AccountId: 011433970860
ContactId: 5e1c2ff7-292e-4c8e-8ef0-e3eb8f56db1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575210 ms
Total Talk Time (AGENT): 233379 ms
Total Talk Time (CUSTOMER): 366648 ms
Interruptions: 9
Overall Sentiment: AGENT=0.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/5e1c2ff7-292e-4c8e-8ef0-e3eb8f56db1d_20250513T20:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Yeah, thank you for calling me.
[CUSTOMER][NEUTRAL] Hi, good afternoon. Um, yes, I have a question. I'm currently in.
[CUSTOMER][NEUTRAL] The hospital and
[CUSTOMER][NEUTRAL] I just wanna see how this works because.
[CUSTOMER][NEUTRAL] Uh, yeah, so anyway, uh, I was admitted, uh, yesterday, um, but I think they admitted me on an observation. You know, it's for, um, kidney stones, and they're gonna do a procedure to remove one of the kidney stones tomorrow. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, my primary insurance is Blue Cross Blue Shield is how does it work with the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know that I've been here for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A couple of days. How does that work?
[AGENT][NEUTRAL] OK, I can, I can go ahead and go over your benefits and tell you how it works. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Absolutely sorry I probably led with the wrong stuff um yeah it's [PII] and it's [PII] is the phone number. What else did you want?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Um, do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Oh, policy number, yeah, um, it's the group ID is that, is that what you're looking for?
[AGENT][NEUTRAL] No, the number in the bottom where it says inpatient or outpatient er number. Just give me one of the two.
[CUSTOMER][NEUTRAL] Uh, OK, well, it doesn't say inpatient, it says in hospital, but um, it's, uh, that one is uh 0232.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 3310.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry.
[CUSTOMER][NEUTRAL] 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, and Mr. [PII], um, may I have your date of birth, mailing address and email address for verification for security?
[CUSTOMER][NEUTRAL] Yeah, [PII], uh, mailing address is [PII] and the email address is [PII] unless you have [PII]. I can't recall.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh no, we have the, the first one is good. Thank you. All right. OK. So you have one of our secondary supplemental plans for the major medical and you said you've been in the hospital, um, more than 18 hours now, correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, right, but I, I came into the ER and then they're keeping me because they're gonna do this procedure, but I've been here.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Definitely more. I've already been here more than 18 hours, so is it matter if, if it's if it's an, not an out patient but um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Observation. Yeah. Mhm.
[CUSTOMER][NEUTRAL] An observation hold or?
[AGENT][NEUTRAL] Yeah, I can go ahead and just give you, yeah, yeah, I understand. It's OK. Um, so, Mr. [PII], um, let me give you the benefits, and this is not a guarantee of payment, just a verification of coverage. Now, um, with this policy, whenever you are in the hospital, 18 hours or more, either admitted or in observation is considered under the inpatient or in-hospital benefits, OK? Mm OK.
[CUSTOMER][NEUTRAL] Yeah, you know what I mean?
[CUSTOMER][NEUTRAL] Oh OK, oh, that's, that's, that's, that's what I'm looking for. OK, got it.
[AGENT][NEUTRAL] All right. So then that will be that $5000 per occurrence benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so whatever the primary insurance does not cover, and I think in this case they're only they may only charge the copay, uh, which would be the in the ER copay, OK, so, so it's even if it's uh observation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, hold even if it's for like 48 hours, they, it's, it's still considered in hospital is what you're saying, 18 hours.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm. Correct. 18 hours or more either in observation or admitted. It's gonna be outpatient, inpatient, I'm sorry, inpatient benefits, which is the 5.
[CUSTOMER][NEUTRAL] Oh, that's, that's
[CUSTOMER][POSITIVE] That's actually extremely helpful and.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I, I've never heard of, uh, the observation hole, which she, she told me was some kind of a, um, you know, originally like a Medicare thing, but, um, because they held, you know, they kept me, but uh I guess admitted me under the observation rather than inpatient. So, yeah, OK. So hopefully this kidney stone gets taken out tomorrow morning and then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Conservation, mhm. Yeah. Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I think they're gonna
[CUSTOMER][POSITIVE] Let me go. No, that's actually very helpful. I hate that I have to worry about the, the, the funds part, but this, this is, this is, uh, gives me a lot of relief already, so.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah. Mhm.
[AGENT][POSITIVE] Yeah, I'm glad, yes, but yeah. You're welcome. Yeah, do you have any other questions about any benefits or anything else?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] No, and it's, uh, when, when it does go to 1818 hours it's, it's per confinement, right? Like it's per it's not per day it's per, uh, they up to up to and including what what the um what the primary insurance does not pay for that's what it is, right?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK. It's per occurrence. The, the way this one works, Mr. [PII], is, um, if it's related to the same treatment or condition, it needs to be separated by 90 days for us to pay again that $5000 for inpatient. Uh, now, anything that happened during that, yeah.
[CUSTOMER][POSITIVE] Got it. OK, that's helpful too.
[AGENT][NEUTRAL] Anything that happens during that one-time admission or observation 18 hours or more is gonna be paid out of that $5000. So basically what we do is we help with the deductibles, co-payment, and co-insurance, um, you know, the major medical aid is gonna apply those towards any balance that is remaining. So that's what we pay. It's gonna be the deductibles, co-payment, and co-insurance. So you have up to $5000 for us to help you with that.
[CUSTOMER][NEUTRAL] Got it. OK, so within the what did you say you said 30 or 90 days for, uh, the same, the same, OK, so right, I got you, yeah, they know I was here last week for the same thing because.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 90 days, 90 days.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] They um thought it would pass on its own and it didn't so OK so the when I was here last week it's, it'll be all wrapped up in that 1 $5000 piece right is what you're basically what you're saying is it's kind of.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm, last, last week, let me ask you a question, Mr. [PII]. Last week, did you stay overnight or it was just in and out?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEGATIVE] I did, because they, that was the, the, the, it was bad and they were.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hoping they would do a procedure, but then.
[CUSTOMER][NEUTRAL] They so they kept me over and then the pain kind of subsided, um, and then they said, well, hopefully it'll pass on its own and then um I, I, and then they said, OK, we'll come back if it hasn't and um uh and so the pain kept coming back and I came back um the following Monday. Thank you very much, um, the following Monday, which was yesterday.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh.
[AGENT][NEGATIVE] Gotcha.
[CUSTOMER][POSITIVE] So then they said, OK, well we're, it's, it's, it's lodged, so we're definitely gonna take it out. Thank you very much. Oh yeah, uh, yes, that's me, yeah, thank you very much, [PII], yeah, um, so.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So yes I was kept over uh last Tuesday released Wednesday, so 56 to 57, and then um I came in yesterday and they're gonna keep me till uh tomorrow they're gonna get this procedure done tomorrow and then let me go. So is that sort of where that 90 that about 5000 is that 15,000 that they would up to up to 5000 up to 5000.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm. Mhm. After $5000. Yeah. Yeah. So that, yeah, that is correct. Yeah, if you, if you stayed uh like a week ago or 2 days, 3 days ago for more than 18 hours, and now you're staying again more than 18 hours, it's all gonna be combined to that 15,000. And then after that, you have to wait 90 days. OK?
[CUSTOMER][NEUTRAL] Yep, no, that's fine.
[CUSTOMER][POSITIVE] Yeah, no, that's fine, and but it, but it's, it would only be if it, it would only be if they, they charged me, um, or the uh primary insurance didn't, uh, didn't cover you, you know what I'm saying, so if they only charged me 300 or something then yeah OK um alright well that's great well that's actually very helpful um I've never used this before so uh other than for outpatients, so I, I appreciate it.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The whole thing or. Yeah, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK. You're welcome. All right. Is there anything else I can help you with today, Mr. [PII], before I let you go?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] No, no, you reassured me. Thank you very much.
[AGENT][POSITIVE] You're welcome and I hope everything goes well. Have a good afternoon, Mr. [PII].
[CUSTOMER][POSITIVE] Yes, thank you very much OK bye.
[AGENT][POSITIVE] You're welcome bye bye.