AccountId: 011433970860
ContactId: 54c4c378-7f08-4c2c-902a-ff4ae2dde1da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433929 ms
Total Talk Time (AGENT): 217816 ms
Total Talk Time (CUSTOMER): 200793 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/54c4c378-7f08-4c2c-902a-ff4ae2dde1da_20250314T17:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ACL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], um,
[CUSTOMER][NEUTRAL] You know, probably.
[CUSTOMER][NEUTRAL] You're gonna have to educate me here. Um, I'm not sure how the APL works, but let me just tell you what's about to happen. Um, I got a little skin cancer, basal cell on my nose, and they're gonna have to go in and remove it. And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, they called it something MOHs. I don't know something anyway, and I'm just wondering.
[CUSTOMER][NEGATIVE] If they, they said they gotta see if they are subscribed to y'all, is that how that works? Do I need to have this done somewhere else? Because I'm at Austin skin.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Here in [PII], that's who I was gonna have do it because they're the ones who found it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's take a look. What policy number do you have?
[CUSTOMER][NEUTRAL] Is that on my APL card?
[AGENT][NEUTRAL] It should be uh your member certificate number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, policy certificate number 024.
[CUSTOMER][NEUTRAL] 58525
[AGENT][NEUTRAL] OK, let's take a look. um.
[CUSTOMER][NEGATIVE] I just don't know how I'm not good with insurance. I don't understand it. I don't unders I have Aetna. I get that. I file a claim through them, but I don't, I don't know what you do. OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right. So let me just verify, please, your name, date of birth and address.
[CUSTOMER][NEUTRAL] OK, name is [PII]. Date of birth is um [PII]. Address is [PII].
[AGENT][NEUTRAL] OK, thank you so much. All right, so what you have with us um is a secondary policy. So the purpose of a secondary policy is to bridge the gap between your primary
[AGENT][NEUTRAL] And this in hopes that when you have procedures done, that there's no out of pocket cost. So,
[CUSTOMER][NEGATIVE] Well I didn't happen last time because I had a, I had a, I had a deviated septum last year and I had to pay like $2600.
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] I don't know what happened there.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] And I use somebody on their plan on Aetna's plan.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Apparently didn't cover all of it so I had to pay a chunk of change that I was not expecting.
[AGENT][NEUTRAL] So your out of pocket maximum for the year is 3000, so the plan isn't gonna pay um anything over that, so like in regards.
[CUSTOMER][NEUTRAL] Is this APL or?
[AGENT][NEUTRAL] This is APL. This is APL. I'm not yeah I'm not gonna give you any information on Aetna because I know nothing on that.
[CUSTOMER][NEGATIVE] I'm confused.
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great, thanks.
[AGENT][NEUTRAL] So whatever you had done last year, um, it paid out the full amount, um, and then, you know, if there's anything remaining.
[AGENT][NEUTRAL] You know, that would be then up to the doctor um if they're gonna bill you for whatever the difference is.
[AGENT][NEUTRAL] So what I generally tell people is the easiest way to use the insurance is to let the doctor you're going to know that you have a secondary insurance. There's not a network required to use your secondary.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] They basically will bill your primary and then whatever your primary doesn't cover, they can bill us for the remaining.
[CUSTOMER][NEUTRAL] Oh, so my doctor could have billed y'all and I didn't have to be out at $2600?
[AGENT][NEUTRAL] I don't know yeah I mean I can't speak on that just because I don't know if a claim was submitted for that. I don't know, you know.
[CUSTOMER][NEUTRAL] Last year.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you ever give them your secondary information? Do you know?
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] So yeah, I mean, I'm not able to know exactly.
[CUSTOMER][NEUTRAL] So you'll only pay up to $3000 a year. You, you only pay up to $3000 a year.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so maybe I'll pay $3000.
[AGENT][NEUTRAL] So for something like.
[AGENT][NEUTRAL] Yeah, so for like something like this, it would be considered outpatient. Um, inpatient's only gonna be if you're in the hospital for over 18 hours or longer. So anything else would fall under your outpatient.
[CUSTOMER][NEUTRAL] OK, so what's my outpatient gonna pay?
[AGENT][NEGATIVE] So your benefit max for the year is the 3000 on your outpatient. We're not gonna cover anything over that, mhm.
[CUSTOMER][NEUTRAL] Oh on outpatient.
[CUSTOMER][NEUTRAL] Got it. Oh, that that is outpatient. OK, so if it, if I'm hospitalized or something, you pay more?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The inpatient, yes, is 8000 for the calendar year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh OK, got you. Alright, so outpatients $3000 and I gotta make sure that they bill y'all for anything that's done outpatient up to $3000.
[AGENT][NEUTRAL] Mhm. Yeah. So, yeah, so they should be able to let you know like whatever you're having done as far as what Aetna's gonna cover.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they should know what the remaining balance is and then they should be able to submit that to us for coverage. Now if the remaining balance after Aetna is $10,000 we're not, you know, we're only gonna cover 3.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect. I get it. You explain things very well. You totally did. I'm not confused. You are so good. You got it. You, you are so good. Thank you. Thank you, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm glad you understand, OK.
[AGENT][NEUTRAL] Yeah, yeah, yeah, yeah, yeah. Yeah. Yeah. So, yeah, no, not a problem.
[CUSTOMER][POSITIVE] I appreciate you
[CUSTOMER][POSITIVE] You're awesome. you, you're in the right job.
[CUSTOMER][POSITIVE] You have, you have a great weekend cause you did not confuse me at all. I followed everything you said and said it so slowly, so I, I absorbed it. Thank you. You're great.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] OK, good.
[AGENT][POSITIVE] OK, good. You're very welcome. You're very welcome.
[CUSTOMER][POSITIVE] Have a, have a wonderful weekend.
[AGENT][POSITIVE] You too, be blessed. Bye bye.
[CUSTOMER][POSITIVE] Bye-bye. Thank you. You too. Be blessed. Thank you. I am. I hope you are too. Thank you. I got the right person today. I was blessed already. Thank you. Bye-bye.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.