AccountId: 011433970860
ContactId: cb0d2b4a-89ee-4448-ac77-37dc827355ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586369 ms
Total Talk Time (AGENT): 229586 ms
Total Talk Time (CUSTOMER): 296206 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/cb0d2b4a-89ee-4448-ac77-37dc827355ce_20250311T20:03_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] Hi, [PII], my name is [PII]. How's your, how's your day going so far?
[AGENT][NEUTRAL] Uh, busy, but OK.
[CUSTOMER][NEUTRAL] All right, that's fair. Um, so, here's the thing. Um, I've had, apparently with my job, uh, my job's benefits, I've had APO for so long, and I've never even thought that I had this.
[CUSTOMER][NEUTRAL] Um, so what kind of information would I need to provide you so you could put to see if I'm still in your system by chance?
[AGENT][NEUTRAL] OK. Um, do you, well, I don't know if you probably don't have a policy number, do you?
[CUSTOMER][NEGATIVE] I mean, not that I could see around me here. Um, my, my, my human resources department just gave me, I guess, um, you're like the provider of APL like telling me what I have covered, what I don't have covered.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me see if I could find.
[AGENT][NEUTRAL] Oh, I can go by your social.
[CUSTOMER][NEUTRAL] Um, yeah, we could, yeah, we could do that. Um, do you need, do you need all the digits, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, so it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Magico, yeah.
[AGENT][NEUTRAL] Thank you. I was gonna mess up your last name. Thank you.
[CUSTOMER][POSITIVE] It's, it's all right, no worries.
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me.
[CUSTOMER][NEUTRAL] OK, so, uh, date of birth would be [PII], um, home address would be [PII].
[CUSTOMER][NEGATIVE] And uh email I I might have changed it's it's been a while but um it might be uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that's what we have. Do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh yeah, uh, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I do show you have a policy with us, um, effective [PII] and it's active. And you say you don't, you just found out about having a policy with us?
[CUSTOMER][NEGATIVE] Yeah, it's, it's, it's been, it's been, um, it's been a hell of a year, so it's, it probably must have slipped my mind after I, I made that policy with you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It happens. Oh, believe it or not, we get a good bit of calls where people forgot or wasn't aware that they had a policy, but
[AGENT][NEUTRAL] Uh, so the type of policy you have with us is a secondary supplemental plan.
[AGENT][NEUTRAL] Excuse me, uh, what it does, it helps with your primary insurance deductible, co-pay or co-insurance for services performed in an outpatient facility or if you are confined as inpatient in the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. Yeah, and, and, um, when I send it for the benefit, I don't recall ever receiving like a card, like a medical card or anything like that. Um, am I supposed to get one of those?
[AGENT][NEUTRAL] I believe so, but let me double check. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, uh, you should have received one. It's probably mailed sometime in May of last year, but um I can send a request to have that mailed out to you and also we do have an online service center to where you can view your policy as well as print out any temporary cards if you need to. And also from the site, you, uh, once any claims have been received, you can check claim status from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now, um, if I, I, I, I don't mean to take up too much of your time. I do apologize, but, um, so.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um, so how would this exactly work? Because right now, um, I'm currently, um, I'm currently in the process. Um, I had, I took a bad fall playing ice hockey.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And I, yeah, and um I have fractured my radio head, but that's healing fine. I went to a specialist, um, I went to a trauma specialist for that in [PII]. But now it seems as though um they want me to do an MRI for, uh for my left wrist. They're saying that I had severed a couple of ligaments there.
[AGENT][POSITIVE] Oh, bless your heart.
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] Yeah, um, so, so the, my healthcare provider that I have right now, um, is UnitedHealthcare. But when I contacted them, well, when [PII] called me, they told me that I had to pay out of pocket, I believe it was like 1100 or 1000 something. Would, would my policy be able to cover that?
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yes, if it was performed in an outpatient facility, yes, sir. Uh, what this policy does is you have, um, after your primary insurance has processed the claim, if they apply any amount towards your deductible, co-pay or co-insurance, that's what we pick up and pay, and you have an outpatient, uh, your benefits are limited, but you have an outpatient benefit that pays up to $250 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um what, what if the MRI was gonna be like in a hospital facility like if it was gonna be um inside Baptist Hospital when they did the MRI?
[AGENT][NEUTRAL] Well, inpatient is considered if you were confined in the hospital 18 hours or more. So if it's done in the hospital, then that would just go towards the outpatient benefit.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK. And um when, um, because, so long story short, [PII] is telling, I, I, I'm, I'm getting three different opinions. So I wanna be sure because, because the, the hand specialist that I went to, he recommended me to do uh surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um, yeah, yeah, so I'm trying to avoid surgery. That's why I'm going to [PII] to see if I could do the MRI. Now if they tell me that I have to go through the surgery, um, and it's through a specialist, like it's, it's, um, it's not a hospital, it's like a, it's like an outpatient surgical place, um, with APL cover for this as well?
[AGENT][NEUTRAL] Uh, outpatient surgery center is considered outpatient or uh covered outpatient facility for the policy, so it could. Yes, sir. I would say when you give them your primary insurance information, you can give them our information as secondary, and that way they can call, verify benefits and submit claims to us.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, now, um, is there, um, it, well, if I get that new, uh, so I get the, the card, the, the APL card, um, what kind of, um, is there a policy number or is there some type of information that I could provide, um, these two medical facilities after I give them my UnitedHealthcare?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can give you your policy number.
[CUSTOMER][NEUTRAL] Uh, wait, I'm sorry. Let me go get a pen. Sorry.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, I'm ready when you are.
[AGENT][NEUTRAL] OK, um, your policy number is 249.
[CUSTOMER][NEUTRAL] 249
[AGENT][NEUTRAL] 1451.
[CUSTOMER][NEUTRAL] 1451.
[AGENT][POSITIVE] And that's it. And I am sending a request. So hopefully, um you should receive your card within 3 to 5 business days.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But yeah, that's the policy number you give to the provider and just give them our phone number and that way they can call and verify benefits and eligibility.
[CUSTOMER][NEUTRAL] OK, perfect. So, so when I go to the MRI and God forbid, uh, surgery, um, I just give this to uh to the receptionist or to their billing office, right?
[AGENT][NEUTRAL] Correct, yes, sir, and just let them know we're secondary. I wouldn't tell them it's a gap plan, just tell them it's a secondary policy.
[CUSTOMER][NEUTRAL] Sec, let me write that down.
[AGENT][NEUTRAL] Yeah, because if you say 2 or if you say gap, most times providers won't submit, they will tell you, you would have to submit the claim, but if you tell them it's a secondary policy, then most times they do file.
[CUSTOMER][NEUTRAL] Secondary policy provide provide phone number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Phone number if card has not arrived yet.
[CUSTOMER][POSITIVE] OK, perfect. Um thank you so much for everything. I think that's about it.
[AGENT][NEUTRAL] OK, and like I said, I did send a request for your card to be mailed, so you can receive it in 3 to 5 business days. But if you need something a lot sooner, like if the providers needing like even a photocopy, we do have an online service center as I stated, where you can print that out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, perfect, uh, [PII], I really appreciate your assistance on this, and I hope the rest of your day gets less busier and more enjoyable.
[AGENT][MIXED] I mean, I mean, it's good. I'm not gonna complain, but you know, it's all gravy.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][POSITIVE] Well, I thank you. Thank you for calling APL. You have a great day, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Enjoy the rest of your day. Thank you so much again.
[AGENT][NEUTRAL] You too. Bye.
[CUSTOMER][NEUTRAL] No