AccountId: 011433970860
ContactId: 8ce34fa1-5909-4aca-ac72-c2de1d1f7dcb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356410 ms
Total Talk Time (AGENT): 186795 ms
Total Talk Time (CUSTOMER): 152516 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/8ce34fa1-5909-4aca-ac72-c2de1d1f7dcb_20250109T22:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. How are you?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Good, good. [PII], by the way.
[AGENT][POSITIVE] Happy [PII].
[CUSTOMER][POSITIVE] Thank you, I have a question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have um a test, some medical tests that I need to get done.
[CUSTOMER][NEUTRAL] And my, um, I just got off the phone with my health insurance and they told me that, um, 3 of them are the things, and I'll give you the codes if that's easier for you, are going to be totally applied to deductible. The other one is not going to be applied to deductible, but it's a co-pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm supposed to call you and find out.
[CUSTOMER][NEUTRAL] Uh, if this is covered.
[AGENT][NEUTRAL] OK. Well, I can definitely take a look at your policy and the coverage. And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][POSITIVE] Yes, I'll give you my cell number, although I'm calling you from work. I'll give you my my cell number. It's [PII].
[AGENT][POSITIVE] Thank you, and then your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] That's 2 I'm sorry, 02579287.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your last name, your date of birth, mailing, and email address?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Alright, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So I have a question. The procedures that you're having, are they in hospital to where you have to be admitted or would it be outpatient? OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] No, no, no, outpatient, outpatient, it's a, it's a nuclear, I think they, they gave me this medical term that I don't understand. That's why I asked them for the colds. It's, it's a stress test, but it's the nuclear and.
[CUSTOMER][NEGATIVE] I'm gonna be, I'm not gonna be walking, I'm gonna be lying down or sitting down. I don't know.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][POSITIVE] So they gave me the codes. They gave me the codes and I think that's gonna be more to you.
[AGENT][NEUTRAL] Well, no, no, no, so I don't need to use the codes. Um, your policy is broken down by facilities, so that's why I was trying to figure out where you were going. So now that I know it's outpatient, your outpatient benefits, hold on one moment, they're populating now.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so for outpatient, we would pay up to $8500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, the type of policy that you have, your Medlink policy, we pay towards the copay, deductible and co-insurance after your primary.
[AGENT][NEUTRAL] So if the facility requires you to pay that co-pay or if your primary insurance requires you to pay a part of the deductible, anything that you have to pay to be seen, you'll have to pay that upfront. And then once we receive the claim, you can be reimbursed or if there's something still owed to the provider, we can, you know, pay the finishing amount there or up to that 8500 per calendar year.
[AGENT][NEUTRAL] So to answer the question, yes, because we do cover, our policy pays towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] After primary, OK, OK, would I have to pay this cause I don't have this kind of money.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For your co-pay and deductible?
[CUSTOMER][NEUTRAL] Yeah, they told me that the whole thing is like $3000 33,000 dollars and something.
[AGENT][NEUTRAL] If there is
[CUSTOMER][NEUTRAL] So we're not talking about, we're not talking about $700 or something like that.
[AGENT][NEUTRAL] Well, it depends on the facility. If they require you to pay that upfront, you will have to see what the options are. If they can bill it, I would then have them, if they can bill it and you still be seen, then on the back end we can take care of that, but it depends on the facility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] Is there anything you could send me of what is covered under my insurance? just so I have it?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Of course, I can send you a copy of your policy documents. It will show like um the calendar year max, and it's just a breakdown of your policy and definitions. Is that what you mean?
[CUSTOMER][POSITIVE] That would be, that would, that would, yeah, yeah, that would be great cause I could take it. I could, you can you email it to me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I sure can. Hold on one moment. Let me add that email.
[CUSTOMER][NEUTRAL] Cause what I'll do is I'll print it out and and take it with me.
[AGENT][NEUTRAL] And can you repeat your email address?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] So [PII], you said?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right, well, I will go ahead and send this over to you now. And was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that would be it so they they don't need to call you for pre-authorization.
[AGENT][NEUTRAL] No, because we're not your major medical. They'll most likely have to call your major though.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, and then just bill you for the deductible and the copay that has to do with this.
[AGENT][NEUTRAL] Right, so they're gonna bill primary first. Primary is going to pay, you know, based on your policy with them, and then anything that's left over, they're gonna automatically bill it to us. Just make sure they have this policy number, so that it goes straight to us, so you don't receive the bills.
[CUSTOMER][POSITIVE] Right, right, right, right, yeah, yeah, perfect, thank you so much, have a great day, [PII].
[AGENT][POSITIVE] You're welcome. You also, and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK you too bye bye.