AccountId: 011433970860
ContactId: e9b23158-918e-4acc-b8ab-95d9181df72e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 710979 ms
Total Talk Time (AGENT): 285034 ms
Total Talk Time (CUSTOMER): 255482 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/e9b23158-918e-4acc-b8ab-95d9181df72e_20250421T20:57_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name is [PII]. Um, our group number is 24214.
[AGENT][POSITIVE] OK. How can I help you today?
[CUSTOMER][NEUTRAL] I, I don't know. I might have just spoken to you about maybe some of this. I had several questions, um, but I'm trying to get an idea of what we're looking at for hearing aid benefit, and um, I spoke to our primary insurance um about our new plan that's effective 51, and I, they originally told me that it is considered durable medical equipment, but.
[CUSTOMER][NEUTRAL] They were incorrect, um, so it's not, it doesn't fall under durable medical equipment, it has its own section, its own benefit, um, and I just wanted to know how APL pays towards that.
[AGENT][NEUTRAL] OK, um, let me get a few pieces of information. Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's your um address of the group?
[CUSTOMER][NEUTRAL] 12,120 for the group, our group address is [PII].
[AGENT][NEUTRAL] OK, thank you. And then your email address?
[CUSTOMER][NEUTRAL] My email address is [PII].
[AGENT][POSITIVE] OK, thank you so much. Um, what policy or what plan are we looking at for this?
[AGENT][NEUTRAL] Just like that.
[CUSTOMER][NEUTRAL] Uh, Medlink.
[AGENT][NEUTRAL] That link, OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And this is our 5. I, there was a little bit of change to our policy, I think, uh, effective 51.
[AGENT][NEUTRAL] OK, let me see, trying to see which.
[AGENT][NEUTRAL] OK, can I place you on a brief hold?
[CUSTOMER][POSITIVE] Of course, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh products here we go.
[AGENT][NEUTRAL] OK, so we've got the med link.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] How do I look at?
[AGENT][NEUTRAL] How do I look it up.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so sorry about that. I was just trying to pull up a member just to see the policy because I can't, I can't see the policy without pulling up a member, so got that.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] OK, so this is for hearing aids, correct? Is that what you said?
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] And you said you talked to somebody earlier?
[CUSTOMER][MIXED] I did um but I had some more questions and I went back to our primary just to clarify and I'm glad I did because I was misinformed um they originally told me that it was it falls under durable, but I mean the, the benefit is the same under durable or not but it's, it's not considered durable it has its own.
[CUSTOMER][NEUTRAL] Uh, benefit.
[AGENT][NEUTRAL] And let me
[CUSTOMER][NEUTRAL] So I just didn't know how yeah APL is.
[AGENT][NEUTRAL] And then who told you that it's not durable medical equipment?
[CUSTOMER][NEUTRAL] Um, our primary insurance, I, they originally told me it was considered durable medical equipment, but hearing aids has its own benefit. So it's not necessarily under durable medical equipment. I don't know. I don't know how it's normally, I don't, she couldn't tell me the codes or anything like that, but.
[AGENT][NEUTRAL] Uh, I, I'm trying to think what else it would be classified under because, so your meddling policy, uh, as you know, it's, it's specific on what it covers, um.
[AGENT][NEUTRAL] Outpatient benefits like hospital ER, urgent care, surgery, etc. um.
[AGENT][NEUTRAL] Let me see if it defines under the policy.
[AGENT][NEUTRAL] For me,
[AGENT][NEUTRAL] It would be as as defined under this policy, it would be durable medical equipment um because durable medical equipment.
[CUSTOMER][NEUTRAL] Well, maybe they, maybe they're getting confused.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] So, so durable medical equipment, uh, based on what is defined under the meddling policy, it can withstand repeated use, it's not disposable.
[AGENT][NEUTRAL] Uh, used to serve a medical purpose with respect to treatment of an outpatient cover charge if applicable.
[AGENT][NEGATIVE] Um, not useful to a person in the absence of sickness or injury, uh, appropriate for use, uh, within the home.
[AGENT][NEGATIVE] Not implantable, which hearing aids aren't.
[AGENT][NEUTRAL] And it's covered under the other medical plan. Um, so does the primary insurance, do they provide benefits, UnitedHealthcare, do they provide benefits for the
[CUSTOMER][NEUTRAL] They do, they pay, they have a benefit for, yeah, I don't know if I'm getting confused, but originally they said, oh, it falls under durable medical equipment, and here's the benefit. And then when I called back, they're like, no, it's not under that, it has its own benefit. So it's not, it doesn't just fall under the lump sum of durable. They might call it durable. I guess there really isn't anything but a durable medical equipment, but, so maybe it really is coded that way, but
[CUSTOMER][NEGATIVE] It doesn't fall under durable medical equipment, so I'm confused. I really don't know how insurance handles this.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, let me um let me do this. Um, do you mind if I transfer you to one of our claims specialists because they're the ones who would get the actual claim and know how to process it. So let me, let me get a claim specialist on the line for you if you don't mind.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] [PII], um, this is [PII], and on the care team. I have a group admin on the line and they are asking about
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If so it's a med link policy and I can, I didn't know how to pull up the policy, but by way of just pulling up one of their members, um, but they're asking about hearing aid coverage. So, do you want me to give you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I guess the policy that I pulled up to try to find the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they didn't have a particular person?
[AGENT][NEUTRAL] No, they're just
[CUSTOMER][NEUTRAL] That they were calling about or yes.
[AGENT][NEUTRAL] No, they're just asking about the policy in general. It's a Medlink SFS.
[CUSTOMER][NEUTRAL] OK, what
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Uh, policy number I pulled up is 2486619.
[CUSTOMER][NEUTRAL] And does that policy have a DME router on it?
[AGENT][NEUTRAL] It does
[AGENT][NEUTRAL] And I didn't know
[CUSTOMER][NEUTRAL] Yeah, so they're hearing, go ahead.
[AGENT][NEUTRAL] Hearing aid is uh well, so she's getting confused because United Healthcare told her that they don't consider hearing aids DME, but by way of the definition under our plan, it seems like it would be DME and that's how we would process it as long as, OK, OK.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, that's what I thought. Um, they do, like I said, they do have a DME writer. I just wanted to make sure I don't want to tell her the wrong thing. So essentially, if you could.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Verify this with me. So if we got a claim under this policy, and it has the DME writer for medin.
[AGENT][NEUTRAL] If UnitedHealthcare has processed the claim, we would potentially process it, you know, whatever co-pay, deductible, co-insurance, etc. right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. It's, they have to cover it in order for us to cover it, yes.
[AGENT][NEUTRAL] For this, OK, OK.
[AGENT][POSITIVE] OK, OK, perfect. OK, I just wanna make sure I, I'm telling her the right thing. Don't want to tell her the wrong thing. So, OK, well, thank you.
[CUSTOMER][NEUTRAL] Oh no, you are, yes.
[AGENT][POSITIVE] OK, thank you so much, [PII]. I appreciate you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] OK, I actually did confirm, uh, [PII], thank you for holding. Um, so, yes, that is under the meddling policy, we would consider this under the durable medical equipment writer. Now, keep in mind,
[CUSTOMER][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If so United Healthcare, as you know, they do have to consider it as well. It doesn't matter if they don't consider it DME, but my point being they can't deny it because then if they deny it, then we wouldn't be able to, so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well, they said that they cover it. They do cover it. I don't know if they, what I'm saying is in, in our policy, we have a, a section for durable medical equipment and it has its own benefits, but they said that this has its own, which, which is basically the same benefit as a DME so I don't know why they even separated it maybe because people use that more than other things. I, I don't know, but as long as they cover it, then APL covers it, correct?
[AGENT][NEUTRAL] But yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That is correct, yes, we would process it under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if they cut and they so if they process it, um, so they, so it's paid for.
[CUSTOMER][NEUTRAL] In full by APL correct? or whatever, uh, yeah, you know, you know what I'm, I guess I don't even know how to say it right, but it's yeah it's covered.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, up, up to that $4000 it's covered up to that $4000 outpatient, yes, correct, yeah.
[CUSTOMER][NEUTRAL] Up to the 4000 OK.
[CUSTOMER][POSITIVE] Perfect. All right, thank you very much. I appreciate your help.
[AGENT][POSITIVE] OK, thank you, [PII]. Anything else I can help with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Not at this moment, thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good evening.
[CUSTOMER][POSITIVE] Thank you, you