AccountId: 011433970860
ContactId: e68e59c7-1033-491f-91d7-89d01a92f333
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511750 ms
Total Talk Time (AGENT): 299625 ms
Total Talk Time (CUSTOMER): 158254 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/e68e59c7-1033-491f-91d7-89d01a92f333_20250128T14:19_UTC.wav
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[AGENT][POSITIVE] Good. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm a new client and I'm just trying to figure out um what this, what my plan will cover.
[AGENT][POSITIVE] Oh it would be my pleasure to assist you.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, sure. Um,
[CUSTOMER][NEUTRAL] Are all the plans the same? This is the gap insurance?
[AGENT][NEUTRAL] We do have gap policies and they are different, so I would need to pull up your policy so that I can give you the correct information for your policy. Do you have that policy number available?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I do. It's 02588448.
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Thank you. And do you mind, I do need to verify your information. Can you verify your name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Thank you. And Miss [PII], can you verify your current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And what about your email and phone number?
[CUSTOMER][NEUTRAL] Um, [PII] and then [PII].
[AGENT][POSITIVE] All right, thank you. I appreciate that verification. And I see you do have an active account on our portal.
[CUSTOMER][NEUTRAL] Yes, yes, I do. Um, I'm just curious on here it says it covers um.
[CUSTOMER][NEUTRAL] Like mental health services.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and I just wanna verify that is correct.
[AGENT][NEUTRAL] Sure. I'll be happy to verify that for you. Let me just get your policy pulled up and we'll look at it together. You do have your policy pulled up, correct? Did you click on your policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Now, most people don't know that, so you did good.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] I'm getting that pulled up. Bear with me just one second.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So you do have treatment of a mental or emotional disorder while confined as an inpatient.
[CUSTOMER][NEUTRAL] OK, then it says treatment of mental or emotional disorder performed in a hospital outpatient facility or outpatient outpatient psychiatric treatment or a physician's office.
[AGENT][NEUTRAL] Hospital outpatient facility.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Yes, ma'am. That is correct. That's under your outpatient benefit. The other was under your inpatient, so you have that benefit for inpatient hospitalization and as outpatient treatment as well.
[CUSTOMER][NEUTRAL] So it covers it if I would go to a um a therapist or a psychiatrist, correct?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] That that's correct, and that's under your outpatient benefit, and that is a per calendar day benefit, and we're gonna pay towards your deductible, co-pay or co-insurance, so it depends on how your primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK, what do you mean by that?
[AGENT][NEUTRAL] So if they have a say a $50 co-pay, your primary, well, the provider will file the claim with your major medical, and then you have a $50 co-pay, then the provider can file the claim with us and we can pay your $50 copay.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And then you wouldn't have to pay that out of pocket. Now some providers, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What if it's like
[CUSTOMER][NEUTRAL] Yeah, what if it says 0% co-insurance?
[AGENT][NEUTRAL] It may be applied to your deductible, if it's applied to your co-pay, deductible, or co-insurance. That's what this policy helps pay toward.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So that would be covered and then when I go to the to the person or the provider, do I just present this card and that card or how does that work?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. I always show your APL card with your primary insurance card.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, do we need the, so the doctor would submit the claim, or yes, and then, OK, I'm, I'm just seeing the part of the thing where it says my clients upload documents.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is if you want to file the claim yourself for benefits to come directly to you.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Is there a difference between that and the doctor? Sorry, I'm just.
[AGENT][POSITIVE] No, you're fine. You're you're asking very good questions.
[AGENT][NEUTRAL] So if the provider files the claims, benefits go directly to the provider.
[AGENT][NEUTRAL] If you file a claim, then benefits would come directly to you.
[AGENT][NEUTRAL] So who we pay depends on who files the claim.
[CUSTOMER][NEUTRAL] OK, so let's say I paid for it in the office and then I would be reimbursed if I filed the claim, but if they.
[AGENT][NEUTRAL] The new
[AGENT][NEUTRAL] Mhm. But if they accept it and then they file the claim, then we would pay them. So normally when you go in, if you have a supplemental policy, they'll call and verify benefits, and then you wouldn't pay while you're there unless there's a patient responsibility other than your deductible co-pay or co-insurance, meaning that your primary insurance wouldn't cover it all. Most of the time that's not the case. Um.
[CUSTOMER][NEUTRAL] In the office and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] They'll follow it with your primary insurance.
[AGENT][NEUTRAL] And then they'll get the claim back, and then the, the explanation of benefits, and that shows how your primary insurance processed the claim, then they file the claim with us at APL with that primary explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we pay them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That way you don't have to pay out of your pocket.
[CUSTOMER][NEUTRAL] Sure, OK, yeah, I was just.
[AGENT][NEGATIVE] Some places don't accept it. We can't control that, unfortunately.
[AGENT][NEUTRAL] So you may need to file for reimbursement. Most places do, but there are some places.
[CUSTOMER][NEGATIVE] Oh, some places don't accept it.
[AGENT][NEGATIVE] That for some reason or another, just won't accept the secondary policy.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, great, so I would just have to call them and make sure that they.
[AGENT][NEUTRAL] But just make sure
[AGENT][POSITIVE] That's right, and just make sure that um if they have any questions, to please tell them to call us and we'll be happy to verify your eligibility, which means your policy is active, and we'll be happy to verify the benefits on your policy.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Well this
[CUSTOMER][NEUTRAL] Yeah, no, I'm just curious, will this count towards um your maximum like out of pocket, or does that, is that how does that work?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, that is considered under your outpatient benefit.
[AGENT][NEUTRAL] That's, that benefit would come from your outpatient coverage.
[CUSTOMER][NEUTRAL] Right, but when it, when I'm looking at my insurance, there's a certain like maximum out of pocket, for example, to to reach to my deductible, will this counter.
[AGENT][NEUTRAL] For your primary?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, as long you know.
[AGENT][NEUTRAL] The only thing we go by when we receive a claim is if the primary applied something to your deductible, co-pay, or co-insurance.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] It's my pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Not today.
[AGENT][POSITIVE] And thank you for calling APL. It's been such a pleasure to assist you, Ms. [PII]. I hope you have a wonderful day and if you have any further questions or curiosities or concerns, please don't hesitate to give us a call.
[CUSTOMER][NEUTRAL] Do they have any
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Good thank you for
[CUSTOMER][NEUTRAL] Yeah, OK, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.