AccountId: 011433970860
ContactId: baf09f02-317c-40e5-9be7-8fc9af38de19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574030 ms
Total Talk Time (AGENT): 252990 ms
Total Talk Time (CUSTOMER): 254363 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/baf09f02-317c-40e5-9be7-8fc9af38de19_20250207T17:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APA.
[AGENT][NEUTRAL] Hello, this is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Um, hi, good afternoon. I'm calling because, um, my husband has an MRI, um, this Monday, and I was just called from the diagnostic place, and they told me that he has a $590 he has um 8 now. I, I don't know if I'm pronouncing it correctly, and then he has this, he has you guys as.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I don't know, like cause I, I, he, he pulled this card out just now and I'm like, why didn't you show this card when we went to get the referral? And he's like, oh I forgot that I had this also, but he doesn't know exactly if you guys.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or can help him, or this plan covers some type of deductible because he needs two MRIs and then for each one, he needs to pay 590, and he was in the hospital and they said that he needed to get um an MRI within 48 hours. So, you know, we don't want to cancel the appointment because of the money, but honestly, we're currently in a hardship.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, so I was hoping to see, I'm like, oh, let me call them to see if, if, if this would cover any way, the deductible, or if it can be like a discount or, or anything that he can use you guys for that procedure.
[AGENT][NEUTRAL] OK, go, go ahead and give me your name and a member's policy number where I can get it pulled up and look at it.
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and it says here, it would it be the outpatient benefit because it's a it's, I don't know if that's an MRI in a diagnostic place, is that considered outpatient or I give you the, yeah, OK, it's 0162.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 88, 80, and then it's M as in Mary.
[CUSTOMER][NEUTRAL] L as in love and then 8.
[AGENT][NEUTRAL] Alrighty. Alright, you said your name was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, my name is [PII] and his name is [PII].
[CUSTOMER][NEUTRAL] The Lord [PII].
[AGENT][NEUTRAL] Alright, [PII], let's see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, um, well, due to the HIPAA, [PII], I'm not allowed to speak with you because you're not on the contract. So is, uh, [PII] around where I can speak with him?
[CUSTOMER][NEUTRAL] I, if, if you, can I make a, can I make, can I call him on the other line and and transfer him to you?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Oh, thank you so much. Give me one moment, OK? I'm gonna call him now. Thank you. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Hello, thank you so much for waiting. He's on the line. Hello?
[AGENT][NEUTRAL] Yes, hello, this is [PII]. Yes, zero, go ahead and verify your date of birth and your address for me, please, sir.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Of course, [PII].
[CUSTOMER][NEUTRAL] And um my address is [PII].
[AGENT][NEUTRAL] OK, thank you so much for all that information. OK, now, um, [PII] was asking about you're gonna have a MRI done and she was checking the benefits. Is that correct? OK, so let me get over, get over to your policy. OK, now, of course, what we are is your medical supplemental plan.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the only thing that we will pick up and pay on is anything that is applied towards your deductible, your co-pay, or any co-insurance at your primary insurance carrier for sickness and injury only. Nothing routine here would be covered. Um, now I do show that for your outpatient benefit here, you have a zero deductible, no preferred, and a $5000 outpatient benefit here at APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you understand that [PII]? Um, so.
[AGENT][NEUTRAL] But, but what
[CUSTOMER][POSITIVE] Yes, yes, go ahead, I'm sorry.
[AGENT][NEUTRAL] Yeah, but what you do definitely need to do is, uh, wherever you're having this MRI done, go ahead and give them your primary insurance carrier's information, your ID card, but you also need to give them your APL information as well. Now, [PII], uh, you had the incorrect policy number.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Uh, you have transferred over to a different policy number. I'm gonna give you both your correct policy number. This will be the policy number you need to give, uh, any doctor or hospital, um.
[CUSTOMER][NEUTRAL] Oh, I did, OK.
[AGENT][NEUTRAL] For your APL benefit and they can call me on the same number you just did, and we can give them your benefits so they'll know what your benefit here, but your policy number is gonna be 024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 024.
[AGENT][NEUTRAL] 329. I'm sorry, yeah, 02432944.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 44. And if they tell me like, if I can send them a copy of the, of the card, um.
[CUSTOMER][NEUTRAL] What do I do because I, I, we only have this card and it has that number that I gave you.
[AGENT][POSITIVE] Yes, and, and that's fine you can they can still print that if they need it because when they call here we can we can actually locate the correct policy number so that's not a problem for our end at all.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, OK. Now, um, but would they need to process the whole paperwork again, like the authorization, like the same process that they did with the primary because since the appointment is for Monday, um, because I don't.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That I can't answer. Yeah, that I cannot answer. That's up to them. Yeah, I can just tell you what your benefit is here. I, I can't tell you what the process is there. Yeah.
[CUSTOMER][NEUTRAL] Right, but definitely, but definitely, um, you think that there will be no co-pay on my behalf, right? on my behalf?
[AGENT][NEUTRAL] Well, you have a $5000 outpatient benefit here so whatever bill comes in first that accumulates that for covered benefits you do have $5000 though for outpatient benefit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, cause they're telling me my wife that I'm supposed to pay $500 for the MRI. 59,059,050.
[AGENT][NEUTRAL] Yeah, no. Yeah. Now what they make you pay upfront is between you and the hospital. We can't change that. But I can't tell them what your benefit is here.
[CUSTOMER][NEUTRAL] So, so in other words, um, to understand the, you know, because I'm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In other words, like if they, if they try to charge the 590 on Monday upfront, I tell them to, I show them this card.
[AGENT][NEUTRAL] Yeah, you definitely need to show them the card, but I'm not sure that that's gonna make a difference in what they're making you pay up front. I don't know that's like I said between you and that hospital.
[CUSTOMER][NEGATIVE] Oh, so this card like it wouldn't cover the 590.
[AGENT][NEUTRAL] Uh, if it applies towards the deductible co-pay or co-insurance at his primary insurance carrier, and it's a covered service here, then yes, but of course I can only give this benefit. I cannot guarantee a payment over the phone.
[CUSTOMER][NEUTRAL] No, yeah, because she did explain to me that they checked his primary care insurance and that he does have a $5000 deductible that hasn't been met.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, well, that's what he has here. Yes.
[CUSTOMER][NEUTRAL] So in, in this case, if I show this card.
[CUSTOMER][NEUTRAL] Yeah. So if I show this card, it
[AGENT][NEUTRAL] Yeah, and maybe them just calling him. Yeah, maybe them just calling here, uh, will surpass and knowing that you have a supplemental plan that will help, uh, pick up that deductible, will help maybe defer them into making y'all pay it upfront, but like I said, it's strictly up to the hospital.
[CUSTOMER][NEUTRAL] OK, yeah, because let's say if we pay it up front, can we then, um, can you guys refund us while they do the authorization process or no, that's not a possibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, because usually the hospital is gonna send that claim in a sign.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Unfortunately, I have to come from the hospital, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Oh, wow.
[CUSTOMER][POSITIVE] OK, all right, thank you for the clarification. I appreciate it.
[AGENT][POSITIVE] Well, well, yes, ma'am, then is that all I can help y'all both with?
[CUSTOMER][POSITIVE] Yes, yes, thank you, thank you for your time. OK, thank you, bye.
[AGENT][POSITIVE] OK. All right. Well, yes, ma'am, and thanks for calling APL. Mhm. Bye-bye.