AccountId: 011433970860
ContactId: 7caffd6d-8064-432a-b391-368815409817
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549250 ms
Total Talk Time (AGENT): 262482 ms
Total Talk Time (CUSTOMER): 243040 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/7caffd6d-8064-432a-b391-368815409817_20250527T21:15_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name is [PII]. Um, I do have, um,
[CUSTOMER][NEUTRAL] Uh, gap insurance with you guys, um, I have a question, um, because I do have a medical, um, billing statement from [PII] and [PII]. If, uh, if I give that to the, the doctor, will that help lower my, my bill, my statement from the doctor's office?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's take a look real quick. [PII], can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Uh, the number it is, uh, let's see.
[CUSTOMER][NEUTRAL] Is it the payer ID that the one?
[AGENT][NEUTRAL] Uh, no, is there, is there a benefits inpatient or outpatient benefits number?
[CUSTOMER][NEUTRAL] Was it in there.
[CUSTOMER][NEUTRAL] Yes, so there's an inhospital benefit and there's an outpatient benefit hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, either one should work.
[CUSTOMER][NEUTRAL] Um, the, the one that I have, OK, so it is uh 02467218 M as in Mary, L as in Larry, A as in 88 as in number 8.
[AGENT][NEUTRAL] Let me look it up for you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And the address and phone number that we have on file?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, [PII], that's in [PII].
[CUSTOMER][NEUTRAL] In the
[CUSTOMER][NEUTRAL] What else do you need the phone number?
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And have you submitted the claim already and you're wanting to know about adding extra paperwork into it or?
[CUSTOMER][NEUTRAL] Um, no, I have, um, I haven't submitted or I haven't paid the bill, um, but when I called them they said, um, I have to call the insurance first and see if they will, uh, pay the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It looks like the policy number that you gave me because you're talking about uh a service that was provided in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that policy number that you gave me.
[AGENT][NEUTRAL] Is a lapsed policy and I do have your active policy number that you will want whenever you're filing for that claim, um, are you ready for that policy number?
[CUSTOMER][NEUTRAL] Um, yeah, let me get a pen and paper. Hold on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this will be because I was just, I was hospitalized uh two weeks ago so um uh is the, the policy number, uh, that you're gonna give me both for uh outpatient and uh inpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it looks like it's going to be relatively the same um any time you get a new policy number it's typically just because there there could be any type of change, minor or significant change to your policy we have to issue you a new policy number um and since that date of service is within this range.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, because this policy that I'm about to give you start it's effective date was [PII], and it's currently active, so that's the one you're gonna want to file under, um, and I can check and make sure that the benefits are the same as well, um, we can go over that in a moment. Um, did you get a pen and paper? OK, it's 02.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 51
[AGENT][NEUTRAL] 9455.
[CUSTOMER][NEUTRAL] OK, so let me repeat 0251.
[CUSTOMER][NEUTRAL] 9455.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is your policy number for this one,
[CUSTOMER][NEUTRAL] So, so the
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You wanted your outpatient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I would like to remind you that this is gap insurance so you will need to um file the claim through your primary insurance provider first um and you'll need to provide whenever you submit this claim you'll want to provide the explanation of benefits or you might see it as EOB you'll need to uh send that in with this claim from the primary showing that they paid um some amount towards.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Your claim, um, so if your primary insurance denies the claim, this one won't cover it, um, it has to be some benefits have to be paid through the primary first.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] So let me see about your benefits.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, they did, they did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah send that EOB in or if you didn't get one I would ask them to mail you or email one to you.
[AGENT][NEUTRAL] OK, and this is a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your outpatient benefit maximum is up to $2,025 per plan year meaning from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then so on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like you have an outpatient.
[CUSTOMER][NEUTRAL] So the maximum is how much.
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] OK, so that's per plan year so that's when the plan started mhm.
[CUSTOMER][NEUTRAL] Uh, so the outpatient, what is?
[CUSTOMER][NEUTRAL] OK, it was [PII], and then you said the outpatient for the max maximum outpatient is how much again?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] $2,025.
[AGENT][NEUTRAL] And so when it when you see something that says plan year it's from the year starting it's from the month that you started for one year to the month of the next year.
[CUSTOMER][NEUTRAL] $5 OK.
[AGENT][NEUTRAL] So it's not going to be January [PII] to December for you for this policy.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so it's always [PII] until the [PII]. OK, OK. And then, so what, so should I go ahead and fax this, this, the EOB plus a statement from the doctor?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, did you get an itemized bill at all that had procedure codes or diagnosis or your hospital admission? OK, OK, you want to send all of that in?
[CUSTOMER][NEUTRAL] How does it work?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the hospital, not OK. So actually this is from November. This is from the doctor's office, uh, as an outpatient, um, the one that it was two weeks ago, I haven't got, I haven't received those.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK, yeah, go ahead and send everything in that you've got so far, um, and then whenever you were admitted that can be a separate claim.
[CUSTOMER][NEUTRAL] Because it was just 2 weeks ago, yeah.
[CUSTOMER][NEUTRAL] Mhm yes.
[CUSTOMER][NEUTRAL] OK, so, um, I see here a fax number of [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, just fax it over with and then just include the policy number of uh 02519455.
[AGENT][NEUTRAL] Yes, you'll want to submit it under that claim because that's when the policy was active mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, what about for, yeah, so for this year since like what I said, I just, I was hospitalized two weeks ago, um, same policy number that I'm gonna use once I receive the statement and the EOB, am I right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and we also don't have timely filing so if it takes a while for it to get to you, I know that's not ideal, but we don't uh deny claims just for how long it's been as long as your policy was active during the date of service, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, got it. OK, OK, well thank you.
[AGENT][NEUTRAL] Because I know sometimes it takes a while to get to get everything ready, so.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, correct. OK, got it. OK, I'll go ahead and fax fax over whatever I have.
[AGENT][NEUTRAL] Alright, and is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you.
[AGENT][POSITIVE] Great thank you so much for calling APL Maria. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][NEUTRAL] Mm bye.