AccountId: 011433970860
ContactId: 86aaafa8-8076-49be-a7df-37074829a53e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 566440 ms
Total Talk Time (AGENT): 311606 ms
Total Talk Time (CUSTOMER): 152078 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/86aaafa8-8076-49be-a7df-37074829a53e_20250407T18:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I probably, well maybe I'm not like other people but I think I've signed up for something that I don't know what it is.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] In full disclosure, I need help, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I thought I was doing the APL sort of like a um.
[CUSTOMER][NEUTRAL] We used to have a healthcare savings account.
[CUSTOMER][NEUTRAL] Is that what the APL is? I mean, did I pay into something to use it for copays and stuff?
[AGENT][NEUTRAL] So we don't offer any sort of health savings accounts or anything like that. We offer supplemental insurance.
[AGENT][NEUTRAL] And so we offer varying different types, um, some.
[AGENT][NEUTRAL] Carrier groups, we offer um a gap plan like a supplemental insurance. Some we offer uh disability, life insurance, cancer insurance. Um, do you have a policy number or anything I can look?
[CUSTOMER][NEUTRAL] I have a payer ID. Would that work?
[AGENT][NEUTRAL] Mm, no, payer ID is.
[CUSTOMER][NEUTRAL] The policy number
[CUSTOMER][NEUTRAL] Policy number is 025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 79024
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm good.
[AGENT][NEUTRAL] OK, let me pull this up here.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then [PII] for security, I need to verify please your uh date of birth and address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you so much. OK, so the plan that I see here, let me see if there's any other plans. One second.
[AGENT][NEUTRAL] OK, so the plan that I see here is a secondary insurance. Some call it gap insurance um for as a different term. Uh, basically what it's meant to do is to bridge the gap between your major medical.
[AGENT][NEUTRAL] Um, and then now you have this, and so if anything were to happen as far as medical cost, hopefully, uh, the secondary being us picks up the majority of any out of pocket cost, therefore, uh, relieving any sort of out of pocket cost on yourself. So that's the purpose of the plan.
[CUSTOMER][NEUTRAL] So and that's what I signed up for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, so it does not help pay with diagnostics and things like that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Unless, unless my insurance.
[CUSTOMER][NEUTRAL] Has to be billed first, correct?
[AGENT][NEUTRAL] So your primary has to be billed first and then they can bill us as the secondary. If your primary is not gonna cover anything, then we're not gonna cover anything that's usually a good rule of thumb.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It does cover if you have any sort of like treatment in a doctor's office, things like that. Um, are you looking for something like specific?
[CUSTOMER][NEUTRAL] Well, and I guess this, this is for my entire family, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, um, like my husband had to have a, uh, MRI.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, having some prostate issues and we're just trying to make sure it's not cancerous. And I think that might be why I took this out because of, but what you're saying is that I would give this as a, as a insurance card as well. So they would be my Blue Cross and they would build this as a secondary.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, exactly. Uh-huh. Yeah. And you just let them know that this is your secondary. Um, and you do have some diagnostic testing on here. Let me scroll through this. Give me just a second.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] So I guess unfortunately paid $1000 out of pocket for an MRI that we probably should have just let it hit hit our insurance.
[AGENT][NEUTRAL] I mean you guys can still claim it, um.
[AGENT][NEUTRAL] If you've paid out of pocket for it, if you have the itemized receipt or bill from them and then an explanation of benefits from Blue Cross Blue Shield, you guys can submit the claim yourself or you can go back to the well, not if you've already paid the provider the provider won't submit it if you've already paid them I take that back.
[CUSTOMER][NEGATIVE] Yeah, and when they get their cash they're done with us.
[AGENT][NEUTRAL] I know. Um, I was trying to find the list of diagnostic tests that are covered here.
[AGENT][NEUTRAL] So it shows you have a writer for diagnostic testing in a hospital outpatient facility or MRI facility.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I mean, I think it's gonna be a moot point now because we already paid for it.
[AGENT][NEUTRAL] Yeah I mean it's up to you as far as if you wanted to uh get the claim form and submit it to get reimbursed yourself which you can do um you know if you.
[CUSTOMER][NEUTRAL] But the hospital, no, we pay for the procedure outright with cash, so they're not gonna go back now and bill your insurance.
[CUSTOMER][NEGATIVE] I don't think they would.
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] So the primary insurance didn't pay anything on it. It was just you paid out of pocket totally?
[CUSTOMER][NEUTRAL] Yeah, it was cheaper to pay.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Out of pocket than it was to pay for the deductible.
[AGENT][NEUTRAL] OK.
[AGENT][MIXED] Yeah, it's probably a moot point at this point. You're correct, um, unfortunately, yeah.
[CUSTOMER][NEUTRAL] And that's fair. So what I need to do is just keep this in my wallet, and when I give out my one insurance card, I need to give out the second insurance card too.
[AGENT][NEUTRAL] Yes, yes, sir, and then, um, Mr. [PII], I would just tell any provider, um, this is my primary and then hand them our card as secondary and I would not pay anything until you see that they've billed both, you know.
[AGENT][NEUTRAL] Um, because this is meant to pick up deductible, co-pay, all of that from the primary. So in the first instance, you know, they may have said to you, well, you owe us $2000 because that's deductible, and then you say, well, OK, that's fine, but build the secondary first and then come back and talk to me, you know.
[CUSTOMER][NEUTRAL] Alright, so what's the maximum benefit on on this insurance? Is there a maximum?
[AGENT][NEUTRAL] Yeah, there is, let's see, so.
[AGENT][NEUTRAL] There's no deductible under your outpatient.
[AGENT][NEUTRAL] Uh, there is outpatient for the calendar year is 1000 and inpatient is 5000. Inpatient is defined as being in the facility hospital for 18 hours or longer consecutive.
[CUSTOMER][NEUTRAL] OK, so an observation, I would qualify. OK, but this is not, definitely not for co-pays for like going to the doctor's office and things like that.
[AGENT][NEUTRAL] It's not gonna pay for a doctor's office visit. Um, if you had to have any sort of like treatment in an office, so let's say you, uh,
[AGENT][NEUTRAL] Go to the doctor and have to have, let's say, a breathing treatment for bronchitis. Uh, the, the insurance would cover the breathing treatment that was administered to you in the office, but not the co-pay for the, the office visit. Does that make sense?
[CUSTOMER][NEUTRAL] Right. So, like, um, I have a child who has to have a echocardiogram. And so when he has his echo, I could give them this to help pay for the echo.
[AGENT][POSITIVE] Yes, absolutely. Uh-huh.
[CUSTOMER][POSITIVE] Alright, well that explains it, thank you very much.
[AGENT][NEUTRAL] Yep.
[AGENT][POSITIVE] You're welcome. Have a good rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.