AccountId: 011433970860
ContactId: 62cb7c58-ab60-4e86-abcc-5ea7abe6e3d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512330 ms
Total Talk Time (AGENT): 242680 ms
Total Talk Time (CUSTOMER): 199768 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/62cb7c58-ab60-4e86-abcc-5ea7abe6e3d7_20241230T15:50_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] Oh
[CUSTOMER][NEUTRAL] Um, yeah, I'm calling to see how, how much like the benefit of me using this one, like what the total is, cause um.
[CUSTOMER][NEUTRAL] And I, I also had a question about whether or not like this would help OK cause I'm probably gonna have a procedure done on, on January.
[CUSTOMER][NEUTRAL] So I wanted to see if this would help pay towards that.
[AGENT][NEUTRAL] OK, so you want to know what your calendar year max is like the dollar amount that you have to spend and if it'll cover a particular procedure you're having in January.
[CUSTOMER][NEUTRAL] Yeah, because, um, um, yeah, because, because there's like a gap insurance, right, the APL, um, I don't know if I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let me
[AGENT][NEUTRAL] Um, pull up your policy and then I'll be able to see what type you have, but I'll be more than happy to help you, um, understand the benefits and how it's applied. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[CUSTOMER][NEUTRAL] My middle initial [PII]. Last name [PII]
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And a good contact number and then do you have your ID card with you?
[CUSTOMER][NEUTRAL] Yeah, I'm, yeah, I'm right here my um call back number uh area is 561.
[CUSTOMER][NEUTRAL] 846
[CUSTOMER][NEUTRAL] 9752.
[AGENT][NEUTRAL] And then on the card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Yes, the inhospital benefit sir number is 02.
[CUSTOMER][NEUTRAL] 53
[CUSTOMER][NEUTRAL] 98
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] The letters M as in mother, L as in last.
[CUSTOMER][NEUTRAL] And then number 7.
[AGENT][NEUTRAL] Thank you for that, and I have your policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] And then what was the other thing that you said? My address?
[AGENT][NEUTRAL] Your mailing address and email, yes, sir.
[CUSTOMER][NEUTRAL] Oh yeah, my mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then my email is the letter [PII]
[CUSTOMER][NEUTRAL] Um, [PII]
[CUSTOMER][NEUTRAL] [PII]. So [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, um, this is the Metlink policy, so it is your gap insurance. So we pay towards your co-pays, deductible and co-insurance, um, after your primary, which is United Healthcare.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for this policy, you have, hold on one moment, I'm waiting for it to come up.
[AGENT][NEUTRAL] You have inpatient and outpatient benefits. Inpatient is when you're admitted to the hospital. Outpatient is, it could be like a same day procedure. You, you, you go in the hospital and you come home that same day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you have a $2000 max per calendar year for both the inpatient and outpatient, so $2000 for each.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know what type of procedure you're, um, you'll be having? Will it be outpatient or inpatient?
[CUSTOMER][NEUTRAL] I guess it would be outpatient because one I think is like a colonoscopy and uh like and the costs, hold on, let me see. And
[AGENT][NEUTRAL] Oh, colonoscopy and endoscopy.
[CUSTOMER][POSITIVE] And yeah, and that's OK. I'm sorry.
[AGENT][NEUTRAL] It's OK. Um, so, no, that's fine. So most likely.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] But that, I think that that's considered like outpatient, right? Because I think that's like um you do it the same day and you can go home the same day.
[AGENT][NEUTRAL] Right, so you would have that full 2000 to use for, you still have that full $2000 to use for the remainder of the year.
[CUSTOMER][NEUTRAL] OK, so, and just to verify how it works just because I was calling my insurance and since I have like a deductible, so whatever, like the insurance so they, I'm assuming they run it through the insurance first and get the contractor rate and then whatever if I haven't met that deductible, so you guys kind of pay towards that? is that what I'm understanding like I would be able to use like that.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So once your services, you know, once you have the procedure, the bills are gonna come out. The hospital or wherever it's done is going to bill UnitedHealthcare first. UnitedHealthcare is going to pay, you know, based on their policy, and then they're going to send the remaining balance and the explanation of benefits back to the hospital.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] At that point, the hospital makes sure, you know, when they ask you for your insurance information, you give them this card because once United Healthcare sends it back to the hospital, they'll then bill us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we'll be able to see with that explanation of benefits, what was charged as in deductible copay, you know, your charges.
[AGENT][NEUTRAL] What you paid
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's still owed to the provider. If you pay a co-pay or deductible, you could be reimbursed for it from this policy here with APL or something still owed to the provider, we can pay out, or it could be both, but it's going to be up to that $2000.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then either we would, you know, after everything is processed, either the check is sent to you or the provider or both, and um,
[AGENT][NEUTRAL] If there's anything outside of that 2000, then the provider will have to get with primary to determine responsibility and how that works.
[CUSTOMER][MIXED] OK, but OK.
[CUSTOMER][POSITIVE] Alright, yeah, I just, uh, and then, so this, uh, to end so it would cover definitely help me cover with those procedures right with the colonoscopy and stuff like those are like eligible for to use this.
[CUSTOMER][NEUTRAL] Towards
[AGENT][NEUTRAL] You're saying like do you have diagnostic testing?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, like, like those, like they would qualify as events that I can use this API. I just want to make sure, like, like those are.
[AGENT][NEUTRAL] Um, let me see if your policy specifies. Hold on one second.
[CUSTOMER][NEUTRAL] Cause I was thinking of doing, doing this or and possibly even like a vasectomy, so.
[CUSTOMER][NEUTRAL] Like, are those like all events that qualified towards that I can use this or no?
[AGENT][NEUTRAL] Um, hold on one moment. I'm pulling up all the full benefits so I can see if there's any specifications anywhere.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so that's inpatient let me see for outpatient.
[AGENT][NEUTRAL] Yeah, so there's no specification under diagnostic testing. Um, it just says diagnostic testing in a hospital outpatient facility or MRI facility. So as long as the diagnostic testing is in an outpatient facility, or like if you needed an MRI at an MRI facility, it could be covered up to that $2000 per year.
[CUSTOMER][NEUTRAL] OK, so it sounds like they would qualify, OK.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, that's pretty much it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] OK, you too, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.