AccountId: 011433970860
ContactId: eadc33d9-845a-451b-ae47-d9f938c2869a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352079 ms
Total Talk Time (AGENT): 180044 ms
Total Talk Time (CUSTOMER): 130522 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=2.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/eadc33d9-845a-451b-ae47-d9f938c2869a_20250306T20:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I have an APL card through my employer, and I just had a question about it. Um, I'm having a procedure through a surgical center, not a hospital, tomorrow. Does the APL card cover the co-pay for that?
[AGENT][NEUTRAL] I can check.
[CUSTOMER][NEUTRAL] Or is it only hospital visits?
[AGENT][NEUTRAL] I can check and see what's covered under your policy, Ms. [PII]. Um, may I have a, um, callback number just in case we get disconnected, followed by the policy number.
[CUSTOMER][NEUTRAL] It's OK, my phone number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what do you need the payer ID?
[AGENT][NEUTRAL] The policy certificate number.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] In the bottom of the card, outpatient.
[CUSTOMER][NEUTRAL] Oh, outpatient. OK. 01343232 ML 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. May I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] My date of birth is [PII]. My home address is [PII]. You may have my old email which is [PII], but I need to update it to [PII]. I did get married, so my last name changed from
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] Probably an old email that you had.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, we have your work email. Is that OK?
[CUSTOMER][NEUTRAL] Oh yeah, [PII] or [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With [PII].
[CUSTOMER][POSITIVE] Perfect. Yes, that is my current updated one.
[AGENT][POSITIVE] Alright, and let me look at your benefits really quick.
[AGENT][NEUTRAL] And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and let's see, OK, let me look at the surgery benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna pull the certificate just to be 100%. 1 moment.
[AGENT][NEUTRAL] And you can always view this information as well if you register online through our website at [PII]. You can view all this information as well by double clicking your policy number once you register, OK, um, alright and let me, I'm waiting on the paperwork to upload, OK, one moment.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, for outpatient surgery in a hospital or outpatient facility or outstanding sur um outpatient surgery center. So it's included in all those for surgery and that's gonna be out of your outpatient maximum of 1500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Perfect. So any surgery or procedure at a surgery center, anything like that is $1500 towards it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's um 1500 per covered person per calendar year for any outpatient service including that um surgery center or surgery in the hospital. Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect. And does that have to be broken up or can that 1500 be used all at once at one place, one procedure, one time?
[AGENT][NEUTRAL] Mhm. Yeah, it could be breaking up or it could be used at once. Um, if the, um, just an example, if the procedure, um, if they apply like um $2000 to the deductible, you have $1500 you're responsible for the other $500. Now, if it's a small surgery and they only charge like $750 then you have the other $750 available for any anything else they need to send in.
[CUSTOMER][POSITIVE] Yeah, cause they were saying like my deductible with my insurance is 1500 and then there was an additional fee on top of that because my insurance does like 20% or something. So this card would cover the 1500 out of pocket deductible and I would pay the difference.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, yeah, but it, it is, uh, basically whoever sent the claim first, so we don't know if we're gonna get the claim for the surgeon or for the facility or who's gonna send the claim first, but you do have 1500 yeah.
[CUSTOMER][NEUTRAL] Oh, gotcha.
[CUSTOMER][NEUTRAL] OK, so like, yeah, cause they said the doctor has one bill, the facility has one bill, the anesthesiologist, so is it only for one of those? Is it for only the facility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Only for one of those if it doesn't exceed the amount. So like the example I was giving you before, if it doesn't exceed the amount, so let's say that we get the anesthesiologist bill before we get any other bills and the anesthesiologist's bill is just 500, then whatever bill comes next is gonna take that 1000 if it's more than 1000. Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] Have a good day bye bye.
[AGENT][POSITIVE] Thank you you too.