up to that $4000 a year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your durable medical equipment though, like it would have to be um non-disposable, um, I mean things like that, but you do have coverage. So just make sure, well, I don't know that a hearing aid.
[CUSTOMER][NEUTRAL] Yeah, but see, UHC isn't considered, yeah, but you see that here's all the confusion. UHC isn't considering it durable medical equipment they said it has its own policy benefit, not it own policy, but it's own benefit.
[AGENT][NEUTRAL] Well, that doesn't
[AGENT][NEGATIVE] That doesn't matter. As long as UnitedHealthcare covers the the hearing aids, you're fine. If United Healthcare said, oh we don't cover hearing aids, then it's a problem because we a second can't apply anything.
[CUSTOMER][NEUTRAL] Oh, however they however they cover it, whether they cover it as a DME or not, now that we have the DME you will cover it.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Yes and no. So, basically, as long as they cover the hearing aids, whether, no matter how they categorize it, we just need them to cover it so that us a second can apply your benefits for our policy too. So if they cover it, it's just they're just gonna bill UnitedHealthcare, UnitedHealthcare is going to apply, you know, whatever, based on that policy, and then if something is left over, they're gonna send that to us so that we can apply up to that 4000 or, you know, whatever the balance is after primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, and then so what just so I understand because I'm also the benefit administrator so it helps me understand this is the first time we've had a DME um writer so if we didn't have the DME writer and because you consider those a DME equipment then it then APL wouldn't have even though UHC covered it. APL wouldn't have because we didn't have the writer and that's how you consider it, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Exactly, and, and APL has its own policy coverage or benefits is what I'm trying to say, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I understand. OK, it's just, it just helps me because I'm, I'm the benefit administrator, so I have to make decisions when we do renewals and how our employees use things and so that's, that's good for me to understand. So, OK, that's, that's good to know. I that that helps because I'm like, well if they don't consider this and you do, does that matter even though they're covering it and I was always understood that as long as UHD covers it, you will, although you consider a DME, we would have to have that writer, which is fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, as long as I understand that correctly. OK, thank you I appreciate you helping me. It helps. I've been trying to figure this out for some time and I just wasn't sure if I was getting it. OK, sounds good thank you very much.
[AGENT][NEUTRAL] You got that.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, you were very helpful. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a good day.
[CUSTOMER][NEUTRAL] And you too bye