AccountId: 011433970860
ContactId: 9f6e4386-2a11-4215-99ab-989029b10a21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265279 ms
Total Talk Time (AGENT): 135665 ms
Total Talk Time (CUSTOMER): 91434 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/9f6e4386-2a11-4215-99ab-989029b10a21_20250611T21:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I, I'm, uh, you know, I have APL as a secondary insurance, and I had a question about, um, an MRI that I've got scheduled for tomorrow.
[AGENT][NEUTRAL] OK, well, I can help you with your coverage and may I have your name and a contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, I have a group number. I have an outpatient, outpatient benefit certification number.
[AGENT][NEUTRAL] Yes, that's your policy number.
[CUSTOMER][NEUTRAL] Oh, the outpatient one?
[AGENT][NEUTRAL] Well, the numbers are the same for outpatient and inpatient that ML 7 or 8 is different. Mhm.
[CUSTOMER][NEUTRAL] Oh it is I see that yeah.
[CUSTOMER][NEUTRAL] Yeah, it's the MLA but it's 14806.
[CUSTOMER][NEUTRAL] 86 ML 8
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And the group number is one OK.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][POSITIVE] Thank you and your email address.
[CUSTOMER][NEUTRAL] My email with you all is probably [PII]. If that's not it, I can give you my personal email.
[AGENT][NEUTRAL] No, that's correct, and thank you for verifying. All the information provided is a verification of benefits, not a guarantee of payment. And what questions did you have in reference to your MRI?
[CUSTOMER][NEUTRAL] Um, will you guys pick up the, the full amount of the MRI? The MRI is.
[CUSTOMER][NEUTRAL] Is gonna run me like 11 or the cost is like $1100.
[CUSTOMER][NEUTRAL] And I just want to make sure that that.
[CUSTOMER][NEUTRAL] You all are covering that part. It's of the insurance, of the charges.
[AGENT][NEUTRAL] So your secondary policy pays towards the copay, deductible and co-insurance after primary. So your your outpatient max per day is $500. So it does, the policy does um cover diagnostic testing in a hospital outpatient facility or MRI facility, but the max that your secondary policy will pay to a claim for outpatient is $500 up to $500 per day.
[CUSTOMER][NEUTRAL] OK, so in other words, it's on you, you're gonna pay 500 of this 1100.
[AGENT][NEUTRAL] Right, up to, of course, I can't guarantee that until we process the claim, but your max is 500 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you go to the facility, um, and you give them your primary insurance, just give them the APL card as well. So they'll bill primary and then us automatically second. And then uh if there is anything outstanding, um, you could receive a bill, but they'll have to bill insurance first.
[CUSTOMER][NEUTRAL] 500.
[CUSTOMER][NEGATIVE] Yeah, they're saying that that the insurance isn't gonna pay any of it because I haven't covered my deductible on my insurance.
[AGENT][NEUTRAL] Well, now that's different. So if, so that's a totally different situation. Hold on one second.
[CUSTOMER][NEGATIVE] Which is a little bit weird.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] So if your, if your primary United Healthcare does not apply to a claim, we as second cannot apply to a claim because we're second only to them, but they have to apply first. So if, if United Healthcare will not cover the, is not covering or paying towards the claim because the deductible hasn't been met or um whatever the reasoning, then this policy, they could bill it, but it will most likely be denied um because
[AGENT][NEUTRAL] The primary insurance hasn't applied anything to the claim.
[CUSTOMER][POSITIVE] Hm, OK, I'll call my primary. All right, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No thank you though.
[AGENT][POSITIVE] Alright, well thanks for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thanks bye.
[AGENT][NEUTRAL] Bye bye.