AccountId: 011433970860
ContactId: dcfbc075-8162-4462-97bd-df5cd54ce4fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538140 ms
Total Talk Time (AGENT): 191663 ms
Total Talk Time (CUSTOMER): 206430 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/dcfbc075-8162-4462-97bd-df5cd54ce4fa_20250214T15:53_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 [PII], I was just wondering if the plan, I just called my healthcare, and they said what I needed would cover 80% after the deductible, so I just wanted to make sure on the APL side if it'd be covered for hearing aids.
[AGENT][NEUTRAL] OK, I can definitely check and see if um hearing aids are covered on the policy. May I have your name and contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that, and [PII]. May I have your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. 01848863.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Sure. It's um [PII].
[CUSTOMER][NEUTRAL] And it's um [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And do you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's fine. I just can
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? I'm just gonna look through the policy benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] OK, I'm ready.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute, did I click out of one piece? I wasn't trying to click out of it.
[AGENT][NEGATIVE] Oh no, definitely wasn't trying to do that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, I think hearing aids are considered DME, so really I just need to see the DMA is uh DMA DME is covered.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, um, hearing aids are typically under durable medical equipment, and on your um policy with us, you do have under outpatient, we would pay up to $2000 per calendar year, and you do have durable medical equipment, um.
[CUSTOMER][NEUTRAL] Oh, no, that's fine.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The durable medical equipment writer, so it's an additional benefit to your policy.
[CUSTOMER][NEUTRAL] OK, so it will cover up to 2 to 2000 then.
[AGENT][NEUTRAL] Right, now, of course, I, we can't guarantee it until we get the claim and the coding, but you do have durable medical equipment writer and that max is 2000 per year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, what's it
[CUSTOMER][POSITIVE] Um, durable.
[AGENT][NEUTRAL] Durable medical equipment?
[CUSTOMER][NEUTRAL] Medical equipment. OK. They don't file the claim, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They said, where did they pay, but if I get all the codes and everything, I've been diagnosed with the tinnitus, and I've got the high frequency ringing of the ears.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And but they don't file a claim, which I, they said I have to file the claim. Does that make any sense? It seems kind of weird.
[AGENT][POSITIVE] Yes, that makes sense. Um, I would
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, in that case.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Because it's probably just a DME store and they wouldn't, they wouldn't file with the insurance.
[CUSTOMER][NEUTRAL] No, this was actually out of the hospital. It was a Burlington ear, nose and throat.
[AGENT][NEUTRAL] Oh, well then I don't know why, but either way, if they say they don't file the claim, yes, you do, you can file the claim. You'll just need the claim form, um, which can be found on our website.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the claim form, OK.
[AGENT][NEUTRAL] So it's, it'll be, um, OK.
[CUSTOMER][NEUTRAL] Trying to write this down hold uh.
[CUSTOMER][NEUTRAL] OK, claim form on the web on the website, OK.
[AGENT][NEUTRAL] Yes, it will be the Medlink claim form.
[CUSTOMER][NEGATIVE] Mad link.
[CUSTOMER][NEUTRAL] Speaker phone I'm trying to write this down.
[AGENT][POSITIVE] Oh, take your time. It's no problem.
[CUSTOMER][NEUTRAL] Here we go. Sorry, I couldn't write, hold this phone. OK, so the med link claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, and then, um, then it would do that, and it's called durable medical equipment?
[AGENT][NEUTRAL] Equipment. Mhm.
[CUSTOMER][POSITIVE] I gotta call them back and get everything set up, but they haven't picked them out yet. So, OK. And so let's go up to the 2000 durable medical. OK, wonderful. And I think is that all, uh.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] So the $2000 isn't just for durable medical equipment, it's $2000 for the year for all your outpatients, OK. I just want to make sure, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh yes, yes, I do. Well, we've got the UnitedHealthcare, and then what they don't do, then I, then they file with the APL. So, but this was weird because they wouldn't, they don't file. I have to file my own claim, so I haven't got any farther. I had the appointment and everything. So, all [PII], do I need to know anything else? I just do the claim form and the med medley claim form.
[AGENT][NEUTRAL] So you'll need the meddling claim form, you'll need the item, um, the itemized bill. So really you would
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, you said it was the hospital. So you would just call the billing department and just ask for their itemized bill or the universal bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Or universal BM.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Yeah, whatever the, whatever part of the hospital you go to to get the um hearing aids, just go there and let them know you're gonna file the claim, but you need your insurance company is requesting the itemized bill.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[CUSTOMER][POSITIVE] Itemized bill. Alrighty, thank you so much. You've been very uh-huh and then what?
[AGENT][NEUTRAL] And then, hold on, you also need the explanation of benefits from United Healthcare.
[CUSTOMER][NEUTRAL] OK, so I just called them before you, so X X say it again.
[AGENT][NEUTRAL] The explanation of benefits?
[CUSTOMER][NEUTRAL] Wait a minute, explain.
[CUSTOMER][POSITIVE] Of benefits.
[AGENT][NEUTRAL] Mhm. And then it'll be for whichever day um you're filing for.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, um, explanation of benefit from United Healthcare, OK.
[CUSTOMER][NEUTRAL] United Healthcare.
[CUSTOMER][POSITIVE] Yeah this is a little bit different so alrighty thank you so much and if you think I need anything else.
[AGENT][NEUTRAL] Um, no, that's all you'll need, and you, you have your policy number, so yeah, that's all you'll need.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][POSITIVE] OK, wonderful. I might call back for help when I get them, so I haven't gotten them yet, but OK.
[AGENT][POSITIVE] Well, if you need us, definitely give us a call. That's what we're here for and we'll be more than happy to help.
[CUSTOMER][POSITIVE] Oh, thank you so.
[CUSTOMER][POSITIVE] I really appreciate it thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thank you for calling APL. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, that was it today.
[AGENT][POSITIVE] All right. Well, have a great day and a great weekend.
[CUSTOMER][POSITIVE] You too. Thanks so much. Mm bye-bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.