AccountId: 011433970860
ContactId: b0bf0bbc-71a0-4d63-84ac-a9ac76f866a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467299 ms
Total Talk Time (AGENT): 206815 ms
Total Talk Time (CUSTOMER): 260061 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/b0bf0bbc-71a0-4d63-84ac-a9ac76f866a6_20250128T16:34_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] Oh, hi there. I just, um, I have a, a question once again about my um benefits, my coverage, if you could help me out, please, and I have my um policy number.
[AGENT][POSITIVE] OK, well, I can definitely help you out with the benefit questions. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and my number is [PII] area code [PII].
[AGENT][NEUTRAL] Thank you for that, Ms. [PII]. May I have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's 0245488889.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yes, um, it's [PII]. The address is [PII], and the email address is [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And what type of benefit questions did you have?
[CUSTOMER][NEUTRAL] So, and I, I, someone just recently helped me a lot with something else, and then I forgot to ask about this. So, again, I just to be clear, so what is not covered with my plan with my employer are co-pays, coinsurances, or office visits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, OK, no, no. So your, so your secondary policy pays for co-pays, deductibles and co-insurance after primary.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In terms of the off.
[CUSTOMER][NEUTRAL] Oh wait, OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh wait, let me just write this sorry this is where like I need help here. OK, so wait, so you guys do will pay copays?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so
[CUSTOMER][NEUTRAL] Co-insurance
[AGENT][NEUTRAL] So basically, so Blue Cross Blue Shield, like, let's just say you go to the doctor's office, they say it's a $25 I'm just guessing, a $25 co-pay.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Like it's
[CUSTOMER][NEUTRAL] Or 60 specialists, yeah, yeah.
[AGENT][NEUTRAL] Right, whatever the amount. There's a co-pay that that Blue Cross Blue Shield is charging. Once we get the claim,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, on the back end, so there's, so there's two ways to do it. If the place you're going to makes you pay to be seen, then you will have to pay it upfront and then once we receive the claim, you could be reimbursed on the back end.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They do.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] But then the
[CUSTOMER][NEUTRAL] Oh my gosh, OK.
[AGENT][NEUTRAL] So you would just need.
[CUSTOMER][NEUTRAL] I didn't know any of this. OK, sorry.
[AGENT][NEUTRAL] Yeah, you would just present them with your ID card if you've already been seen, just give them a call with your policy number. You can give them our phone number too if they want to verify benefits. There's no like deadline or anything to file a claim with us a second, so, you know, you still have that time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know, which is great. No, and like literally I'm, oh my God, no, so this, so just so like, OK, so I have to go, my daughter is going to a specialist. They charge $60 every time we go.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And they're charging me like, even they have the secondary insurance, but they don't care, you know, so they charged me the 60. So you're saying though I could submit.
[CUSTOMER][NEUTRAL] That $60 invoice to you guys and I'll get reimbursed for that.
[CUSTOMER][NEUTRAL] Or if I show them my APL card.
[CUSTOMER][NEGATIVE] They shouldn't be charging me the 60.
[AGENT][NEUTRAL] No, no, no, no, that's not how it works. So on, so on the, everything that we do is going to be on the back end because we have to receive the claim to process it, but that's usually after the services are done. So, um, yeah, yeah, everything that we do would be on the back end. Now when you're talking of coverage and what will apply to, so your, your primary insurance has its own set of benefits and we have our own set of benefits. We just can't apply anything.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Unless primary does because we're 2. So if you, if you're going to like uh when you were speaking about the office visits.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I don't, so for your policy, there is no your secondary policy, there is no coverage for the in-office setting.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, got it, which is what this is, so the $60 that they charged me is an in office setting.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so then most likely it would not be covered on your secondary policy. This is more so like if you're in hospital and admitted or like outpatient for emergency room, urgent care, maybe like an outpatient surgery, just those two types of facilities.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure, so, but if I did go to an urgent care and I paid $40 there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's something though I could maybe get back.
[AGENT][NEUTRAL] Right, I would just give the anytime you give your Blue Cross Blue Shield card, just go ahead and give our card, because that way they'll bill Blue Cross Blue Shield first and then once Blue Cross Blue Shield pays, then they'll automatically bill us the provider as second instead of billing Blue Cross and then you receiving the bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I, and I do.
[CUSTOMER][NEUTRAL] Right, no, no, no, when I do this, but I'm, I just feel like there's a, there's a like a gap like a issue, there's a disconnect, um.
[CUSTOMER][NEUTRAL] Like, for example, and at least I just fixed it where I was gonna get an ultrasound.
[CUSTOMER][NEGATIVE] And they literally have the your guys' information. They have the secondary to ATL. And when I go there, it's for an ultrasound diagnostic. They're telling me I owe $500. And I'm like, so then finally, I canceled that appointment and I did call them just now. And I said, you guys, you know, I have, I now I'm clear though I have $500 per day that you guys will pick up or pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But it, it's more for like you said, like diagnostic, you know, hospital, right, emergency room or urgent care though, because I do have an urgent care bill that I paid. So that's something I'm gonna submit to you guys online. I'll, I'll figure that out. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, OK, so, uh, then my other question was though, how do I
[CUSTOMER][NEUTRAL] How would I handle, um, OK, I see like a um integrative health.
[CUSTOMER][NEUTRAL] You know, like hormone replacement therapy doctor, that's astronomical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and, but then she's saying, I guess she does take insurance, but I see, like, granted though, if I have an office visit with her, you guys wouldn't pick anything up. But what about, um, medications?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Do you guys do I have that on my plan? Because it's very expensive, the hormone replacement therapy.
[AGENT][NEUTRAL] No, so not, so because we're not a major medical, not just for you, any policy, when it comes to medication, it would be more so like the administering of it and where it's done versus the medication itself. You see what I'm saying?
[CUSTOMER][NEUTRAL] That I get
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, I do, I do. Yeah, no, no, and this is just the med it's like topical. No, this is the medication itself. OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] All right, I'm just thinking, OK, out loud. All right, well, I guess that I guess in that that whole doctor is not applicable as far as.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] That OK.
[CUSTOMER][NEUTRAL] All right, well, thank you. I think I'm OK. I'll, um, I'll call my main insurance for that.
[AGENT][NEUTRAL] All right, Ms. [PII], was there anything else I can help you with? You're welcome.
[CUSTOMER][POSITIVE] OK, thanks so much.
[CUSTOMER][POSITIVE] Um, no, that's it, thank you.
[AGENT][POSITIVE] All right, well, thanks for calling APL. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Have a good one bye.