AccountId: 011433970860
ContactId: 9f7ec022-cda6-4968-8873-f08e805fd02e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458130 ms
Total Talk Time (AGENT): 172811 ms
Total Talk Time (CUSTOMER): 222111 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/9f7ec022-cda6-4968-8873-f08e805fd02e_20250220T22:03_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] Good afternoon. I know my name is [PII]. I'm just calling regarding to my plan. Um, let me see which, what information do I need to provide to you so you could pull up my account?
[AGENT][NEUTRAL] Um, may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] 786
[CUSTOMER][NEUTRAL] 707.
[CUSTOMER][NEUTRAL] 1270.
[AGENT][NEUTRAL] Thank you for that. And your policy number?
[CUSTOMER][NEUTRAL] What would be my policy, policy number? I see it's 024.
[CUSTOMER][NEUTRAL] 501
[CUSTOMER][NEUTRAL] 68.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, and I just need you to verify your last name, your date of birth, mailing, and email address on file.
[CUSTOMER][NEUTRAL] OK, my last name is [PII]. My date of birth is [PII].
[CUSTOMER][NEUTRAL] My address is [PII], and my email on file should be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um when was the claim sent in to us?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A um
[CUSTOMER][NEGATIVE] I'm not even calling about a claim.
[AGENT][NEUTRAL] Oh, I thought you said claim status. What did you say the reason for the call was? I'm sorry, I misunderstood you.
[CUSTOMER][NEUTRAL] Oh, I'm just trying to understand my policy, how it works.
[CUSTOMER][NEUTRAL] What kind of because I, I genuinely do not understand how my, my, my benefit, what, what, what, what, what, what, what kind of plan I have or what how it works.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alright, so this is your secondary policy. We're 2nd to AMed, your major insurance. Um, so anytime you, anytime you give your AMed card, just go ahead and give your Medlink card. We pay towards the copay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect that was literally what I was trying to figure out.
[AGENT][NEUTRAL] Oh, well, yes, that's what this is for, yes, sir.
[CUSTOMER][NEUTRAL] OK, so I
[CUSTOMER][NEUTRAL] Beautiful. So I because I have Amed, right? And I, and I, and I have this, and I always wondering why is like it's two different insurance. I'm not understanding why I have two different insurance companies.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, yeah, OK.
[CUSTOMER][NEGATIVE] And I went to the doctor like 2 times and I gave them both cards, but for some reason, I, I got a charge.
[CUSTOMER][NEUTRAL] For I think I got 2 charges because I went 2 times for $100 I think.
[CUSTOMER][NEGATIVE] I should pay for I'm not I'm not let me see what they say the charge was for just to make sure uh.
[CUSTOMER][POSITIVE] How do I find it? Oh perfect.
[CUSTOMER][NEUTRAL] Uh, 2 seconds.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, give you an invoice.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] You still know.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][POSITIVE] OK, perfect, so.
[CUSTOMER][NEGATIVE] I got charged $100.02 times for an urgent care visit and
[CUSTOMER][NEUTRAL] I'm not sure exactly why I'm being charged if my insurance doesn't cover that visit as well, but when I called [PII], they say they only cover for.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] By the medical part and part of the
[CUSTOMER][NEUTRAL] The co-pay, so I'm saying what is APL for it? Does this insurance cover the other half of that visit?
[AGENT][NEUTRAL] OK, so let me get the dollar amount. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So your policy is broken up into inpatient and outpatient. Is this something to where you're admitted to the hospital or this is, you said urgent care, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, it's urgency. I just went to have a check.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] So that would be under outpatient. So for outpatient, your policy would pay up to $500 per day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I was that I remember I was told.
[CUSTOMER][NEUTRAL] That's with my APL or that's with Amin?
[AGENT][NEUTRAL] So, once, OK, so when the bill comes out, they're going, their bill asmed and then after they bill admed, AMed is going to pay or you know, give their decision and then send it back to the provider. At that point, the provider is supposed to bill us.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that you don't receive the bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That's what, no, it's making sense because whenever I gave them my twins, they always just pay the admin card. I'm not sure why they're not, they're not understanding when I'm explaining to them my other insurance is supposed to cover for any other payment that's supposed to be done.
[AGENT][NEUTRAL] So in that case, I would just um give them a call, let them know that you have a secondary insurance. I would say um here's their phone number for verification and you can bill them for these claims because they, they haven't billed us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got you because that's man, no it's making sense. OK, so I'm gonna give, I'm gonna go ahead and call them and then they might be contacting you guys and we should go from there.
[AGENT][NEUTRAL] Yeah, as long as they have your policy number, um, of course, your first and last name and your date of birth, we can verify them and then we can go through the, the benefits with them and then give them all of our claim information, but a lot of um providers will turn the patients away because they're not familiar with the secondary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm. Exactly, man, you are the best. Thank you for providing me with this information. So when I call them, I just give them this insurance and the policy number basically.
[AGENT][NEUTRAL] Yes, give the policy number and then let them know we're your second. Um, we're supposed to, you can even say we're supposed to be billed after Amed.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Beautiful, beautiful. OK, thank you so much. I will be calling them if I have any problems I will give you guys back a call.
[AGENT][NEUTRAL] Alright, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] I was there anything else I could.
[CUSTOMER][NEUTRAL] Uh, one last, so basically I have never used this insurance then.
[AGENT][NEUTRAL] Right. Um, let me just double check though.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, um, the policy has been active since [PII], but there's been no claims filed, so we, um, you haven't used it yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well you
[CUSTOMER][POSITIVE] OK, so it's all making sense. Thank you so much and I might be contacting you guys back if I have any problems.
[AGENT][POSITIVE] All righty. Well, thank you so much for calling APL and I hope you have a great evening.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.