AccountId: 011433970860
ContactId: ab562e98-5437-49ee-ae87-daddb99cc686
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294019 ms
Total Talk Time (AGENT): 144659 ms
Total Talk Time (CUSTOMER): 140346 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/ab562e98-5437-49ee-ae87-daddb99cc686_20250117T16:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling because I, we got disconnected. I, I don't know, I was talking to somebody else that was checking for me something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but, um, I went to a doctor's appointment today, and, um, they were charging me, uh, deductible, co-insurances, stuff like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and they said that it was because of the, the beginning of the year and so forth. And I told them that I had a gap insurance and they told me that it would, that it
[CUSTOMER][NEUTRAL] My benefits would come, uh, starting in June, from June to June. Is that right? Or I thought it was a calendar year.
[AGENT][NEUTRAL] Um, I can check for you.
[CUSTOMER][NEUTRAL] Like, I thought it started.
[CUSTOMER][NEUTRAL] I'm, I thought it started like now in January to January. You understand?
[AGENT][NEUTRAL] Mhm. You thought it was a calendar year and they're telling you it's a plan year. I can check for you. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, [PII], and the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I hold on let me see if I have it here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. 02493162.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify your, well, hold on one moment. You just got off the phone. I don't want you to have to verify everything again.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Like she, she even told me, can you give me a, provide me a number so that in case we get disconnected, but she never called me back, that's.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, I don't see any notes on here either. They, she may be trying to call, um, but it's OK. I can help you. So, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Just for the call since there's no notes, can you just verify your date of birth, your mailing and email address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. So I'm pulling your policy now so I can see the benefits.
[AGENT][NEUTRAL] Oh no, this is calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean, the, it did start in June, but it's a calendar year, so [PII], everything starts over again. Well, you know, [PII] that just passed.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK, right, and so it's $3000 correct?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Yes, ma'am, for outpatient, you have 3000 for the um calendar year.
[CUSTOMER][NEUTRAL] OK, so it, it should have started from [PII], correct?
[AGENT][NEUTRAL] Mhm. [PII], the 3000 restarted. Now, in terms of the co-pay, deductible, all of that, if they're requiring you to pay that upfront to be seen, then on the back end, once we receive the claim, you can be reimbursed for that or if they're still owed something we can pay them. But it depends on the provider. Sometimes they say they can bill the co-pay or the deductible. Uh well, recently they make you pay for everything upfront now, so, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, yeah, yeah.
[AGENT][NEUTRAL] So it'll be on the back end that you you see the claim processed and the reimbursement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And, and the reimbursement would come from you guys to me or from the doctor's office?
[AGENT][NEUTRAL] Um, it depends. If you give the doctor your policy, uh, your card, and they have it on file, then they, they're supposed to bill your primary first and primary pays, and then they'll bill us automatically after primary. So if they file it, then you don't have to do anything, but if you're um filing it then
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, it would come to you. I'm sorry, I said that backwards. If they're filing it, if they're filing it, we can still see what you paid and the reimbursement can still come to you. Um, so it's it either or you can file it or they can file it, but we'll still get the same information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. You're welcome. Have a great weekend.
[CUSTOMER][POSITIVE] All right you too thanks bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.