AccountId: 011433970860
ContactId: 862a9f1f-fdee-455f-ae90-30497866c50c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379390 ms
Total Talk Time (AGENT): 129414 ms
Total Talk Time (CUSTOMER): 167613 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/862a9f1f-fdee-455f-ae90-30497866c50c_20250203T19:52_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. I just had a quick question about uh my, my plan and uh what it covers.
[AGENT][NEUTRAL] OK, I'll be happy to assist with your plan information and what is your first and last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And Mr. [PII], what is your policy number?
[CUSTOMER][NEUTRAL] Um, is, OK, so I'm not sure which number you're asking for here. There's an in-hospital benefit cert number, outpatient benefit cert number, a payer ID, and a group number.
[AGENT][NEUTRAL] Either one of the er numbers will do.
[CUSTOMER][NEUTRAL] OK, uh, 02501560 ML 7.
[AGENT][NEUTRAL] OK, and if you can verify your date of birth and email address.
[CUSTOMER][NEUTRAL] [PII]. Uh, I think the email address I have on file is [PII]. Is that right?
[AGENT][NEUTRAL] No, we don't have that one.
[CUSTOMER][NEUTRAL] Uh, is it [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and please be advised that a verification of coverage is not a guarantee of payment and what questions did you have in regards to the policy?
[CUSTOMER][NEUTRAL] Yeah, so, um, I understand that this is a gap insurance and I did, uh, have to use it last year and we did something as an outpatient procedure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm curious, is that the same thing, like, does that work the same way if uh we have to go to like an urgent care for something, or is, does that, does that not fall under the categories um covered by the gap insurance?
[AGENT][NEUTRAL] OK, so urgent care would be considered outpatient. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me just pull up the.
[AGENT][NEUTRAL] The list one moment.
[AGENT][NEUTRAL] OK, so outpatient is gonna consider ER urgent care, surgery in a hospital outpatient facility, uh, freestanding outpatient surgery center, diagnostic testing in hospital, outpatient facility or MRI facility, outpatient treatment for a mental or emotional disorder in a hospital outpatient facility, physical therapy facility, and ambulance. So all of those categories fall under the outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the outpatient benefit is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5000 per calendar year.
[CUSTOMER][NEUTRAL] OK. And um this policy covers me and my wife, so the 5000 is just like that's between both of us, correct?
[AGENT][NEUTRAL] Uh, no, it's per person, so you each get your own $5000.
[CUSTOMER][NEUTRAL] Gotcha. OK, good to know. Um, so my next question is, I know that it's a gap insurance, so like I would go in there, I would still give them primary insurance information. I know that there's a um like a deductible that I pay.
[CUSTOMER][NEUTRAL] To see an urgent care, um, and then, you know, obviously it would be like whatever other services are needed. Um, does, would all of that fall under it or um do I still pay the, like the out of pocket, um, sorry, I, I get these terms confused, but, um, so like that $50 charge that I would pay, I guess is, uh, the out of pocket.
[CUSTOMER][NEUTRAL] Um, is that something that would still end up getting covered, or I would pay that and then they would bill you for anything that would be, uh, the, the services that they provide?
[AGENT][NEUTRAL] Um, I think I understand what you're asking me, um.
[AGENT][NEUTRAL] They would, if they're, if they're gonna be, so, so you go to the urgent care and let's just say, and I don't know what your policy um entails, but let's say you have a $100 co-pay for urgent care visits. Um, when you present that to the urgent care, it all depends on whether or not they bill secondary. Some may require you to pay the $100 up front and then they say, well, we're gonna take the 100, we'll bill, and if we get a payment from your secondary, we'll reimburse you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so I just don't know what the guidelines are based on where you're going for treatment, but under normal circumstances, you would go to the urgent care, present both cards, the major medical and the supplemental, and then that way, they'll know not to bill you because they're going to end up billing us after they billed your primary main insurance.
[CUSTOMER][NEUTRAL] Gotcha. OK, that makes sense.
[CUSTOMER][POSITIVE] All right. I think that answers all my questions.
[AGENT][NEUTRAL] OK, well, was there anything else I could assist with outside of that?
[CUSTOMER][POSITIVE] No, thank you so much for your help today. I appreciate it.
[AGENT][POSITIVE] Well thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Mhm bye bye.