AccountId: 011433970860
ContactId: bc71c6b0-25c7-4e3d-b100-2928e2c0a9c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311989 ms
Total Talk Time (AGENT): 133056 ms
Total Talk Time (CUSTOMER): 157779 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/bc71c6b0-25c7-4e3d-b100-2928e2c0a9c2_20250127T15:39_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, yes, good morning, [PII]. Uh, my name is [PII]. I have coverage through APL and I'm just calling to check on um on benefits.
[AGENT][POSITIVE] OK. Well, I can definitely help you with your benefits. And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and I don't have a policy number. I have a group number.
[AGENT][NEUTRAL] OK, um, I can find you through your group. What's your group number?
[CUSTOMER][NEUTRAL] Is 222-08.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, I believe I just found you. Um, I just need you to verify, oh, there's two, what's your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, this is right, and then I just need to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, date of birth is [PII]. Email is [PII], and my address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And what type of benefits did you want to go over like outpatient or would it be in hospital?
[CUSTOMER][NEUTRAL] It'll probably be in hospital.
[AGENT][NEUTRAL] OK, so if you do have to get admitted, um, the policy would pay up to $5000 per calendar year for your in-hospital visits. There's no deductible.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][POSITIVE] Oh, you just saved my day.
[CUSTOMER][NEUTRAL] OK, so I'm just.
[CUSTOMER][NEUTRAL] Uh, overwhelmed a little, so I apologize, but I have to have some pretty extensive neck surgery and you know they're saying I have to come up with this huge amount of money that I, I, I can't afford. So you're saying is that um I'm, if I have the surgery in hospital inpatient within spending the night, so I would be inpatient, you would pay 5000 right off the top.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, no, so,
[AGENT][NEUTRAL] Your so we pay towards the copays, deductible and co-insurance after Florida Blue.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] So let's say if Florida Blue is is saying that there's a co-pay that needs to be paid or maybe a deductible that needs to be paid before the surgery, there's two things. It depends on the facility that you're having it at. You know, some places they would say, well, you have to pay this for the service to be done. If that's the case, then you would give them your Florida Blue and then you give them your um APL card.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEGATIVE] They will bill Florida Blue first, Florida Blue is gonna pay whatever and then whatever is left over, they're gonna bill us.
[AGENT][NEUTRAL] If they're requiring you to pay that upfront, it's going to have to be paid upfront and then on the back end, there could be a reimbursement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let's just say the numbers are they're saying I gotta come up with uh $7500 prior to uh well I don't know the hospital I'm just talking about the surgery center which I'm probably not gonna use, but I'm just using the figure $7500 I would have to come up with and that would be um co-pay and deductible together so I would really come up with just $2500 and you guys would cover the other $5000.
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It it depends. If they're making you pay that upfront, the 75 upfront to have the service, then it will have to be paid upfront and then you could possibly be reimbursed on the back end once we process the claim. If it's something to where they say they'll bill it, then you wouldn't have to pay that upfront. They'll just bill us and we'll pay it on the back end.
[CUSTOMER][NEUTRAL] Right, I understand.
[CUSTOMER][NEUTRAL] OK, [PII], OK.
[CUSTOMER][NEUTRAL] I understand. OK, well, I would think the hospital would bill. I think the search center is a different, uh, a different animal, but, um, but just knowing about the benefit is, uh, is huge. OK, so it wouldn't be part of the, uh, the entirety of a hospital uh visit bill you're just talking about co-pays and deductibles is where you guys come in.
[AGENT][POSITIVE] Right, mhm, that's correct.
[CUSTOMER][POSITIVE] Right, perfect, you're a darling. That's all I needed from you at this point, and I do so much appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Well, thank you so much for calling APL. I hope you have a great day and a great week.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] All right bye bye.