AccountId: 011433970860
ContactId: dcf5a91e-bcf0-4c67-9de9-ecf120e91afc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579130 ms
Total Talk Time (AGENT): 295030 ms
Total Talk Time (CUSTOMER): 151796 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/dcf5a91e-bcf0-4c67-9de9-ecf120e91afc_20250318T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, I'm calling on behalf of my husband.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] We were in the process of getting hearing aids. Do you all cover that benefit?
[AGENT][NEUTRAL] OK. Um, I would have to check the policy to see. Um, can you please give me your name and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02168607.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and is [PII] available?
[AGENT][NEUTRAL] Um, for me to get consent to discuss the policy with you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, no, can I try to three way him because he's at work and I'm at work.
[AGENT][POSITIVE] Absolutely. Yes, ma'am. That'll be fine.
[CUSTOMER][NEUTRAL] OK, hang on, let me get him on the phone.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Fan
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi [PII], this is, yes, I'm here. Hi [PII], this is [PII] with APL. I've got Miss [PII] on the other line and uh she wants to get your benefits for you, and I just need to verify your policy real quick with you. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Are you there, ma'am?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and then what is your address, phone number and email address that we have on the policy for you, sir?
[CUSTOMER][NEUTRAL] She'll have to give you the address.
[CUSTOMER][NEUTRAL] He doesn't have an email and it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you so much. And then, sir, is it OK if I discuss your policy with Ms. [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Alright, thank you, sir. I appreciate you taking time to give me that consent.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] OK, thank you so much, Ms. [PII] for getting him on the phone. So I'm looking at the policy and this is just to verify benefits. It's not a guarantee of payment. Um, this is a supplemental insurance policy.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's billed secondary to your primary, so your primary insurance is the first and this one's billed second, and it helps with deductible, co-pay, and co-insurance only. So, um, you have a benefit amount per calendar year for outpatient which is $2500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me look and see if you have office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, we should have a few or a couple.
[AGENT][NEUTRAL] OK, I look real quick.
[CUSTOMER][NEUTRAL] OK, well, we went to this hearing aid place and he has to pay his deductible before his insurance will pay 80% and we pay 20%, but we were always under the understanding that the American public life would pay, would cover the deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It will in a uh covered facility. So let me make sure that that facility that you're going to, which would be.
[AGENT][NEUTRAL] Is it considered, is he, is it considered like a doctor's office?
[CUSTOMER][NEUTRAL] Um, I think so. Let me look him up real quick.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Well, he's an audiologist.
[AGENT][NEUTRAL] OK, so he would be a physician. I need to check in the physician's office visit, see if that's covered under your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] The benefit will help with treatment in a physician's office, but not the physician office visit fee.
[CUSTOMER][NEUTRAL] Well, the hearing aids would be the treatment. That's how he's gonna get hearing.
[AGENT][NEUTRAL] Right. So what you'll need to do is um when the primary pays their.
[AGENT][NEUTRAL] Actually the office can send in the claim for you. Um, they'll have to bill your insurance, get the explanation of benefits from your primary insurance and then send the claim to us second, and we, we pay based on what the primary pays.
[CUSTOMER][NEUTRAL] OK well they emailed me and said that the insurance benefit manager contacted your secondary insurance that we have on file when she called this morning she could not find that there was a benefit however this may be the type of insurance that we are unable to file it could be that we pay initially and then we get reimbursed for the expenses.
[AGENT][NEUTRAL] OK, so if you need to file the claim yourself if the um office is not.
[AGENT][NEUTRAL] Able to file for you, let me give you um a website to go to that you guys can sign up for and you can file the claim yourself.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] See, I tried to get him enrolled in that, but it wouldn't take the policy number.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It said it needed the account number or something but it couldn't be the policy number so what number do I need to put there?
[AGENT][NEUTRAL] You're gonna put the social security number.
[CUSTOMER][NEUTRAL] Oh, OK, his social?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so go there and.
[AGENT][NEUTRAL] And then once you, yes, and once you get everything back from your primary insurance, you can just uh upload it from your computer there if you wanna do it electronically. If not, let let me give you the um fax number and the mailing address to send claims to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII] is the fax number.
[CUSTOMER][NEUTRAL] I'll just use the fax number now so do we go ahead and pay what the pay what it's costing now and then submit the claim of what we paid out of pocket?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] From what they're from what the office is telling you, that sounds like what they're going to do.
[CUSTOMER][NEUTRAL] OK, so go ahead and.
[CUSTOMER][NEUTRAL] And then we just fax this all this information like from the insurance and the audiologist we fax all that to this number and then we will he will get reimbursed.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, the claims examiners will review the claim and like I said um.
[AGENT][NEUTRAL] It was just to verify your benefits. It's not a guarantee of payment, but it will go through a claims examiner. Once we receive the claim, it takes 7 to 10 business days to process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But it's not guaranteed that they're gonna cover.
[AGENT][NEUTRAL] Right, right, it has to go through a process with claims examiners that's why we give that disclaimer, um.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Because I'm not a claims examiner, I can't say yes it's going to pay because it does have to go through a process with the claims examiners.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we have no way to do it without paying the money and all that.
[AGENT][NEUTRAL] From what I understand from the way you said the office said that you were gonna have to uh file it yourself, it sounds to me and I'm not sure what their rules are, but it sounds to me like they're wanting you to pay up front and then file your own claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you so much for your help.
[AGENT][POSITIVE] Well, you're so very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Not today.
[AGENT][POSITIVE] OK, well, you have a blessed day and thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Bye-bye, ma'am. You're welcome.