AccountId: 011433970860
ContactId: e7143717-8856-46b0-a1b2-8f9da2a73484
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 779900 ms
Total Talk Time (AGENT): 240657 ms
Total Talk Time (CUSTOMER): 184149 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/e7143717-8856-46b0-a1b2-8f9da2a73484_20250602T19:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh hi, my name is [PII], and, uh, I have an insurance with you guys with PPL.
[CUSTOMER][NEUTRAL] And I have a question for a procedure.
[CUSTOMER][NEUTRAL] Uh, see if it's in the network and if it's gonna be covered, that's the question actually.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, and may I have the policy number?
[CUSTOMER][NEUTRAL] You need to
[CUSTOMER][NEUTRAL] Yeah 009.
[CUSTOMER][NEUTRAL] 451
[CUSTOMER][NEUTRAL] 21.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Uh, mail address it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the email address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you. And what type of procedure is being rendered?
[CUSTOMER][NEUTRAL] It's an EMG electromyography or something like that.
[CUSTOMER][NEUTRAL] And it's done at uh.
[CUSTOMER][NEUTRAL] You need the address or?
[AGENT][NEUTRAL] OK, so it's gonna be done in an office setting or is it an outpatient facility or hospital?
[CUSTOMER][NEUTRAL] It said
[CUSTOMER][NEUTRAL] It's uh Harry Ford neurodiagnostics [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I think it's hospital.
[AGENT][NEUTRAL] To a diagnostic center.
[CUSTOMER][NEUTRAL] Yeah, it's, I'm not sure.
[CUSTOMER][NEUTRAL] It's part of [PII] in [PII].
[AGENT][NEUTRAL] What's the name of the center again?
[CUSTOMER][NEUTRAL] I can't tell the other.
[CUSTOMER][NEUTRAL] The name of the sender, it's 1 2nd.
[CUSTOMER][NEUTRAL] Harry Ford's neurodiagnostic Lakeside.
[CUSTOMER][NEUTRAL] It's, I have the address if that's that's right.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How do you spell the name of the street?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sterling Heights, Michigan.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Like [PII] Lakeside, that's I know the name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it's, it is not clear how they're gonna bill. Um, now, let me go ahead and give you your benefits, OK?
[AGENT][NEUTRAL] And this is not
[CUSTOMER][NEUTRAL] The procedure is not covered or the, the location?
[AGENT][NEUTRAL] It's not clear how how they're gonna bill. So what I can do is give you information based on the policy because we don't know if they're gonna bill as an office or if they're gonna bill as an outpatient facility, which it looks like an outpatient facility, but we, we don't know until we receive the claim, and that's why we cannot guarantee any payments until we receive the claim. We are your secondary. Mhm.
[CUSTOMER][NEUTRAL] OK, I know, uh, I know that.
[CUSTOMER][NEUTRAL] I know that
[CUSTOMER][NEUTRAL] That's what I, I need to know if it's the right location. It's an outpatient location.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's really.
[AGENT][NEUTRAL] Uh, we're, we're not gonna know how they're gonna charge until they charge. Um, that's not something that it is, um.
[AGENT][NEUTRAL] Something we decide is something that they decide. So in order to know if they're gonna charge us an office or if they're gonna charge us an outpatient facility, you need to get in contact with them and ask them, are you an outpatient facility? Are you gonna charge the bill as an outpatient facility or are you gonna charge this bill as an office?
[AGENT][NEUTRAL] Um, if they're gonna charge us as an office and then let me check and see if there is office benefits.
[AGENT][NEUTRAL] Bear with me, which it doesn't look like there is any office benefit under this policy.
[CUSTOMER][NEUTRAL] I don't think it is, but yeah, please check.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, sure, one moment, bear with me just a minute. I'm waiting on the documents.
[AGENT][NEUTRAL] OK, so no, this one doesn't have any office benefits. So it will only cover if, if they charge as an outpatient facility. You do have outpatient benefits, your outpatient benefits, and this is not a guarantee of payment, just a verification of coverage. You have 1500 that you can use uh per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you have a deductible of $100. So the 1st $100 is your deductible and then we pay up to $1500.
[CUSTOMER][NEUTRAL] But then there was paid already I'm assuming so I think what it's 2000 right but maybe it was covered and I have left only 1000.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] That's all I know so.
[AGENT][NEUTRAL] OK, so you have used some of your benefits, let me see.
[AGENT][NEUTRAL] OK, so it looks like so far you have already made that deductible and you have used $104.39 out of your policy. So that's the only amount you have used out of the $1500. So you still have that remaining balance, OK, that you can use.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you just need to
[CUSTOMER][NEUTRAL] Maybe not all the claim maybe are any claims there?
[CUSTOMER][NEUTRAL] Portfolio process.
[AGENT][NEUTRAL] Um, the only ones that we have received and processed, let me tell you which ones are those.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] We have one for Henry Ford McComb Hospital.
[AGENT][NEUTRAL] For [PII] and we send $100.16 for that one.
[AGENT][NEUTRAL] And then we have another one.
[CUSTOMER][NEUTRAL] What, what was done there?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] An MRI should be there.
[AGENT][NEUTRAL] That was the facility charges. That was the hospital charges.
[CUSTOMER][NEUTRAL] Uh, he for me in the hospital. I was in the hospital.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] I'm not sure what that for.
[CUSTOMER][NEUTRAL] By date
[CUSTOMER][NEUTRAL] Only if you tell me what, what was done.
[AGENT][NEUTRAL] Oh, I'll have to pull the documents. Do you mind holding for me? I'll have to pull the documents of the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK. It was an ultrasound.
[CUSTOMER][NEUTRAL] Uh, we just saw
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, oh.
[CUSTOMER][NEUTRAL] Or echocardiogram maybe?
[AGENT][NEUTRAL] Um, no, this one was an ultrasound. That's what it's indicating that it was an ultrasound.
[CUSTOMER][NEUTRAL] OK, please and uh showing the facility like in for day.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Yeah, again, um, it's.
[CUSTOMER][NEUTRAL] The name of the
[AGENT][NEUTRAL] It's saying that it was on Henry Ford McComb Hospital that it was a um abdominal ultrasound done on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and that was covered, right? Or it's not covered?
[AGENT][NEUTRAL] Mhm. So that's the only, yeah, yeah, we already covered that one, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, for now I, I need to I I know what I need to.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah.