AccountId: 011433970860
ContactId: a7f74249-65f8-4dba-9188-0a0a650d0dbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560679 ms
Total Talk Time (AGENT): 180844 ms
Total Talk Time (CUSTOMER): 207232 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/a7f74249-65f8-4dba-9188-0a0a650d0dbd_20250603T17:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and our group number is 24214.
[AGENT][POSITIVE] 14 OK thank you.
[AGENT][NEUTRAL] And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, and Miss [PII] verify the name of the group, mailing address and the email address please.
[CUSTOMER][NEUTRAL] It's SFLRE Group [PII]. The email is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Um, I'm trying to come up with a cost after, um, a particular item is run through our primary insurance, which, which is UnitedHealthcare, and then through APL to see what our out of pocket would be. So I'm kinda hoping they gave the, the, it's for a hearing aid.
[CUSTOMER][NEUTRAL] And the um audiologist gave us the procedure code and the diagnosis code, and I called UHC to confirm that it is covered. We just, it's just the deductible, no coinsurance. So I wanted to see what APL would cover.
[AGENT][NEUTRAL] OK, do you have a particular insured's name or policy number?
[CUSTOMER][NEUTRAL] Um, I can give you my number, my, my, my, uh, social security number, yeah.
[AGENT][NEUTRAL] Oh, it
[AGENT][NEUTRAL] OK, is it for you?
[CUSTOMER][NEUTRAL] Yeah, it's for my husband, but you can use it because we're still trying to figure out if we're gonna do it, so it's the same policy. It wouldn't matter.
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh yes ma'am. What's your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] That would be nice if I can type today.
[AGENT][NEUTRAL] OK. And Ms. [PII], verify your date of birth and mailing address, please.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] Ma'am, are you still there?
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][POSITIVE] OK. Thank goodness. My system decided wanted to act up today. I'm so sorry.
[CUSTOMER][POSITIVE] I know that's what happened when I called a few minutes earlier. It just cut me off, so I'm glad you asked.
[AGENT][MIXED] Yes, ma'am, for some reason it doesn't wanna work either, but that's fine.
[AGENT][NEUTRAL] See, is for, you said a hearing aid?
[CUSTOMER][NEUTRAL] Hearing aid and I've got a procedure code and a diagnosis code and I did confirm that UHC United Healthcare covers it. It's just our deductible.
[AGENT][NEUTRAL] 66.
[CUSTOMER][NEUTRAL] That is, um, so it's deductible, no coinsurance.
[AGENT][NEUTRAL] OK. What is that procedure code and diagnosis code?
[CUSTOMER][NEUTRAL] Procedure code is V as in Victor 5261.
[CUSTOMER][NEUTRAL] And the diagnosis code is H as in Harry 90.3.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, ma'am. And Miss uh [PII], verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your personal email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you and let me see.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK, you have to meet benefits under the plan.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] There no additional bilateral.
[AGENT][NEUTRAL] H9 0.3.
[AGENT][NEUTRAL] It could be covered under the policy since you do have DME benefits, uh, durable medical equipment.
[AGENT][NEUTRAL] And go on by the uh.
[CUSTOMER][NEUTRAL] Is that considered durable medical cause I'm not sure that's what they're considering it because on UHC they have, it has a whole own like section just for hearing aid. That's why I was wondering.
[AGENT][NEUTRAL] Um, it would.
[AGENT][NEUTRAL] Classified uh DME because especially if it follows the direction or the definition of durable medical equipment is uh defined by the policy, like can uh stand repeated use. It's not an insert, um.
[AGENT][NEGATIVE] It's not a disposable.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Most hearing aids fall within that category unless it was implanted, which is, wouldn't be covered.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] But yeah, it will fall under uh the DME benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is outpatient, so not a guarantee of payment, just a verification of coverage. Under your outpatient benefit, the max payable is up to 4000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, and then, OK, that's fine, that makes sense, um.
[CUSTOMER][NEUTRAL] And if it didn't fall under DME.
[CUSTOMER][NEUTRAL] I, I'm, I'm just, I'm, I've been kind of trying to figure this out because I'm also the plan administrator so we're gonna have other people that's gonna have these similar questions so I need to understand that if it didn't fall under durable medical equipment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is it still covered?
[AGENT][NEUTRAL] As far as hearing aid, no, ma'am.
[CUSTOMER][NEUTRAL] Because UHC is paying it?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] So it needs to fall under is was that OK, was that what the procedure code would be for the V5261, the diagnosis code?
[AGENT][NEUTRAL] Uh, yes, ma'am. Um, that would be considered DME since it's um a medical supply, durable medical equipment. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that would, OK, because they didn't say that when I called about it so that it fell under DME. OK, OK, so it would take up to $4000 total every year. OK, OK.
[AGENT][NEUTRAL] Oh, the outpatient, yes, ma'am.
[CUSTOMER][NEUTRAL] Outpatient, is that have has has part of that already been satisfied or is that per item?
[AGENT][NEUTRAL] Uh, it's per calendar year, give me one moment.
[AGENT][NEUTRAL] And I show he's already just used $72.26 of the $4000.
[CUSTOMER][NEUTRAL] OK, so there would only be $3920 some dollars.
[AGENT][POSITIVE] Good. I cannot do math without a calculator.
[AGENT][NEUTRAL] Uh, 3,92774 will be remaining for this year so far.
[CUSTOMER][POSITIVE] 2774. OK. OK. All right, thank you very much.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's good. Thank you.
[AGENT][POSITIVE] Uh, yes ma'am, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you. You too