AccountId: 011433970860
ContactId: 929c9e25-2a9d-4de6-979c-7afbe2a2aa20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569510 ms
Total Talk Time (AGENT): 272592 ms
Total Talk Time (CUSTOMER): 217711 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/929c9e25-2a9d-4de6-979c-7afbe2a2aa20_20250509T19:15_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, I am, uh, going in for surgery on Monday and United Health is my primary, and I wanted to find out exactly how.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my APO benefit will work.
[AGENT][POSITIVE] OK. Well, I can definitely help you with your benefits and your coverage. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] And my number I'm calling you on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] It's the group number is 25026.
[AGENT][NEUTRAL] Um, do you have your ID card with you?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, it should say inhospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Yep, I got both of them. You want the hospital er number?
[AGENT][NEUTRAL] Um, they're the same. I just need the numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] It's 02371753.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And I guess you don't need the ML.
[AGENT][NEUTRAL] Oh, no, no, it's OK. That's just for the card. The number is actually your policy number, just in case you need it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it, got it.
[AGENT][NEUTRAL] All right, so I have you here and I just need you to verify your date of birth, your mailing and email address.
[CUSTOMER][NEUTRAL] OK, date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] Not sure if I use my office address or my email is either gonna be [PII].
[CUSTOMER][NEUTRAL] Is that what you have?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Or you have [PII].
[AGENT][POSITIVE] I have [PII]. This is correct.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] All right. Thank you for verifying and all the information provided is a verification of benefits, not a guarantee of payment. And um hold on one moment, I'm just waiting for the benefits to populate here.
[AGENT][NEUTRAL] And the surgery, is it going to be an outpatient surgery or will you be admitted?
[CUSTOMER][NEUTRAL] Um, I will be, my understanding is I'll be admitted.
[AGENT][NEUTRAL] And will you be going home the same day or you have to stay there for a few days or, you know, a day?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, they said that the doc, I actually just got the um, the time, and they said he's uh that I'll be staying over, but when I saw the doctor, he said he he's gonna decide, I guess after the surgery, so I don't know if he made that decision or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'll give you both. So, oh, actually, hold on.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I have to assume right now uh.
[AGENT][NEUTRAL] Is there? OK, yeah. So I'll go ahead and give you both just in case once the surgery is over, he decides you're OK to go home and it's outpatient, we can, um, you'll just have both of the, you'll just know all of it.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So in case you are inpatient, um, admitted, and you're staying, the policy will pay up to $3000 per calendar year.
[AGENT][NEUTRAL] And that's after primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, does your facility, do they have this, um, insurance card for billing already?
[CUSTOMER][NEUTRAL] They said they will not do anything with with APL.
[CUSTOMER][NEUTRAL] Is that common?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEGATIVE] They said we can't take that. I said I, I did not understand why.
[AGENT][NEGATIVE] I would, when they do that, I would say to give them your policy number and give them our phone number and have them call to verify benefits because they're supposed to bill us right after they receive everything from your primary, you know, explanation of benefits and and and everything. Once they receive that, they're supposed to bill us.
[AGENT][NEUTRAL] Directly 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so the best thing to do is to have them call us to verify coverage.
[CUSTOMER][NEUTRAL] So they bill you for the any the.
[CUSTOMER][NEUTRAL] OK, so basically my understanding is APL is covering my deductible from my primary.
[AGENT][NEUTRAL] Right, co-pays, deductible up to that 3000 per year.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it's inpatient.
[CUSTOMER][POSITIVE] This is OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it's outpatient, the policy will pay up to $500 per day.
[AGENT][NEUTRAL] So it will be that $500 for that first because outpatient, you won't have to stay, so it'll just be the day of the surgery.
[CUSTOMER][NEUTRAL] But if it's in the hospital, isn't that inpatient?
[AGENT][NEUTRAL] Well, the difference between inpatient and outpatient is inpatient, you're admitted and you're staying. Outpatient, you can still be admitted, but you're not staying, you're going home that day. So, depending on what, like you said, what decision he makes, once the surgery is done, you may stay and be inpatient or you may go home and change the outpatient.
[AGENT][NEUTRAL] So it depends.
[CUSTOMER][NEUTRAL] OK, so it's the same so if I, if I do go home.
[AGENT][NEUTRAL] It's outpatient.
[CUSTOMER][NEUTRAL] It even though it's in the same hospital, I'm if I go home the same day, it's outpatient if I stay overnight it's in it's in inpatient.
[AGENT][NEUTRAL] Correct. If you're going home the next day, if you go home outpatient, if you stay inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if it's outpatient you cover $500 if it's inpatient you cover $3000.
[AGENT][NEUTRAL] Mhm. Cause inpatient, it'll be for that whole
[CUSTOMER][NEUTRAL] Because you said 500 per day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, which you said per day, but if it's.
[CUSTOMER][NEUTRAL] 2 days it wouldn't be per day because then it turns it would only be 1 day because if it's 2 days it becomes inpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the only thing you need to remember to decipher between in inpatient and outpatient is if you go home. If you go home, it's outpatient and you'll be billing for that one day because you went home.
[CUSTOMER][NEUTRAL] What am I missing? I'm not getting.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it's inpatient, then you're gonna stay and you're gonna have multiple days, so that's inpatient.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So depending on what he sees, you have coverage for both.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and do the part of the same thing you said covers copays also so is everything leading up to this because I have to pay a copay for the doctor's visit for this after I went to an emergency room. I had to go to a um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A, um, an urgent care to get my um pre-op stuff done would that all be covered because it's all part of the same thing?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, anything you do medical.
[AGENT][NEUTRAL] Go ahead and give them your um APL ID card so that they can just go ahead and bill us. As long as the policy was active on the data service, you can file at any time, um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, because I didn't get on the ones that I did for the copay. I didn't give that, so that is that something I can claim after with you?
[AGENT][NEUTRAL] Yeah, as long as the policy was active on the day that you want to receive the services, you can file at any time.
[CUSTOMER][POSITIVE] Yep, absolutely.
[CUSTOMER][POSITIVE] OK, alright, perfect.
[AGENT][NEUTRAL] So you can either um like call them and let them know, hey, I have this secondary policy, here's my policy number, here's their phone number, call them, verify benefits, and we'll take it from there, or you can file a claim on your own, whichever you prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I think, uh, I think that there's nothing all I so there's no other number I need from you. I just need to give them this card.
[AGENT][NEUTRAL] Yes, just um give them the card and then if they give you any pushback, have them give us a call to verify benefits, but they definitely should be billing us after they bill your primary.
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] Yeah, uh, one other quick thing if, if they say they absolutely will not and they charge me.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I if they bill me and I pay, then can I submit it to you?
[CUSTOMER][NEGATIVE] I know you're saying they should, but on the phone they told me they would not, so.
[AGENT][NEUTRAL] If you, if
[AGENT][NEUTRAL] If you receive the bill, don't pay it, submit it to us.
[CUSTOMER][POSITIVE] OK, got it perfect.
[AGENT][NEUTRAL] But if you do want to pay, you, you have that option and then we could reimburse or go from there, but I wouldn't pay anything until I see what my insurance does.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. My name is [PII].
[CUSTOMER][NEUTRAL] And what is your name?
[CUSTOMER][POSITIVE] [PII], you've been great. I appreciate your help.
[AGENT][POSITIVE] Yes, sir. Well, thank you and thanks for calling APL and I hope you have a good weekend and happy healing from your surgery on Monday.
[CUSTOMER][NEUTRAL] Alright bye bye.
[CUSTOMER][POSITIVE] Thanks so much. You have a good weekend too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Right.