AccountId: 011433970860
ContactId: 95ffec1e-ef49-4ac2-9a8a-3ae9385ffa2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402739 ms
Total Talk Time (AGENT): 182574 ms
Total Talk Time (CUSTOMER): 194768 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/95ffec1e-ef49-4ac2-9a8a-3ae9385ffa2d_20250203T18:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name? It cut out.
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] OK. Uh, my name is [PII] from Portland Pain Care, and I'm calling regarding a patient's multi-plan uh, insurance that I need to get effective date and benefits breakdown such as specialty office visit, co-pay, in and out of network deductible and out of pocket max with accumulators, as well as the general outpatient surgery benefit for and out of network.
[AGENT][NEUTRAL] OK, so you need outpatient surgery and you need office benefits, correct?
[CUSTOMER][NEUTRAL] Say, say it again, I'm sorry.
[AGENT][NEUTRAL] You need outpatient benefits for surgery and office benefits.
[CUSTOMER][NEUTRAL] Yeah, as well as in network as well, so I need in and out of network and then uh out of pocket and deductible with accumulators.
[AGENT][NEUTRAL] OK, um, first, let me see what type of policy is it. Um, Ms. [PII], um, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So the policy is 02560051 for [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, may I have her date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Miss [PII]. All right, so this particular policy is one of our hospital indemnity plans. There is no network.
[AGENT][NEUTRAL] Um, so there's no co-payments, co-insurance or deductibles because it pays a flat amount.
[AGENT][NEUTRAL] Based on the service, and this is not a guarantee of payment, just a verification of coverage. Um, we have an effective date of [PII]. It is active at the moment.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Mhm. OK. And the outpatient surgery, is it gonna take place in an office setting or is it gonna be in an outpatient facility or hospital?
[CUSTOMER][NEUTRAL] It would be either ambulatory surgery center or a hospital. But my question is, so if they're coming in, they were sent to us for, uh, they come in for the consult and then they would decide if there was a procedure that would be fitting for them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And then if so, then of course, they would get all the necessary information regarding that procedure. But, so is this, I mean, she's able to come in for the consult and all of that. This isn't just hospital hospital care, correct or no?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] This is a hospital indemnity plan. It does have additional benefits in it, um, and for like the consultation in the office, uh, we do cover, but it's just, again, it's a flat amount. It's a limited plan, so it's a limited amount and it's a flat amount. So, um, basically for the office visit consultation, we cover $50 and that's up to 4 visits per covered person per calendar year.
[AGENT][NEUTRAL] And um if
[CUSTOMER][NEUTRAL] It only covers $50 of the visit.
[AGENT][NEUTRAL] It only covers $50 correct.
[CUSTOMER][NEGATIVE] So they, oh my God, this is horrible. So they come in for the visit and $50 of it, you guys pay and then the remainder they pay.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] If they don't have any other insurance, then um it's up to the provider's discretion. This is not a, this is not a major medical and this is not a secondary. This is just an indemnity plan, which is a limited plan.
[CUSTOMER][NEUTRAL] 00, it's sweet. OK. This is the only insurance they have listed, so I'm like, why did they even bother? OK. And then, um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Then is it do they have to pay for this like out of every month? do they have to pay to have this?
[AGENT][NEUTRAL] Uh, it's through the employer. I'm not sure if it's, uh, self funded or fully funded, but, um, it's, it's through the employer.
[CUSTOMER][NEGATIVE] Oh, OK. All right. I'm sorry. I just, it blows my mind how horrific some of these plans are. Um, anyhow, go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And uh for this surgery, um again uh if it's in a hospital or freestanding surgical center, um, it's gonna be 250.
[AGENT][NEUTRAL] The flight amount.
[CUSTOMER][NEUTRAL] That they pay or you cover?
[AGENT][NEUTRAL] That's what we cover. The amounts that I'm giving you is just the amounts we cover.
[CUSTOMER][NEUTRAL] OK and then so the remainder would then be up to them.
[AGENT][NEUTRAL] Yes, it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and then so that's in network, is that correct or?
[AGENT][NEUTRAL] That's, there's there's no network.
[CUSTOMER][NEUTRAL] Oh, that's what you were saying. I'm sorry. OK, I'm sorry. This is just, uh just a unique, uh, plan that I'm not, I'm not um I, I haven't really come across this too much, so it's really kind of just taken me by surprise and I'm, I apologize for my ignorance, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's OK. I, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um that's fine.
[CUSTOMER][POSITIVE] It's just, this is just just unique, um.
[AGENT][POSITIVE] Yeah, yeah, we, we, we, we learn everything, something every day, so it's fine.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEGATIVE] Yeah, yeah, yeah, cause I'm like, I wouldn't even, what, what would be the point cause I, most insurances, you know, companies nowadays make you pay so much a month to have, you know, they, of course they pay in their percentage or whatever, but um it's just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, um, alright, so then that's all basically that they do, uh, so then can I get a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will, Miss [PII]. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] So, [PII] and then what's the first initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. All right. Well, thank you so and thank you for dealing with me. I apologize again for my ignorance, but no, I appreciate your help.
[AGENT][POSITIVE] You're welcome. No, no, no, no problem. I understand, no worries, and thank you for calling HR. Have a good day, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.