AccountId: 011433970860
ContactId: aa4d6c53-5a52-4d17-adbf-2b0a14967a7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492820 ms
Total Talk Time (AGENT): 261780 ms
Total Talk Time (CUSTOMER): 214592 ms
Interruptions: 8
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/aa4d6c53-5a52-4d17-adbf-2b0a14967a7a_20250109T19:24_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] Hi, [PII]. My name is uh [PII] for [PII]. Um, I have a question. Um,
[CUSTOMER][NEUTRAL] So my son actually had a surgery um last year. Um, uh, he had a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A meniscus staff and actually, he got the surgery. And I got an uh out of pocket cost from the, uh, from the surgical center.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I think that this cost actually is covered under my policy.
[AGENT][POSITIVE] No, it would be my pleasure to assist you, Mr. [PII]. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Uh, no, I don't have the card. I, I can provide you with my social and need of my address.
[AGENT][NEUTRAL] All right, what is the social, please, sir?
[CUSTOMER][NEUTRAL] Um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. Thank you, Mr. [PII]. And what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you verify your uh mailing address, email, and phone number, please?
[CUSTOMER][NEUTRAL] Yeah, [PII]. And then uh my email is [PII].
[AGENT][NEUTRAL] And current mailing address?
[CUSTOMER][NEUTRAL] [PII] in the state of [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And well that was outpatient surgery?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, so you do have outpatient coverage. And was the surgery for um
[CUSTOMER][NEUTRAL] [PII], my son, yes, yes.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Got you. Let's see. I see that we received a document looks like.
[AGENT][NEUTRAL] Today
[CUSTOMER][NEUTRAL] Yeah, I just uploaded it, but I, I don't know how the procedure is. Do I need to pay it first or you guys can take care of it? I, I don't know.
[AGENT][NEUTRAL] OK, let me take a quick look for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mr. [PII].
[AGENT][NEUTRAL] Bear with me just one moment.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's just taking my computer just a moment to get that image up. Bear with me just one second.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And have you paid anything toward the surgery?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yeah, so this, um, actually part of the cost has been covered by my, um, my main insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So basically the uh the cost cost $18,000 and basically um.
[CUSTOMER][NEUTRAL] You know, there has been some adjustment made so partial has been made paid by my um health uh insurance and it is the remaining balance that is for me to pay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you know if that's what your primary insurance applied to your deductible?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, that is a good one. I do not know that.
[AGENT][NEUTRAL] OK, because this, sure, you know, this policy pays towards your deductible, co-pay or co-insurance of your primary. So when they process a claim, normally if you have a deductible remaining, they apply an amount to your deductible.
[CUSTOMER][NEUTRAL] Can you repeat your question?
[CUSTOMER][NEUTRAL] Mhm. This is.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And let me just take a quick look at this it finally came up.
[CUSTOMER][NEUTRAL] this time.
[AGENT][NEUTRAL] And the easiest thing to do actually, Mr. [PII], is to contact Miami Surgical Center and make sure that they have your APL information on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what they can do is they can submit a claim to us and we can pay them any amount that was applied to your deductible co-pay or co-insurance for that service up to the benefit amount on your policy and your benefit amount is $1000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So thank you for that.
[AGENT][NEUTRAL] That we can pay to cover procedures on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if they file the claim, we will pay the provider or the hospital direct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] And then that way you don't have to pay out of your pocket.
[CUSTOMER][NEUTRAL] Oh, OK. OK. Can you, sorry, I interrupted you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] No, you're fine. Go ahead. I apologize.
[CUSTOMER][NEUTRAL] Can you give me my policy number so I can, when I call them that, um I can provide that to them so they can provide the claim to you.
[AGENT][NEUTRAL] Absolutely. Now, do you have a a card, an APL card?
[CUSTOMER][NEUTRAL] Uh, I might have ever got that, but I don't remember if I, I can, I probably, I cannot find it, but do you guys have an app or so that I can.
[AGENT][NEUTRAL] What I
[AGENT][POSITIVE] Mhm. I'm gonna help you and I can even email you a copy of your card if you would like.
[CUSTOMER][POSITIVE] Oh, that would be great.
[AGENT][NEUTRAL] I'm gonna do that right now for you so it will have at the bottom of the card, it's going to have the outpatient, well it'll have your policy certificate number and that is gonna be your policy number but I can give it to you if you'd like to write it down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it's fine. You can mail me too it's fine. Uh, then I have it at hand and then, uh, I can give them a call and then let them submit the claim directly to you.
[AGENT][NEUTRAL] OK, I'm emailing that to you. Just give me just one second.
[CUSTOMER][NEUTRAL] And yeah, go ahead.
[AGENT][NEUTRAL] And I'm, I'm gonna put your policy number in the subject line. I apologize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have another one actually, so I can send that to to, I can, uh,
[CUSTOMER][NEUTRAL] I can send that too. I can ask them 2 to bill you directly.
[AGENT][POSITIVE] Absolutely it's easier because the providers are always going to have the documents.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Needed
[AGENT][POSITIVE] To process a claim and that way you don't have to go and get all the documents that are required.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Give me just one second because I would like to make sure that you can open the card attachment.
[CUSTOMER][NEUTRAL] You need it
[AGENT][NEUTRAL] If that's OK, and I just emailed that to you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check if I got it.
[AGENT][NEUTRAL] It's gonna be from the care team.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And also I see you have an active account on our portal. You can print additional cards from there as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can view your policy.
[CUSTOMER][NEUTRAL] I'm gonna do that.
[AGENT][NEUTRAL] But anytime that you or your dependents go for medical assistance or attention, always show your APL card with your primary insurance card.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the providers can file the claims for you so you don't have to pay out of pocket if, if they ask for that if it's for a deductible co-pay or coinsurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And some providers may require that you pay upfront if that's the case. If it is a covered benefit, you can always file for reimbursement.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. OK. Thank you for that.
[AGENT][POSITIVE] Mm my pleasure.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] That, that was all. Thank you very much.
[AGENT][POSITIVE] Mr. [PII], thank you so much for calling APO. It was a pleasure to assist you. And if you need further assistance, please never hesitate to give us a call.
[CUSTOMER][POSITIVE] Yes, thank you. Thank you, ma'am.
[AGENT][POSITIVE] My pleasure, Mr. [PII]. Thank you for calling APL and you have a lovely day.
[CUSTOMER][POSITIVE] Have a good one. Take care, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.