AccountId: 011433970860
ContactId: b33b321c-a717-4d52-b9e2-445f234a7b63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353390 ms
Total Talk Time (AGENT): 241325 ms
Total Talk Time (CUSTOMER): 77719 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/b33b321c-a717-4d52-b9e2-445f234a7b63_20250606T12:40_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] Hey [PII], my name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Good good good. I was calling to see uh what does this co-insurance cover?
[AGENT][NEUTRAL] What does the co-insurance cover or what does your policy cover?
[CUSTOMER][NEUTRAL] On my policy?
[CUSTOMER][NEUTRAL] Yeah, on my, uh, what does my policy cover? How about that?
[AGENT][POSITIVE] OK, um, I can definitely help you with your um benefits. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] 2579094
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[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] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, hold on one moment, I'm just waiting for your um policy breakdown to pull up and let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So your your policy is broken down into like inpatient and outpatient. So we pay towards the copays, deductibles, and co-insurance of covered charges after your primary insurance. Um, this policy is second to UnitedHealthcare.
[CUSTOMER][NEUTRAL] Well, actually the insurance now is Aetna.
[CUSTOMER][NEUTRAL] My [PII]
[AGENT][NEUTRAL] OK, well, the group is gonna have to um contact the group of the employer. We'll have to contact us and let us know that their major medical has changed, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once they, because this policy is second only to UnitedHealthcare, um, but
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, so once they let us, once they notify us of that in writing, we can go ahead and
[AGENT][NEUTRAL] And update that. Let me check, yeah, because it says it for the whole group.
[AGENT][NEUTRAL] United Healthcare, yeah, OK. So, we'll update that once they notify us that it's changed. And then um for inpatient, inpatient is anything after admission to the hospital and like you get your room, that's all inpatient. You have $5000 per calendar year to, to use towards inpatient expenses.
[AGENT][NEUTRAL] You have $1000 per year to use towards outpatient. Um, outpatient is uh emergency room, urgent care, outpatient surgeries, um, outpatient as you're going home the same day, um, physical therapy, diagnostic testing, that's all under outpatient. There is a $300 deductible if you do go to the emergency room.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, per occurrence, so occurrence is the related issues. So if you go for your shoulder every time you go for your shoulder, that's one occurrence. But if you go for your knee, that's another occurrence cause it's a different issue. Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have independent lab riders. So like if you have to go to um what's the Quest Diagnostic or Labor to get your labs, you have um coverage for that. It'll come out of the outpatient up to that $1000 per year.
[AGENT][NEUTRAL] So like if you have to pay.
[CUSTOMER][NEUTRAL] OK, so do I need?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so do I need to send that to you guys or would it automatically just happen?
[AGENT][NEUTRAL] Well, it depends. Um, I usually encourage my patients just go ahead and whenever you give the primary card like hospital, doctor's office, wherever you go, if you give your primary card, just go ahead and give your APL card because we're second to them. And um now, primary has its own benefits, secondary has its own benefits, but um if primary applies to the claim, for the most part, as long as it's covered by our policy, we will apply. Um, if you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you give them your card, they'll bill primary and then they'll automatically bill us next. So you won't have to worry about it, but you do have the option to file on your own if you like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have to do um.
[CUSTOMER][NEUTRAL] Infusions once a month.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would that be covered? It's an outpatient. I go in I get infused at the hospital and then they, I go home.
[AGENT][NEUTRAL] Um, it depends on the coding. If they send it over, uh, it depends on the coding, because if it's considered like an outpatient procedure, yes, because you have the outpatient, um, coverage, but if it's, uh, yeah, it depends on the coding, but for the most part, yes, if it's outpatient, you do have the coverage. I just don't want to, we can't really guarantee it until we see what all they, they're saying happened.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see what they're doing, yeah, yeah, yeah, OK, sounds good, that's all I needed to know.
[AGENT][POSITIVE] You're welcome. Well,
[CUSTOMER][NEUTRAL] So I don't know, I guess I'll call HR and see if they can let you guys know that it's a new insurance. It's been like that since January. I don't know why they haven't told you guys.
[AGENT][POSITIVE] Oh yeah, I would definitely um tell them that.
[CUSTOMER][POSITIVE] OK, [PII]ove.
[AGENT][NEUTRAL] Alrighty, well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all, honey.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APM Miss [PII]. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.