AccountId: 011433970860
ContactId: a11babd7-5e2b-4ec0-81e3-2e4dbeeb7575
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 944830 ms
Total Talk Time (AGENT): 530928 ms
Total Talk Time (CUSTOMER): 346075 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/a11babd7-5e2b-4ec0-81e3-2e4dbeeb7575_20250103T15:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII], and my policy number is 02473029.
[AGENT][NEUTRAL] I'm so sorry it kind of cut out there at the beginning um did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sorry about that, could you repeat all that?
[CUSTOMER][NEUTRAL] OK, the policy number is 02473029.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK thank you what was your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what can we help you with today?
[CUSTOMER][NEUTRAL] OK, I just have a question. OK, um.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] In with regards to like paying payment, where do I use this card specifically?
[AGENT][NEUTRAL] Um, let's see, OK, um, you, you, where can you use your secondary medical? Is that what you mean?
[CUSTOMER][NEUTRAL] Right, because some places, um, like they don't accept it and when they do accept and send in a claim, you, you guys denied so I just wanna know where.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I understand. OK, well, first I'll check on those claims and look at those denial reasons. Um, uh, really quick, if you don't mind, I'm gonna verify some information. Um, can I get your date of birth please [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII] and the zip is [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] All right, thank you so much for verifying that. OK, so in short, to answer your question, it, this card, your secondary medical is very dependent on your primary insurance. So as long as your primary insurance will is willing to cover any uh thing that you, any kind of treatment that you receive medically, then this policy has the potential to help. If your primary will not pay, it's not something that they'll cover, then this policy can't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now as to where you can take it, unfortunately it is going to be up to each provider whether they choose to file those claims for you. Some simply don't mess with secondary coverage at all or any sort of supplemental coverage that doesn't mean that it would not be covered though in those cases you could still file those claims yourself. Does that make sense?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm mhm OK.
[AGENT][NEUTRAL] OK, I know it's a bit confusing alrighty and then so let me take a look here. I've got we've received two claims for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The first one looks like it was for a date of service for [PII] uh at Elite Imaging.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that one did let me take a look at this one. OK, so that service was simply not covered uh when it's performed in a doctor's office or clinic, so that was just something that's not covered under this policy. I do see another, yes, go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so, so in other words, in other words, at the elite imaging where I've used this card before.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] It wasn't covered. That's what you're saying? Because I see where you say you paid like $35 and that's like.
[AGENT][NEUTRAL] You know, I'm looking at that. I think they resubmitted it. And let me make sure this is the same procedure.
[CUSTOMER][NEUTRAL] this is, this is uh like a.
[CUSTOMER][NEUTRAL] An ultrasound.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, yes, I think they resubmitted the information um it might not have shown correctly because yes this is the same essentially it's the same claim, so they submitted it the first time it looks like it might have been incorrect or incomplete information. The second time looks like it was, so we did pay that $35. Let me see, and that was simply the.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] But $35 is is what I would pay my out of pocket.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's, that's what this policy helps with. So this policy is designed to help with co-pay, deductible and co-insurance. Again, as long as your major medical pays. So that's what this policy helps with.
[CUSTOMER][NEUTRAL] You know, so I don't understand.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's so it's like at first when I signed up for this uh coverage, they were saying like it's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think the average is like 200 and something dollars.
[AGENT][NEUTRAL] Oh, you the benefit amount? let me see.
[CUSTOMER][NEUTRAL] Per
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] OK, so your outpatient benefit amount is on a per calendar day basis, so there's no yearly maximum, so yes, it is $300 max per calendar day. Now, um, was there supposed to be more um that was owed for this procedure?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] $300.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm assuming because I, I see your total bill charge is $616 and, and from that $616 you guys only pay $35 and the $35 is what I would pay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that amount that you're showing that 600, uh, was that after your major medical paid, is that the balance they sent you?
[CUSTOMER][NEUTRAL] I haven't seen in the balance. It's just that I'm going over what um the statement that you sent.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] OK. Let me take a look. Um.
[CUSTOMER][NEUTRAL] It should pay to provide the $35.
[AGENT][NEUTRAL] Oh, that's
[AGENT][NEUTRAL] Yes, OK, give me just a moment let me pull up so we're looking at the same thing.
[AGENT][NEUTRAL] Bear with me just a moment, it's thinking about it. Here we go.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] There we go. OK.
[AGENT][NEUTRAL] OK, I see what you're saying right, so when it says the total bill charges, yes, so in that case I'm going to take a look at what was actually submitted to us there's a couple of uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Circumstances that could be and a lot of the cases that simply means the total bill amount um meaning before your major medical contributed like that's what it shows before anything was taken out. So give me just a moment, let me take a look.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so I'm not seeing any of that. Here's what we can do, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you don't mind that, I can put you on a brief hold and reach out to our claims specialist just to make sure that this is accurate. Um, they might be able to see something that I don't because I'm, I'm kind of see see surface level. Worst case, I would reach out to Elite Imaging and verify that, especially if you've not received any bill from them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, just to make sure that that is accurate and maybe you know what I'm assuming is that that's the balance before your major medical since $35 is all that we were technically billed, um, that we were billed, that's what I'm assuming was just left over but if you want to just for good measure, um, I'll reach out to them to make sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a moment I'm gonna put you on a brief hold, OK? I'll get right back with you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] Hi, I'm sorry, who was this?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][NEUTRAL] I'm fine. How are you?
[AGENT][NEUTRAL] Doing good thank you um I was wondering if you could help me out. I have a uh insured on the line calling regarding a claim. Um, she's a bit confused. Uh, we paid $35 she sees on the EOB where it says total bill charges $616. Um, I can't see. I looked in on base and I'm not able to see what was submitted to us. I'm assuming that that's what it the balance was before major medical.
[AGENT][NEUTRAL] Um, but I wonder just wanting to make sure, especially since she hasn't heard from that provider, but she wanted to make sure that that was it.
[CUSTOMER][NEUTRAL] Yes, of course. Um, what is the policy number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it is 0247.
[AGENT][NEUTRAL] 3029.
[CUSTOMER][NEUTRAL] Thank you. And the insured's name and date of date of birth?
[AGENT][NEUTRAL] Um, it's [PII], give me just a moment. Hang on.
[AGENT][NEUTRAL] For for [PII], I think is how you say the last name. Um, date of birth is uh [PII].
[CUSTOMER][NEUTRAL] Of course, let me see what I've got here.
[CUSTOMER][NEUTRAL] Looks like this is just done.
[AGENT][NEUTRAL] And she confirmed the 35 is usually what she would pay out of pocket and so again that's what I'm assuming I know sometimes on our EOBs when it says total bill charges that's before primary pays.
[CUSTOMER][NEUTRAL] Right, right, yeah, that.
[AGENT][NEUTRAL] But and that's again what I'm assuming but I don't, I don't see what was submitted to us. I looked in on Base and all I can see is our EOB.
[CUSTOMER][NEUTRAL] Oh right, of course. Um.
[CUSTOMER][NEUTRAL] Let's see what we've got here.
[CUSTOMER][NEUTRAL] OK, so this is for late imaging. Um, it looks like she had, uh,
[CUSTOMER][NEUTRAL] Uh, some sort of scan done. Now, um, the original, uh, cost of this, uh, is, is you were mentioning a $616. Um, now, what ended up happening is, is that the, uh, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Her total, her total patient responsibility is at $35. Uh what they did was the provider paid $111.30 and, uh, it looks like they uh they approved, they only allowed.
[CUSTOMER][NEUTRAL] Um, $146.30. So the, the billed amount may have been $616 but the, uh, uh, Blue Cross and Blue Shield, which is her major medical, only allowed 14,630. So, uh, her, her responsibility was $35 which we paid and then Blue Cross and Blue Shield paid 111,130 cents. So, um, she doesn't owe any, she probably hasn't heard anything from the, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, provider because it's been, it's been taken care of. It's been paid in full as far as
[AGENT][NEUTRAL] That's what I assumed. OK, yes, I appreciate you verifying that. So going forward, so I don't have to bug y'all more than I have to, um, is it probably be safe to assume those total bill charges that's, and especially if that's not what we show what we were billed um out of the payment, um, that's gonna be before primary that's what I've kind of noticed but is that safe to assume?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] It is, but you know, um, if you ever have any questions, that's actually what we're here for, so, uh, and if you wanna send them over to us to talk to, you know, but, but yeah, um, absolutely, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You know that's, that is what you, that's usually what that means but if you ever have any questions, um please uh just um let us know and we're here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I sure appreciate it. I like trying to do it myself, but that's what I like you know teaching, yes.
[CUSTOMER][POSITIVE] No, no, of course, but if you have any questions, no, if you're not begging us at all, that's really what we're supposed to be doing. So, um, uh, it's helping you guys. Sure, if any questions, just let me know. Otherwise have a good weekend. Thanks for letting me mhm bye.
[AGENT][POSITIVE] Well, I sure appreciate it. Thank you, [PII]. Absolutely, yes.
[AGENT][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you so much bye bye.
[AGENT][NEUTRAL] All right, [PII], sorry about that wait, are you still with me?
[CUSTOMER][NEUTRAL] Yes, yes, I'm here.
[AGENT][POSITIVE] OK, so we did, I did verify um that this information is correct so your patient responsibility was just that $35 so that was all that we paid and that's why that's all that we paid. Your Blue Cross Blue Shield took care of uh everything else, so you are, you are set. I know it's a bit confusing and I'm sorry about that. I was a bit confused myself, um, but yes, I did get confirmation and that's probably why you haven't heard from Elite imaging because it has been resolved.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, OK. So bottom line, you pay out like $30,300 maximum per day, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's correct, yes, for no, that's for outpatient, yes, um, that's the maximum, yes, so if for some reason there was a higher, um, and and again it goes towards co-pay, deductible and co-insurance. So any of those things it's up to that $300 limit per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For outpatient, OK.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and OK, so for example, I have to do like a stress test now that office doesn't accept um your
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your policy, right? So I can still pay um.
[CUSTOMER][NEUTRAL] Whatever claim that that office um that I that I'm responsible for, but at the end of the day I can submit a claim to you after I've.
[AGENT][NEUTRAL] Absolutely, absolutely you can um and there's a few different ways you can do that. I would say the quickest and easiest way for you to file claims to us would be through our online portal um have you created an account online with us before?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. Do you have access to a laptop or a desktop computer?
[CUSTOMER][POSITIVE] Yeah, yeah, I do, I do.
[AGENT][NEUTRAL] OK perfect um I say that because the site uh does not have any mobile support, so you wouldn't be able to do it through a phone or a tablet um if you'd like I can give you that web address, um, or I can email it to you, whatever's easier for you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][POSITIVE] Yes you can please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You can email it to me.
[AGENT][NEUTRAL] OK, yeah, um, I will go ahead and get that sent to you, um, while I'm sending you an email, [PII], um, I don't know if you have this or not, but would you like me to send you a copy of your policy?
[AGENT][NEUTRAL] That does go through what is and is not covered frequencies, dollar amounts.
[CUSTOMER][POSITIVE] Right, right, right, right. Yes, yes, that would be helpful.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][POSITIVE] Absolutely all right well I will get all of that sent to you um was there anything else I could help you with? Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, that's it. That's it.
[AGENT][POSITIVE] OK, alright, well I'm happy I was able to help you get that resolved.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I hope you have a great rest of your day. Thanks for giving us a call.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Thank you. You too. OK, bye.
[AGENT][POSITIVE] Oh, you're very welcome thank you bye bye.
[CUSTOMER][NEUTRAL] Right