AccountId: 011433970860
ContactId: eae9404f-1d95-4dbb-beb1-f09e42aa7106
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413980 ms
Total Talk Time (AGENT): 243684 ms
Total Talk Time (CUSTOMER): 169979 ms
Interruptions: 3
Overall Sentiment: AGENT=2.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/eae9404f-1d95-4dbb-beb1-f09e42aa7106_20250206T14:46_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] Hey [PII], it's [PII] how are you doing?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you today?
[CUSTOMER][NEUTRAL] Good, I'm doing well, thank you. Um, so just before I give you this information, I wanna make sure you guys can take this call. Um, I couldn't get the med link you on the line. I think everybody's tied up. Can you answer benefit questions?
[AGENT][POSITIVE] I sure can, and it would be my pleasure. What's the policy number?
[CUSTOMER][NEUTRAL] OK, OK, so, um, it is 252-1540.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and it's [PII], so he actually called in. He's the group contact, so I verified the group information because he wanted to make a payment, so I already took care of that, but then he asked me for his individual policy, um, he, he has a surgery coming up on Tuesday and so he wanted to know, you know, he had questions about a co-pay.
[AGENT][POSITIVE] I will be happy to assist him.
[CUSTOMER][NEUTRAL] OK, um, and so the number he's calling from is his callback number, the [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Oh, he can't even make an OSC account because we don't have his email.
[CUSTOMER][NEUTRAL] Um, OK, uh, I wonder it might be the same as the group email.
[AGENT][POSITIVE] I'll, I'll get that and verify it with you. I'll, I'll take care of all that. My pleasure, [PII]. Thank you. Thank you.
[CUSTOMER][POSITIVE] OK, OK, thank you so much, [PII]. OK, here he comes, mhm.
[AGENT][POSITIVE] Good morning, Mr. [PII]. My name is [PII] in the care team. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing well, [PII]. Hope you are as well.
[AGENT][POSITIVE] I am, thank you
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm calling because I have a surgery upcoming on Tuesday.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I believe there's a like a $500 co-pay and I wanted to see if that would be covered uh through APL or is it something I would have to pay out of pocket?
[AGENT][NEUTRAL] Oh, I can certainly help you with those benefits, Mr. [PII]. And I don't have an email on file for you. Do you, would you like for me to add your email?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And just to verify, that's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Alright, I've added that for you. So if you ever want to create an online account.
[AGENT][NEUTRAL] Um, we have the information and you can.
[AGENT][NEUTRAL] Do that and she said you're the group contact so are you, are you accustomed to the online service center?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, yeah, uh, in fact, let me backtrack a little bit because I have that's the email I use for my group. I am, I'm the I'm, I'm, I'm the employer as well, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is that the one I'm giving you? Is that for my personal account? Is that what uh you were referring to that email I gave you?
[AGENT][NEUTRAL] Yes, sir, is that the one you would like for your personal account or you wanna use a different one?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] No, let's, let's, let's change it so there won't be no confusion if you don't.
[AGENT][NEUTRAL] Not a problem. What's that personal email?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right, I've updated that to your personal.
[AGENT][NEUTRAL] Um, so for your procedure, that will be on an outpatient basis? Is that, OK.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] So you do have coverage up to $1000 per calendar day.
[AGENT][NEUTRAL] That we can pay towards your primary insurance deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now that is a verification of coverage on your policy. It's not a guarantee of payment simply means we can't process it guarantee payment until we have the claim in house and processed, but you do have that benefit amount, so be sure to give them your APL information along with your primary insured information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, excellent, very good. And with that, that they would be able to get back to me, uh, rather quickly right? with that or?
[AGENT][NEUTRAL] So it depends on
[CUSTOMER][NEUTRAL] Well, I could speak with them.
[AGENT][NEUTRAL] Yeah, it depends on when they file the claim, you know, sometimes the providers have to process through your primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so that's, you know,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have to wait for that cause they have to send the primary explanation of benefits along with the claim.
[AGENT][NEUTRAL] Once we receive the claim document, it normally takes between 7 to 10 business days, more, you know, give or take, just depending on holidays or, um, but that's the average time frame.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And you can always.
[CUSTOMER][NEUTRAL] OK, if I need to pay them and go ahead.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] I was just gonna say you can always check online if you create that portal. Once we receive a document, there's an open document once it's processed, they'll have a claim number. You can sign up for text messaging as well, and you'll receive a text message once it's processed. There's also direct deposit option if you would prefer benefits go directly to your bank account.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you, because I could alternatively I could pay for it in case and then I would get reimbursed.
[AGENT][NEUTRAL] You can get reimbursed for the claim if you want to pay upfront. Now we will need an itemized bill from the facility with the diagnosis codes and procedure codes, and we'll also need a copy of your explanation of benefits from your primary insurance showing what they applied to your deductible for that date of service.
[CUSTOMER][NEUTRAL] Or no?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, that they would be able to fill at the office, at the doctor's office, or is it something I would have to handle that would be the situation.
[AGENT][NEUTRAL] The itemized bill with the diagnosis codes and procedure codes would come from the facility where you're going to have that procedure. The explanation of benefits that is provided by your primary insurance, once they process the claim, then that would be available. So there, you know, you would need to wait for your primary insurance to process the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you. Alright, very good man.
[AGENT][POSITIVE] But the facilities should submit it for you that way you don't have to worry about getting the documents and getting them to us.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] That's usually the easiest for you anyway.
[CUSTOMER][POSITIVE] Definitely.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] But however, you, you definitely have that option of reimbursement.
[CUSTOMER][POSITIVE] Definitely, definitely.
[CUSTOMER][POSITIVE] Alright ma'am, very good, thank you very much, appreciate it, [PII].
[AGENT][POSITIVE] It's been such a pleasure to assist you. Is there anything else I can help you with, Mr. [PII]?
[CUSTOMER][POSITIVE] That's it for today. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] And thank you for calling APL. You have a lovely day as well. Take care.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.