AccountId: 011433970860
ContactId: 74bcf3cf-1461-4cd2-97f1-ca1660a5566d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1098849 ms
Total Talk Time (AGENT): 618767 ms
Total Talk Time (CUSTOMER): 474177 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/74bcf3cf-1461-4cd2-97f1-ca1660a5566d_20250310T13:14_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] Hi, [PII]. My name is [PII], and I just have a couple of questions about the service that I've enrolled into.
[AGENT][NEUTRAL] OK. Well, I can help you with your benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can say where's my card?
[CUSTOMER][NEUTRAL] The API card.
[CUSTOMER][NEUTRAL] In your purse. I'm sorry, I'm at the hospital, so I'm
[AGENT][NEUTRAL] Oh, you're fine. I can look it up with your social too if you want.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, don't worry about [PII]. [PII].
[AGENT][NEUTRAL] You wanna do that? OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Are you cold?
[CUSTOMER][NEUTRAL] So it's cold in here.
[AGENT][POSITIVE] That is so funny that you just said that because my window, I was about to say yes because.
[AGENT][NEUTRAL] My window is open. I thought you were talking to me. I was gonna say yes. I'm about to close it.
[CUSTOMER][NEUTRAL] Yeah, it was cold in here.
[CUSTOMER][NEUTRAL] Uh, we're in the hospital and it's cold in here.
[AGENT][NEUTRAL] Oh my God, that is, I literally just looked over at the window and you said, are you cold?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me find out you in here too at the same hospital.
[AGENT][NEUTRAL] Hold on one second, it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][POSITIVE] Thank you, and then just your um mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I'm just waiting for your benefits to come up here. And um, so your policy is broken down into like inpatient and then outpatient. So, inpatient is after admission. Did you want to, you want me to just give you everything?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] So for inpatient, once you're admitted, the policy will pay up to $3000 per calendar year.
[AGENT][NEUTRAL] So whatever, um, so this is your secondary, so they'll bill your primary first, primary will apply and then as long as they have um your policy number with us and everything, they'll go ahead and bill us the hospital will bill a second and then whatever is left over up to that 3000, um we can, we can pay towards your claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there's no deductible except for the emergency room. If there is an emergency room visit, it's a $300 deductible per occurrence. Occurrence is anything with the same.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, related issues. So if you go for the shoulder, you won't have to pay another emergency room deductible for the shoulder again, but if you go for your, excuse me, for your knee, that's another occurrence, you know, because it's a different body part.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then your outpatient would pay up to $1000 per calendar year, so that's, um, the emergency room, urgent care, if there's like any outpatient surgery or anything, um, diagnostic test and maybe if you need an MRI or um some type of testing, diagnostic, X-ray, CAT scan.
[AGENT][NEUTRAL] Um, you also have mental illness, um, and outpatient facility treatment, physical therapy, ambulance. You also have the independent lab riders, so if you have to go to like,
[AGENT][NEUTRAL] Lab cou diagnostic. You have some coverage for that too.
[CUSTOMER][NEUTRAL] I'm gonna have to call. Hold on a moment and I'm gonna have to reach out to them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm sorry, go ahead.
[AGENT][NEUTRAL] Oh, no, you're fine. Um, that's pretty much all the benefits. So we apply to your deductible, your co-pay, and your co-insurance of coverage charges after your primary insurance. So if you have to pay like a deductible, I mean, if you have to pay a co-pay, well, your deductible too, but if you have to pay like a co-pay upfront, once we get that claim on the back end, you could be reimbursed for that or something, you know, still owed to the hospital or wherever after the primary, we could pay towards that or both.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Uh, indemnity.
[AGENT][NEGATIVE] Uh oh, it's, it's breaking up again. Say that one more time.
[CUSTOMER][NEUTRAL] The hospital indemnity.
[AGENT][NEUTRAL] No, you don't have hospital indemnity with us. This is like a second, like a gap policy.
[CUSTOMER][NEGATIVE] What do you mean I don't see that's what's confusing me. This is the 2nd policy that I've taken that out with and then they say I don't have it.
[AGENT][NEUTRAL] Well, you don't, let me see, hold on. Yeah, this is the only
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So you only have this one policy with APL, you've had it since January of this year, but this is the only one we have for you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so I had the policy I took out was where I was, if I was to go into hospital, they would pay me for each day that I was in there, but you're saying I don't have that either with you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, that sounds like hospital now that does sound like hospital indemnity and hospital confinement like a daily hospital benefit, that that's what that sounds like, but no.
[CUSTOMER][NEGATIVE] I see, I took it out with you guys. I wouldn't pay $46 for just this.
[CUSTOMER][NEGATIVE] That's what I'm saying, cause I'm looking, I look on my check stub and it's what I'm paying for it. It's coming out to like $40 something dollars a month. And then I took it out also with Chu, and they're saying I paid for life insurance, but on my check stub, it's coming out for a hospital day. That's what it's titled and they're saying I don't have it with them either. I have life insurance with them. But both of them were supposed.
[AGENT][NEUTRAL] So this
[AGENT][NEUTRAL] This is $444.86 is your premium. Um, now you're on um payroll deduction, so it, so your job takes it out your payroll and then they pay us. I don't really know what it comes up as because we don't take it out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, that's what it's coming up as, but when it breaks down, yeah, when it breaks down on my stuff on, on there, it does show the hospital part.
[AGENT][NEUTRAL] The hospital
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is what I took it for, so that I would be paid while I was in here, in the hospital.
[CUSTOMER][NEGATIVE] But now I'm being told that this one doesn't cover me while I'm in the hospital either.
[AGENT][NEUTRAL] Well, you are.
[AGENT][NEUTRAL] No, no, no, OK, so the difference between, OK, so the hospital indemnity policy, that I don't want to say that's not what you want because if it is, then it is, but that's more like a limited policy. This
[CUSTOMER][NEUTRAL] OK, maybe I don't get it. Maybe I'm, I don't know, maybe I'm confused. This is my first time taking it out, but I know when I took it out, that's what I was trying to make sure that I had and they were like, that's what that is when you're in hospital, you will be covered, you know, you'll be, you'll receive uh a separate, you know, if there's any money owed additional they will cover it and I'm like yeah but you always hear that you will get paid for each day that you're in hospital, you know, you can still get covered for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And I'm like, OK, that's what I want, and they're like, that's what this is. It's like a gap, a coverage that will cover you while you're in the hospital, you'll get paid for each day, but now you're saying that's not what that is.
[AGENT][NEUTRAL] So yes and no. Hospital indemnity and the meddling policy, they're, they're similar, but they're not this, so the hospital indemnity, yes, it does have the daily hospital benefit, but hospital indemnity has way less benefits than what you have. You have benefits for if you're in the hospital and out.
[AGENT][NEUTRAL] Patient. Hospital indemnity won't cover you for all of this. So it versus the, the deal, so let's say, OK, so like a hospital indemnity policy might say, OK, we'll pay you $50 a day for every day that you're in the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But if you're in the hospital, $50 you know, $50 it is daily that you're getting paid, but $50 might not really help. It's a hospital bill. I don't know how much $50 you know what I'm saying, how much that will help cover, but you, you on your policy, you have $3000 for the year. So I mean unless you go to the hospital a lot, $3000 for one year, that's usually a lot of money to use for in hospital.
[CUSTOMER][NEUTRAL] Right, not much, right, right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You see what I'm saying? So it's no, it's not a hospital indemnity policy, but the benefits that you have are better than the hospital indemnity policy. So, I don't want you to feel like you don't, like you're not getting your money's worth because $50 it may be, yes, $50 will pay or even $100 will pay you every day, but it's still not more than $3000 towards, you might get a bill that's $1500 just from signing your name on the paper.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] I mean, it's just true because it's just expensive. So, right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] To go to the doctor's period. So I guess my concern is like, OK, so I came in on [PII]. Today is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And I'm trying to go home today, but I guess I'm just trying to figure out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Am I gonna be
[CUSTOMER][NEUTRAL] Swamp with bills. You see what I mean? I want, uh.
[AGENT][NEUTRAL] Mhm. So the best thing to do when um when they ask you for your insurance card, did you give them this this card as well, your Medlink card?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I believe well I added it to my um my chart at the the my chart at the hospital for my my profile so I added it to it but I don't know if they ran it so I didn't know if I needed to do like a separate upload if I need to get the the bills or that's why I guess I was kind of calling you because I don't, I've never done this before this way.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I would, you know how when the registration ladies come in and check your, your wristband and all that stuff, ask them, because when, make sure it's registration though, ask them what insurance cards do they have on file for you. And if they say they only have your primary, give them your Medlink card while you're there, so they can go ahead and make a copy of it and put it on your.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So then when all the bill after your discharged and all the bills come out, they're gonna go ahead and send everything to your primary first. Primary is going to apply and then if they have our information on there, they'll send it directly, they'll send it straight to us as second. If we're not on there, then yes, you will get bills.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Mm yeah, I don't want that.
[AGENT][NEUTRAL] Only because it's a, yeah, so just make sure they have it on file so that you don't, it'll skip you.
[CUSTOMER][NEUTRAL] OK, so alright, so then my next question is, when I get out of here I'm still going to be, I'm not going back to work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not able to go back to work. I'm gonna be in physical therapy and things like that are you guys able to assist with that?
[AGENT][NEUTRAL] Uh-huh. So for your physical therapy, if it's going to be in a physical therapy facility like an outpatient facility, then um that comes out of your outpatient benefits which pays 1 up to $1000 per calendar year. Um, let me see if physical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one doesn't have some of the policies have like a max of 30 days per calendar year that it'll pay for like physical therapy, but I don't see that on here. So it'll just be, we'll pay up until that $1000 is used for the um for the year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You see, I'm not gonna be able to drive. I had surgery on my spine and I had surgery on my neck, so they're coming to me.
[AGENT][NEUTRAL] Oh, so it'll be in home?
[CUSTOMER][NEUTRAL] So how
[CUSTOMER][NEGATIVE] Yeah, they'll be coming to me. I'm not gonna be able to drive.
[AGENT][NEUTRAL] It depends. Um, I don't know how that would it depends on the coding.
[AGENT][NEUTRAL] It could still be considered physical therapy. They, you know, ah, that's hard to say because of the coding. I don't think there's separate coding for in in home. It would just be whatever that code is for the physical therapy. So in that case, I would still make sure that they have the insurance information so they can go ahead and bill us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I don't want to say no, um, because I don't know how it's going to be coded.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause you do have physical therapy benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, they've already come around and have it set up for starting this week. So I was supposed to have gone home yesterday, but I had a pretty bad night, so I just stayed and um they're coming through. That's what she just came by just now for a discharge. So that's why I kind of calling now to make cause you guys are closed over the weekend, so I couldn't really ask these questions.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I guess I just kinda wanted to know is there something I need to do while I'm here or do I, because when you go online, it just tells you to upload and file a claim online and I'm like, I don't have a clue about uploading nothing or no online nothing.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] You, you, the only thing that I would say for you to do is to just make sure that they have us on file as secondary, um, because you do have the option to file a claim on your own, but if they have all the information, the facility usually does it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't, outside of that, there really isn't anything else in terms of the claims. You just need to um make sure they have our ID card and then on the back is our phone number. So if they need to call and verify benefits or anything, we can verify with them so they know what you have as far as coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, cause yeah, I did send it to them up at the hospital. They had me take a picture of the front and the back of the card, and she's like, OK, well, we'll add it and see if we can use it, but they never said anything. So I didn't, I didn't know what happened from that point on. And then when I went online, everything made it appear as though it was something me as a customer I had to do, you know, as far as filing a claim. So I didn't know if maybe I was like, well, just leave it alone and wait until I was trying to get it done.
[AGENT][POSITIVE] Oh good.
[AGENT][NEUTRAL] I could talk to [PII]ody.
[CUSTOMER][NEGATIVE] Yeah, I was trying to get it set up before I came in hospital, but I just wasn't getting any response.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. Well, yeah, I would definitely make sure they have our information on file and since you've already gave it to them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I would ask them, um, do they need to verify coverage or anything. A lot of times because APL or American Public Life, they think it's life insurance, but it's not, it goes with the UnitedHealthcare. So if they need help understanding the benefits or something, tell them to give us a call so that we can help them with the billing so you don't get.
[AGENT][NEUTRAL] You don't, so you don't get the bill. Yeah.
[CUSTOMER][NEUTRAL] Kit for it. I might call down the registration while I'm still here and just make sure they have it on file.
[AGENT][POSITIVE] Yeah, definitely call the registration.
[CUSTOMER][NEUTRAL] OK, alright then.
[AGENT][POSITIVE] And if, if you have to give this [PII] number, it's, it's totally OK to do that, providers call all the time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright well I will more than likely do that right now when I get off the phone with you I'll get the number for registration and give them a call and just make sure they have the um the APL information on file.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Alright well thank you so much and you feel like what I have is the best as far as additional help.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah, because even though it's not, it doesn't literally have a daily hospital benefit depending on what amount that was, yeah, you're getting paid every day, but is it helping?
[CUSTOMER][NEGATIVE] OK, cause a lot of people are like, well, you know, I went in the hospital and when I came out, I got a check for like $1000. They pay me this much a day. And I'm like, OK, well I need something like that, you know what I mean? And then I was like, well, I thought that's what I set up, but everybody I called was like, no, you don't have that. And I'm like, when you said that, I said, oh no, not again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Oh, I was like I'm tired of paying for stuff and I'm still not getting no type of, you know, comeback, no give back. I'm not getting nothing out of the deal.
[AGENT][NEUTRAL] Be, mhm.
[AGENT][NEUTRAL] Did you have to pay like a co-pay or anything when you when you got when you came, oh, this is for a surgery though, right?
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Well, it still could be a copay.
[CUSTOMER][NEUTRAL] Yeah, I had surgery.
[CUSTOMER][NEUTRAL] Yeah, I had a surgery. I had surgery on the [PII] and then I had another one right after, like on the [PII]. They had to go back in on the [PII].
[AGENT][POSITIVE] Oh yeah, I would definitely send that in.
[CUSTOMER][NEUTRAL] So I would you
[CUSTOMER][NEUTRAL] Would you be able to see any of that if they did use it? Or no, too soon?
[AGENT][NEUTRAL] Wait, wait, say that one more time, would I be able to see what?
[CUSTOMER][NEUTRAL] Would you be able to see if they filed a claim or is it too soon?
[AGENT][NEUTRAL] Oh, it's too soon. They can't file until after you discharge, it's gonna be a couple of days for the bills to generate.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] And then they're gonna send it to UnitedHealthcare.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Alright then, well, I will, like I said reach out to registration right now and just make sure that they have that information on file, and if they don't, I will update it with them so that when they are ready they know who to send the bills to and if they send me if they send me 50 cents afterwards, I'll be happy because everybody always talking about they get money back. I'm like, I ain't never had nobody send me nothing. I'm always paying them.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] So I was trying to see why, why I can't win.
[AGENT][NEUTRAL] Yes, ma'am, and make sure, well, they're gonna file it, so they'll have the explanation of benefits from United Healthcare. So if you do, if you do have to pay a copay, deductible or whatever, then we'll see it from United Healthcare's explanation of benefits, that's how you're reimbursed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright then.
[CUSTOMER][POSITIVE] Alright, Ms. [PII], thank you so much for your explanation. No ma'am, you kinda gave me a better, you gave me a better understanding because I was really confused as you could tell.
[AGENT][NEUTRAL] All right. Well, was there anything else?
[AGENT][POSITIVE] Well, you're very welcome.
[AGENT][POSITIVE] Well, I'm glad I was able to assist you and thank you so much for calling APL. I hope you have a happy heal and get some rest, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you. All right. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.