AccountId: 011433970860
ContactId: 7d53bfca-a4bd-4224-875a-b94f9dfb4a8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 677750 ms
Total Talk Time (AGENT): 264956 ms
Total Talk Time (CUSTOMER): 286039 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/7d53bfca-a4bd-4224-875a-b94f9dfb4a8d_20250512T18:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have uh APL coverage as a secondary gap coverage to my wife's company.
[CUSTOMER][NEUTRAL] And I had a sort of a general question on what it covers and what it doesn't cover, um.
[CUSTOMER][NEUTRAL] So I had a uh.
[AGENT][NEUTRAL] OK, so you're covered. Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, you need to, do you need a, I would guess a.
[AGENT][NEUTRAL] First off, I, uh, no, sir. First off, I need to know who I'm speaking with.
[CUSTOMER][NEUTRAL] Code number
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh. And Mr. [PII], what is like your callback number for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And now your policy number, please?
[CUSTOMER][NEUTRAL] There's 2 of them. There's an in hospitals and there's an outpatient, so at this point I'm assuming that we're doing outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0247887.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 52 M as in Mary, L as in llama.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] OK, thank you. So give me a moment, Mr. [PII], to get the policy information pulled up and then once I do, I will have to verify several pieces of information first for security and then any information I do provide for you today will be a verification of benefits and not a guarantee of payment. So just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if you could first please verify your wife's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] Uh, her name is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then um the phone number that we would have on file for Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII] for verifying all of that information. Just one moment.
[AGENT][NEUTRAL] OK, so Mr. [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Um, well, I'll give you a specific, two specific situations that I'm wanting to know whether.
[CUSTOMER][NEUTRAL] APL covers and then maybe sort of you can tell me generally what some of the rules are um.
[AGENT][NEUTRAL] Well, well, I can tell you, I won't be able to tell you based on a code. I can tell you that, Mr. [PII]. Um, this supplemental policy helps you with your deductibles, co-pay, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we will have to receive the claim along with your primary insurance company's explanation of benefits for our review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Now, under this policy, office visits or treatment done within an office setting is not covered.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] You do have an outpatient benefit maximum per calendar day for covered outpatient services of $300 with no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I got that.
[CUSTOMER][NEUTRAL] Um, the fir the first example is, uh.
[CUSTOMER][NEUTRAL] A lab test that I had to have done for uh.
[CUSTOMER][NEUTRAL] Uh, cancer purposes and
[CUSTOMER][NEUTRAL] They paid the primary paid everything except for $68 and change, which might be some kind of a lab fee um I think that I had said I was that they were going to resubmit that to APL and you know that was a few weeks ago uh actually is there a way of telling whether it's been submitted?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Yes your nose.
[AGENT][NEUTRAL] What data service? I would need for you to give me the data service that you had your lab work done on, but.
[CUSTOMER][NEUTRAL] Um, well, the data service.
[CUSTOMER][NEUTRAL] It was a long time ago because
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There was some issues with how it was transmitted, but I'm looking specific to that up I think it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][POSITIVE] Sure. Take your time.
[CUSTOMER][NEUTRAL] Just say for.
[CUSTOMER][NEUTRAL] Looks like it was [PII].
[CUSTOMER][NEUTRAL] And like I said, there's all kinds of breakdowns, but the part that they didn't pay.
[CUSTOMER][NEUTRAL] It's called a micro dissectional manual. I don't know what it is anyway it was $68.10.
[AGENT][NEUTRAL] But again, you don't know what date in July.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so no, so we don't have a claim on file for you for that data service.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So I don't know if you're gonna be able to answer this question, but my question also because I can call them again they're very.
[CUSTOMER][NEUTRAL] Delinquent, um, and have them res.
[CUSTOMER][NEUTRAL] Resubmit that, um, is that the kind of thing?
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Whatever was paid by a lot of it was paid by regular Blue Cross Blue Shield, um, except for that, is that the kind of thing where they step in and pay the.
[CUSTOMER][NEUTRAL] The rest is the secondary insurance.
[AGENT][NEUTRAL] Now, you do not have a lab writer on this policy, so it would not cover.
[CUSTOMER][NEUTRAL] Oh that's interesting because that'll probably answer my next question. So anything that you with a lab is not covered.
[AGENT][NEUTRAL] I work.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] That is correct, um.
[AGENT][NEUTRAL] Yes, sir. Yes, that is correct. It is not covered under your policy.
[CUSTOMER][NEUTRAL] There's a lab.
[CUSTOMER][NEUTRAL] There's a lab include
[CUSTOMER][NEUTRAL] I assume that my second question was uh.
[CUSTOMER][NEUTRAL] Uh, a biopsy.
[CUSTOMER][NEUTRAL] Reading and report that I got a second opinion on it and it was also $68 and changes. Is that considered a lab? I assume it probably is.
[AGENT][NEUTRAL] We would just have to receive your claim to review it again, office visits. If it was an office visit where you wouldn't have a second opinion, that is not something that is covered under your policy.
[CUSTOMER][NEUTRAL] OK, well, that's covers that.
[AGENT][NEUTRAL] This policy is.
[AGENT][NEUTRAL] Yeah, but you're also I mean you're welcome to submit always submit because we can't pay.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Claims over the phone, receive all of the paperwork. I can just give you the general benefit, you know, information and tell you the office visits aren't covered, that type of thing.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, um, my question was, other question was, so if you have like an MRI or a CAT scan, I don't, I think they covered that.
[AGENT][NEUTRAL] Those are things that we could review.
[AGENT][NEUTRAL] Those are things that we can review under that outpatient benefit, yes sir, that I went over with you mhm.
[CUSTOMER][NEUTRAL] That's the thing that you do
[CUSTOMER][NEUTRAL] OK, because I've, I've seen you pay this before. Um, my last question.
[AGENT][NEUTRAL] Yes, those are things.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] has to do with is some of the insurance companies have something called a cancer writer that pays extra if you've been diagnosed with cancer.
[AGENT][NEUTRAL] So this policy does have a cancer treatment rider on it.
[CUSTOMER][NEUTRAL] You know, if there's
[AGENT][NEUTRAL] And let me pull up that information to tell you what that applies to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] [PII] is going to look at the LA.
[AGENT][NEUTRAL] OK, this is for treatment, mister, um, I'm sorry, Mr. [PII], your, your rider on here is for cancer treatment.
[AGENT][NEUTRAL] So we will pay the out of pocket amounts for cancer treatment performed in a cancer treatment facility. Benefits are also limited to the maximum outpatient benefits shown on the schedule of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, so this, and this is not treatment, this is diagnosis, um, so.
[AGENT][POSITIVE] Right, this would be treatment is what this writer help can help with.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Does that include
[CUSTOMER][NEUTRAL] I mean, I have a procedure that, you know, where it's actually surgery, um.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Again, it is.
[CUSTOMER][NEUTRAL] Well that's another
[AGENT][NEUTRAL] Yeah, the any outpatient, whether it's related to cancer or not, anything outpatient is falls under that $300 benefit maximum per calendar day for covered outpatient services.
[CUSTOMER][POSITIVE] OK. All right, thank you very much. You answered my questions.
[AGENT][POSITIVE] Well, you're very welcome. OK. Can I help you with anything else this afternoon?
[CUSTOMER][POSITIVE] Uh, no, that's good. Thank you.
[AGENT][POSITIVE] OK, well then thank you for calling APL Mr. [PII], and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes sir bye bye.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.