AccountId: 011433970860
ContactId: 7be9fcf2-f051-4aec-a3d3-ebceec9059f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 529280 ms
Total Talk Time (AGENT): 316183 ms
Total Talk Time (CUSTOMER): 196508 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/7be9fcf2-f051-4aec-a3d3-ebceec9059f4_20250116T22:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, I just wanted to inquire about the service APL. I wanted to know what this entails, um.
[CUSTOMER][NEUTRAL] I don't, I don't know what this is, so I was just calling to ask about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, and you're calling from a provider's office or do you have a personal policy with us?
[CUSTOMER][NEUTRAL] I have a policy with you guys.
[AGENT][NEUTRAL] OK, alright, and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy number, Miss [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy number is 02583426.
[AGENT][POSITIVE] Thank you. Mm.
[AGENT][NEUTRAL] Alright, and may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Email address is [PII], and the mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. All right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification coverage and that's just a disclaimer. And you have one of our secondary supplemental plan to the major medical. This is to help with the high deductible from your major medical.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, so you have two benefits. Um, one is for inpatient, which is if you're in the hospital 18 hours or more, either admitted or in observation, we pay up to $2500 per year.
[AGENT][NEUTRAL] And then you have an outpatient. Outpatient maximum is 2500 as well. And this is for outpatient facility, including ER visits, um, um, surgery in an outpatient facility or surgical center or hospital.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] You also have benefits for independent life facility.
[AGENT][NEUTRAL] Diagnostic testing in the hospital or freestanding diagnostic center.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um, let's see, um, you also have benefits for doable medical equipment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Man.
[AGENT][NEUTRAL] You also have benefits for, for a treatment in an office. So if they have to do any procedures in the office, those are gonna be considered under this benefit. The only thing we do not cover on the office is the office visit. So, the co-payment for the office visit is not covered, but if they do any like X-rays, injections, ultrasounds, sonograms, anything like that, then uh that is considered, OK? Um, and let's see.
[CUSTOMER][NEUTRAL] So, regarding like uh uh um maternity and birth uh expenses, what will be covered for that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK. So basically, um, for the delivery, it, it will be considered under the inpatient, which is 2500 per year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so that will be it, that would be, so this will be used with my insurance that I have with my employer and then you guys would technically cover the deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so then.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I just have to show both.
[AGENT][NEUTRAL] Yes, at the time of service, you'll go ahead and show both of your cards.
[CUSTOMER][NEUTRAL] OK. And then at the time at the hospital, how would um the child of the birth of a child, um, how would that be added to my insurance? Would that be applied to, to, to that, to her as well, or?
[AGENT][NEUTRAL] Um, we cover the 1st 30 days of birth. After that, um, you need to get in contact with the HR department and see if you want to add the, the child to the policy.
[AGENT][NEUTRAL] Um, but, um, it's automatically enrolled for the 1st 30 days of birth.
[CUSTOMER][NEUTRAL] For the 1st 30 days, she's automatically insured through my insurance and everything will be covered under, under my insurance. So, um I just have a question because there was
[AGENT][POSITIVE] Correct, through this one.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There was, um, this is my second pregnancy, and on the first one, they went ahead and did a um hearing test. And for some reason, that wasn't covered. So I just wanna make sure like if they do that this time around, should I just reject, deny it?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or, or
[AGENT][NEUTRAL] If it's not gonna be covered by the major medical, um, if the major medical don't pay, we do not pay, but usually those tests are considered preventative. We do not cover anything that is preventative.
[CUSTOMER][NEUTRAL] Oh, OK, so you wouldn't cover it.
[AGENT][NEUTRAL] We cover for sickness. Like if there's, yeah, no, uh uh, like if there's a problem if, if, if it's uh if it's a generic or something like that, then yes, we'll consider if it's like a sickness. But if it's preventative, we do not cover any preventative service.
[CUSTOMER][NEUTRAL] Oh, OK. So what should I do then when I'm at the hospital? Should I just, can I deny it, that test?
[AGENT][NEUTRAL] Um, we cannot really tell you what to do, but, um, yeah, I, I'm not sure how your major medical will cover if it will cover or if it will apply towards the deductible. You would check with them first and see if it's gonna be paid by them, um, and then from there you will make a determination, but it is not covered by us if it's preventative, OK?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so then I have to call, like, for example, Blue Cross Blue Shield, which I'm insured with, I have to ask them if they cover it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, if they cover 100% or.
[CUSTOMER][NEUTRAL] Now if they cover it, you guys will cover.
[AGENT][NEUTRAL] No, if they cover 100 if it's preventative, um, they will let you know if it's covered 100%. We do not cover any preventative. So, unless, like I, like I said before, unless it's a sickness, then we'll go ahead and pay if the major medical pays. But if it's preventative, we do not cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basic
[CUSTOMER][NEUTRAL] So basically, in order for me to prove it's not preventative, they have to kind of show me that some, some type of test that they believe, I don't know, there's a hearing impaired.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yeah, it will be due to a sickness, correct.
[CUSTOMER][NEUTRAL] OK. OK. And then other than that, you will cover all the baby services like them being at the hospital and all the tests that are being done?
[AGENT][NEUTRAL] It will cover, um, yeah, I cannot guarantee any payments over the phone. Um, the only thing I can tell you that it will cover the delivery.
[CUSTOMER][NEUTRAL] To, to her?
[AGENT][NEUTRAL] Um, it will cover, um, if she needs to be put in, um, in ICU for any reason that, that, that is part of the benefit, um.
[AGENT][NEUTRAL] So basically those are the only two I can tell you for sure they will cover. The rest needs to come in and we need to see the coding and see exactly what they're charging for in order to give you better information.
[CUSTOMER][NEUTRAL] And then what about her first visit to the pediatrician? When I take her, you said it's covered the 1st 30 days. That will be covered?
[AGENT][NEUTRAL] OK. Again, we do not cover the office visits. So if, if it's just a consultation, like to check the baby to make sure everything is OK, that's considered an office visit, which is a consultation. And that one is not gonna be covered. If they are given like injections like um
[AGENT][NEUTRAL] You know, vaccines, those are not covered under the policy. Those are all part of preventative service, which is not covered by this policy.
[AGENT][NEUTRAL] Again, this policy only for sickness or injury.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then my insurance, they will cover that, right? Or no, you wouldn't know.
[AGENT][NEUTRAL] I will not know because all the insurance are different, um, most of them do.
[AGENT][NEUTRAL] Most of them pay 100%, um, but I cannot tell you for sure. You have to contact them and see if they pay the, the preventative 100% or not.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] OK well thank you for calling APL. Have a good afternoon.