AccountId: 011433970860
ContactId: b2307711-e51e-428f-a4b1-e07441ef8055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 841390 ms
Total Talk Time (AGENT): 341175 ms
Total Talk Time (CUSTOMER): 328277 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/b2307711-e51e-428f-a4b1-e07441ef8055_20250227T16:59_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] So
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning or afternoon. This is uh [PII], and um I have a question. My wife is going into surgery tomorrow to have her gallbladder removed. And um there's some charges from the hospital that just, they don't seem to clear as far as, or some confusion maybe as what's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Being covered and what's not being covered along with my insurance and then the APL plan.
[AGENT][POSITIVE] It would be my pleasure to assist you, Mr. [PII]. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] And that is
[CUSTOMER][NEUTRAL] Like the outpatient benefit cert number is that the one?
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][NEUTRAL] OK, I'm sorry, let me grab my glasses here.
[AGENT][NEUTRAL] You're fine. I understand that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I can see it now here we go. It is 0249.
[CUSTOMER][NEUTRAL] 3493 M as in Mary L as in Lima 8
[AGENT][NEUTRAL] Thank you. And Mr. [PII], do you mind verifying your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Yes, it is. Uh, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And the mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do we need to update that address? We have a [PII] address for you.
[CUSTOMER][NEUTRAL] I thought she did yesterday. I had called yesterday as well, but um, yeah, that's my old address but yes we do need to update it if it hasn't been updated yet.
[AGENT][NEUTRAL] OK, let's update that address. What is that current address again?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what city was that?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And zip code is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In the state of [PII].
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the zip code is.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what about your email and phone number? Let's make sure we have the correct information on file.
[CUSTOMER][NEUTRAL] It is [PII]. That's [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Alright well I am updating that information for you so you'll be able to receive an account uh.
[AGENT][NEUTRAL] Any mail to your new address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And so this will be an outpatient procedure?
[CUSTOMER][POSITIVE] Correct, I believe so, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not gonna stay there, it's just uh like gallbladder type of thing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So anything under 18 hours is considered in outpatient, I'm sorry, outpatient hospital, and you do have a calendar year max of $1500 that we can pay towards your deductible, co-pay or co-insurance of your primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now that is verification coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So what the confusion is is they're saying well I have my regular.
[CUSTOMER][NEUTRAL] Insurance deductible.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] $1500.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] That's what you guys are going to pay plus another the 20%.
[CUSTOMER][NEUTRAL] Is what they're saying that I need to come up with, but the deductible is paid outside of the $1500 isn't it?
[AGENT][NEUTRAL] So, the $1500 is, yeah, it's actually the max benefit that we can pay towards your deductible. Now, they're talking about the 20%, it, I'm wondering if that is like a co-insurance on your primary insurance.
[CUSTOMER][NEUTRAL] I thought that
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right, it's coinsurance.
[AGENT][NEUTRAL] So if we pay that maximum benefit of $1500 to cover your deductible of your primary, then there would be no more benefits payable. If your primary does apply a 20% co-insurance.
[AGENT][NEGATIVE] If we pay that $1500 deductible, then there's no benefits.
[AGENT][POSITIVE] Available because it maxes that benefit out.
[AGENT][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] If it doesn't need to say something, we'll, we'll, we'll, we'll go at it from a different angle.
[CUSTOMER][NEUTRAL] I guess it um.
[AGENT][NEGATIVE] Insurance is so hard to understand anyway.
[CUSTOMER][NEUTRAL] Yeah, well, cause I thought.
[CUSTOMER][NEUTRAL] My annual deductible was like.
[CUSTOMER][NEUTRAL] $5000 or something like that, right? With my insurance?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So I'm wondering, did they say that that 20% is for a co-insurance, or is it, do you know how much your primary insurance is going to apply to your deductible? Did they pay you?
[AGENT][NEUTRAL] What amount would be for your deductible?
[CUSTOMER][NEUTRAL] 1500.
[AGENT][NEUTRAL] OK, so that's
[CUSTOMER][NEUTRAL] They're saying the deductibles 1500 and then 20% co-insurance of 1402 is what I'm responsible for.
[AGENT][NEUTRAL] OK, so if they send us a claim,
[AGENT][NEUTRAL] And then we pay the $1500 deductible.
[AGENT][NEUTRAL] On the APL policy, there would be no more benefits available to help cover that 20% co-insurance.
[CUSTOMER][NEUTRAL] OK, so that is right then.
[CUSTOMER][NEUTRAL] OK, for some reason I thought that.
[AGENT][NEGATIVE] Unfortunately,
[AGENT][NEUTRAL] That seems high, doesn't it?
[CUSTOMER][NEUTRAL] I always thought it was 100%. Like once the deductible's paid.
[CUSTOMER][NEUTRAL] Which it it always seemed like APL would pay the deductible no matter what.
[AGENT][POSITIVE] Up to that benefit amount, yes sir.
[CUSTOMER][NEUTRAL] Because they're all.
[AGENT][NEUTRAL] And you may wanna call your primary just to see.
[AGENT][NEUTRAL] Um, regarding that co-insurance.
[AGENT][NEUTRAL] Cause it sounds like that's what they are applying to that service.
[CUSTOMER][NEUTRAL] Because I thought isn't there like the 500 $5000 what's the $5000 PPO part of that then?
[AGENT][NEUTRAL] So with your APL policy, you have the $1500 plan and that means you have a $1500 calendar year benefit for inpatient hospitalization and a $1500 benefit for outpatient services.
[AGENT][NEUTRAL] And that is
[CUSTOMER][NEUTRAL] So we don't have.
[AGENT][NEUTRAL] Let me just make sure because.
[CUSTOMER][NEUTRAL] I thought we had the 5000. The way that like my work explained it to me, we have the 5000 like PPO plan which is paired with the 1500.
[CUSTOMER][NEUTRAL] EPO one is what they told me at work, which should cover everything as far as like things like this.
[AGENT][NEUTRAL] I wonder if that could be through a different, uh, insurance provider. Do you have any other insurance?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm mm, it's through APL.
[AGENT][NEUTRAL] Cause with our company, Mr. [PII], you do have the medlink gap policy and an accident policy.
[CUSTOMER][POSITIVE] You're right.
[CUSTOMER][NEUTRAL] The Min gap policy, right?
[AGENT][NEUTRAL] Mhm. And let me just check this accident policy and let's see if there's anything payable on it as well.
[AGENT][NEUTRAL] For gallbladder surgery.
[AGENT][NEUTRAL] We'll take a look at that as well.
[AGENT][NEUTRAL] Just take just a minute.
[AGENT][NEUTRAL] And if you ever want to view your policy benefits, we do have the portal.
[AGENT][NEUTRAL] If you have an active
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Account on my portal.
[AGENT][NEUTRAL] Then, um,
[AGENT][NEUTRAL] You can click on the policy numbers to view the benefits.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I didn't know you had a portal, OK.
[AGENT][NEUTRAL] We do. That is at [PII].
[AGENT][NEUTRAL] I am checking your outpatient surgery benefits, but it's going to be like for an accident surgery, like repair of tendons.
[AGENT][NEUTRAL] Um, torn knee cartilage surgery.
[AGENT][NEUTRAL] It would not be for medical surgery.
[CUSTOMER][NEUTRAL] OK, that gap coverage then thingy, is that what it is or?
[AGENT][NEUTRAL] That's the accident policy that I was looking at just to make sure.
[AGENT][NEGATIVE] That there were no additional benefits for gallbladder.
[AGENT][NEUTRAL] And there's no benefits on the accident policy for your, for that gallbladder surgery, only on the the gap policy, meddling gap policy.
[AGENT][NEUTRAL] If you want to um help in creating if you're at a computer I can help you create that portal.
[CUSTOMER][NEUTRAL] Yeah, so what plan do we have then? Do we have like the $1500 EPO plan? Is that what it is, or?
[CUSTOMER][NEUTRAL] I think supplement that's what it is.
[AGENT][NEUTRAL] We have the meddling supplement. Give me just one second.
[AGENT][NEUTRAL] And you have the 1500.
[CUSTOMER][NEUTRAL] Is that what it is, the 1500? OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And maybe we were talking about something else last year then when she was gonna get it done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think it changed this year then.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'll have to go back through my notes then. OK.
[CUSTOMER][NEUTRAL] But no, I can go ahead, yeah, I'll do that portal later then and then um.
[CUSTOMER][NEUTRAL] If it covers the 1500, then we're still responsible for the 20 after the deductible, then that's what we'll have to pay. I just wanna make sure that's, that was correct.
[AGENT][NEUTRAL] Yes sir, I understand.
[AGENT][NEGATIVE] I'm telling you, medical cost is so expensive now.
[CUSTOMER][NEGATIVE] Oh, I'm telling you, it's, it's insane. This is like $45,000 for a gallbladder thing, you know, it's something so ridiculous. I don't know. If you don't have insurance, I, I wouldn't know what you would do.
[AGENT][POSITIVE] And no problem, yeah.
[AGENT][NEUTRAL] I don't know, and they're probably gonna be in there what, 30 minutes?
[CUSTOMER][NEUTRAL] It's, it's that, yeah.
[AGENT][POSITIVE] It's crazy. I agree.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] OK, well I think you cleared it up then. I just wanted to make sure that's what it was is what it was then and then um.
[CUSTOMER][POSITIVE] Um, I'll just go ahead and pay that, you know, we're good to go.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] And I wish that we could provide more assistance, but that's just according to the policy guidelines.
[CUSTOMER][NEUTRAL] No, no, that's fine. Yeah, it is what it is. So I just wanted to make sure on that. I, I thought that it was $1500 was for the co-insurance and then that there was actual an actual, uh, the deductible part of it was separate, yeah, separate benefit for like the deductible and then something for the coinsurance as well, but.
[AGENT][NEUTRAL] Separate benefit. Yeah.
[CUSTOMER][NEUTRAL] Um, maybe not. I think maybe in the past we had something like that, but maybe not anymore, so OK.
[AGENT][NEUTRAL] Well, it is.
[AGENT][POSITIVE] Well, it's been a pleasure to assist you and I certainly hope that [PII]'s uh surgery goes well.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] And she gets to feeling better.
[CUSTOMER][POSITIVE] Yes, thank you so much.
[CUSTOMER][POSITIVE] I know, I do too, yes, thank you so much.
[AGENT][POSITIVE] My pleasure. If you need any further assistance, don't hesitate to give us a call, OK?
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. You take care.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye-bye.