AccountId: 011433970860
ContactId: c7948972-4367-40bc-ad53-e86774800df0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456640 ms
Total Talk Time (AGENT): 246120 ms
Total Talk Time (CUSTOMER): 177128 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/c7948972-4367-40bc-ad53-e86774800df0_20250530T17:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer services. How, how are you?
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][POSITIVE] I'm good. I have an insured on the phone that's calling for her benefits and how it works.
[AGENT][NEUTRAL] Oh, OK. And may I have the policy number?
[CUSTOMER][NEUTRAL] The policy number is 256-69215.
[CUSTOMER][NEUTRAL] Wait, 256-9215. I'm sorry.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And um her name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And she's been verified?
[CUSTOMER][NEUTRAL] She has and uh I've got a callback number of [PII].
[CUSTOMER][NEUTRAL] [PII] that's her cell phone number.
[AGENT][NEUTRAL] OK, you can send it through.
[CUSTOMER][POSITIVE] All right, thank you [PII] have a good day.
[AGENT][POSITIVE] You're welcome. Have a good weekend. You too.
[CUSTOMER][POSITIVE] Alright thanks bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Hello, hello.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the customer care team. How are you?
[CUSTOMER][POSITIVE] I'm fine and you thank you.
[AGENT][POSITIVE] I'm doing good. So I'll be more than happy to help you with your benefits. Um, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And were you wanting to know just like in general what it covers or you're looking for a particular benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I got a combination. I could tell you my scenario. Um, I'm about to have, um, um, uh, outpatient surgery on one of my fingers, so I was told that I have to pay $100 to the doctor and $200 to the facility, and I wanted to know, can I use this card to do that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so,
[AGENT][NEUTRAL] Yes, your this policy pays up to $500 per day for outpatient um surgeries is one of them, surgery in an outpatient hospital or freestanding um outpatient surgery center. So you would just give them this, your card.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let them know that you have a supplemental insurance, medical insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me write that down supplement um.
[AGENT][NEUTRAL] And they'll
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I could use it to get to have to pay the $200 to them.
[AGENT][NEUTRAL] Right, so they're going to bill your primary insurance first?
[AGENT][NEUTRAL] And then, um, primary is going to pay and then give the explanation of benefits and they'll bill us directly second. Um, hold on one second, let me go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we're second to your Florida Blue policy. So they'll bill Florida Blue first and then they'll bill us next. So, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If there's something that you're required to pay upfront to be seen, you, you would have to pay that upfront and then on the back end, you can be reimbursed or if it's something that they'll bill to us, on the back end we'll pay it. Um it just depends on the paperwork we receive and what's been paid already.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So, so if they want, I could either give them this card, but if I have to pay, how would I get reimbursed?
[AGENT][NEUTRAL] When the claim is filed.
[AGENT][NEUTRAL] So when they file the
[CUSTOMER][NEUTRAL] When a claim is filed from, uhm.
[AGENT][NEUTRAL] When they file the claim, it's going to be after primary, so we're going to see everything that was charged, everything primary paid, everything you paid, and what's left over. So then with that $500 for the day, we can reimburse you, we can pay them if something is still owed, it just won't go over that $500 a day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then how about the $100 that I have to pay the doctor?
[CUSTOMER][NEUTRAL] Maybe to use this card as well for that.
[AGENT][NEUTRAL] When you say the $100 that you have to pay the doctor, is it for like a doctor's visit or like, like a doctor's fee, like?
[CUSTOMER][NEUTRAL] Um, uh.
[CUSTOMER][NEUTRAL] No, it's not for the visit, but um they said that they're gonna have to, they're gonna send me a link. I'm gonna pay the $100 to the doctor. Um, I don't know if that's considered a co-pay or what, but I pay that and then they go on and officially set the appointment for the procedure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, it depends on what type of, I, I'm not sure. It depends on what type of fee it is. If it's something like a co-pay or something that you have to pay upfront, then yes, it will handle that when it's the reimbursement on the back end, um, but it would be the same if it's something that, that they will know they said that you have to pay it first and then you'll set.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It depends on what it is.
[CUSTOMER][NEUTRAL] Right, because when I, right, because when I go to the offices and I did have to pay them $40 so this, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The $100 is different from the $40. That's why I wasn't clear on what it was, but it, it, it seems like it's because it's more of a surgical type of procedure.
[AGENT][NEUTRAL] Surgery. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Versus a doctor's office, that could be what it is. So if that's the case, it sounds like something like a co-pay, but yes, we do that 500 is for co-pays and deductibles, um, and co-insurance. So, so it does pay towards that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so when they send me the link to pay, would I put in this outpatient benefit card num certificate number would I put that number in in is the policy number?
[AGENT][NEUTRAL] Mhm. You will have to make that payment upfront. So this is not a, it's not like an FS like a flex spending card or anything. If this is once the claim is filed and we process the claim, then the payments can be dispersed.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the claims, yeah, so you would have to pay that first and then on the back end, you could be reimbursed.
[CUSTOMER][NEUTRAL] OK, and who files the claim, the doctor's office files the claim?
[AGENT][NEUTRAL] Yes, when you give them your, you know, like when they ask you for your um insurance card, you'll give them your Florida Blue card and you'll give them our card. We're second to your Florida Blue.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, then they'll file the claim and then whatever I pay, I'll get that reimbursed back to me. Do you know how long that takes?
[AGENT][NEUTRAL] Um, so it takes 7 to 10 business days for the claim to process, um, if, um, you know, assuming there's no delays, um, but again, there's no guarantee, it's just once we process the claim, then we'll be able to guarantee for sure what you'll receive back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, and now I get it. OK, well then that's what I needed to know.
[AGENT][NEUTRAL] All right, well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, that'd be it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.