AccountId: 011433970860
ContactId: ec572737-e3a3-44be-8cd4-178a7315dc4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1273430 ms
Total Talk Time (AGENT): 517774 ms
Total Talk Time (CUSTOMER): 561821 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/ec572737-e3a3-44be-8cd4-178a7315dc4e_20250402T20:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good afternoon, [PII]. My name is [PII]. Um, I have the 90 degree, um, uh, I'm involved with you guys, and I look, I am looking, I visited my doctor today and he, uh, want to do a procedure in my back.
[CUSTOMER][NEUTRAL] And I wanted to know who do I contact or how do we go about to see if you guys would be able to cover.
[CUSTOMER][NEUTRAL] This procedure
[AGENT][NEUTRAL] Um, what is your policy number, please, Mr. [PII]?
[CUSTOMER][NEUTRAL] Oh, OK. I do not. Oh, it should be in my card. Hold on please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My apologies.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Oh boy, you know, it's like when you need things, and I guess I should have.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Have that ready.
[AGENT][NEUTRAL] No problem, um, what is your callback number if we were disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 458.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And they said like what.
[CUSTOMER][NEUTRAL] I'm sure you get these uh.
[CUSTOMER][NEUTRAL] Situations
[AGENT][NEUTRAL] It's fine, it's fine, um, if you're not able to find it, no, no worries, I can look you up by name. If you would spell your last name just to make sure I have it spelled correctly, please.
[CUSTOMER][NEUTRAL] Uh, yes, it is uh [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] T I
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. First name is [PII].
[CUSTOMER][NEUTRAL] I work for uh.
[CUSTOMER][NEUTRAL] I work for Oxford.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Prior to
[CUSTOMER][POSITIVE] I like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what state do you reside in, please?
[CUSTOMER][NEUTRAL] Uh, I in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I found my wallet here.
[CUSTOMER][NEUTRAL] And I have all these cards that you have sent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Do you want the group name uh number?
[AGENT][NEUTRAL] I'll tell you what, give me one moment if you could verify your mailing address.
[CUSTOMER][NEUTRAL] OK, you want me to give it to you?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. My mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][MIXED] I'm, I'm usually very good at preparing and I did. I failed this time.
[AGENT][POSITIVE] Oh, no worries, no worries, and if you could also verify that city and the zip code.
[CUSTOMER][NEUTRAL] Uh, OK, so [PII].
[AGENT][NEUTRAL] OK, I, I believe I have it here, sir, and what is your email address?
[CUSTOMER][NEUTRAL] It's [PII], or should say yoohoo.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much for the information. I was able to locate your policy, so thank you. Um, let's see here, give me one moment and you're having a procedure done, um, in your back, on your back and you want to know if it's covered. OK.
[CUSTOMER][NEUTRAL] On my back. Yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I have an employee ID number. Would that help?
[AGENT][POSITIVE] Well, actually I was able to locate your policy. I have it here, so thank you for that information for providing me your spelling of your name and all of that information. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I appreciate that.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEGATIVE] Uh, if you don't mind me, uh, so the, the doctors of the person who takes care of the insurance and so on, uh, they have called you guys, but, and she has left messages but unable to, uh, they have not returned.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The uh the call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we have been able, I'm not able to.
[AGENT][NEUTRAL] Now let's see here, the last time someone called was back last year, [PII], so.
[AGENT][NEUTRAL] Mm, OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, that's a good sign.
[AGENT][NEUTRAL] OK, so it's a procedure. Is it surgery, um, is, is it surgery that you're having?
[CUSTOMER][NEUTRAL] You know, uh, it, it, it, it's called the spinal cord stimulator.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's where they
[AGENT][NEUTRAL] Stimulator, OK.
[CUSTOMER][NEUTRAL] They'll put like a
[CUSTOMER][NEUTRAL] Like a wire inside and
[CUSTOMER][NEGATIVE] They put something else to block.
[CUSTOMER][NEGATIVE] The pain going to the brain.
[AGENT][NEUTRAL] OK. So you said that was a spinal.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] According to the doctor, it's against by
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm so sorry you said it was a spinal cord stimulator stimulator, correct?
[CUSTOMER][POSITIVE] Uh, stimulated, yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one.
[CUSTOMER][NEUTRAL] Uh, and the big, uh, huge gigantic favor that I will ask is if you can, I suffer a lot, [PII] years old, and if I can at least get some of this paperwork through the person that can say yeah or nay.
[AGENT][NEUTRAL] Yeah, we just
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That would be a blessing.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Well, I will more than likely have to transfer your call. Give me one moment please, Mr. [PII], one moment. Again, that was [PII].
[CUSTOMER][NEUTRAL] 00.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes, it is uh let me see.
[CUSTOMER][NEUTRAL] It is called the spinal cord stimulator. And I don't know because I'm, uh, it's a little bit confusing. I didn't know if I should have just had the, uh,
[CUSTOMER][NEUTRAL] The doctor's office called you guys.
[CUSTOMER][NEUTRAL] Uh, so that maybe because they might have questions that I may not know, and they would. What, what are your thoughts on that?
[AGENT][NEUTRAL] OK, well, typically the provider does call to verify if the patient is active and then what benefits are uh under the plan, um, now your policy shows of course it's active and as far as your benefits if is.
[AGENT][NEUTRAL] Um, surgery, is it, it sounds like it may be surgery, um, maybe.
[CUSTOMER][NEUTRAL] Yeah, maybe it's like uh, he said that the doctor said that he can do that inside the, his office. It's just a small incision where they put a wire to block the pain going into my brain, the signals.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so it can be done in the office.
[CUSTOMER][NEUTRAL] Do you think it'd be best if I ask you, the, the doctor folks to call you direct to call you guys directly and if there's a number?
[CUSTOMER][NEUTRAL] That you could give me
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh y[PII], I can provide you our toll free number for them to call to verify benefits, um, OK.
[CUSTOMER][NEUTRAL] For, for, for the for the person you were gonna transfer me, correct?
[AGENT][NEUTRAL] Now when you call or when the provider calls they will of course call here and more than likely they would either get our customer care team and they can answer the question or they would get.
[AGENT][NEUTRAL] This particular department where where which is what I'm in and it's a different department than what you have policy that you have.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] 11 last question before you transfer me. Uh, I'm, I'm just trying to make it easier for you guys as well. Um, I don't just think of myself. Do you think it would, if you gave me, uh, a phone number so that I could call the doctor and have them call you guys again, would it be better rather than me?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, calling them because I don't know the details of what they would do.
[AGENT][NEUTRAL] OK, yes, you can provide them our toll free number which I can verify our toll free number with you. Our number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. So it's [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Would it be best for them to call?
[AGENT][NEUTRAL] Yes, they can give us a call and, and before they call, I can go over what your benefits cover for surgery so that way you'll at least know that, OK? All right, now the policy, yes sir, the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I, I just wanna make it easier.
[AGENT][NEUTRAL] OK, no, no problem, no problem. Yes, sir, I understand. um, the policy that you have is a limited policy, which means it's not a major medical policy, it's limited.
[AGENT][NEUTRAL] And for surgery and anesthesia, I have to read you this disclaimer first. It says, please note verification of benefits provided does not guarantee payment. So we can't guarantee payment over the phone. So I have to tell you that disclaimer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your surgery and anesthesia benefit for the year is $2000 total.
[AGENT][NEUTRAL] Now, a portion of that goes to the surgeon.
[AGENT][NEUTRAL] Or the doctor and the portion, another portion goes to the anesthesiologist if anesthesia is used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So that is the max that we will pay is up to $2000 for the year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] And also let me provide you with a policy number because it will be different from your member ID number so when you call the doctor's office if you would provide them this number I'm about to give you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It is 0233.
[CUSTOMER][NEUTRAL] 0233.
[AGENT][NEUTRAL] 2107.
[CUSTOMER][NEUTRAL] 2107.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is that it?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, let me repeat it to you. It is 2 I'm sorry, it is 02332107.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a number that the doctor can call directly to the place that you were going to transfer me?
[AGENT][NEUTRAL] No, sorry, because it is a toll-free number.
[AGENT][NEUTRAL] So they'll call and ask to speak to someone in this department which the policy that you have the benefits that you have is a limited indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then I think I'm gonna do that. I think I'm gonna ask them to call you guys.
[CUSTOMER][NEUTRAL] Um, directly to see if, if they, they're gonna have more answers for you rather than myself. Does that make sense?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, great, I just wanna also, I just wanted to get a phone number where she can call.
[CUSTOMER][NEUTRAL] And uh we can take it from there and it's [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And the, the department or I think you mentioned that I just didn't catch it.
[AGENT][NEUTRAL] OK, the department would be the hospital indemnity department.
[CUSTOMER][NEUTRAL] Hospital
[AGENT][NEUTRAL] Indemnity.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And how do you spell that?
[AGENT][NEUTRAL] OK. It's spelled I.
[AGENT][NEUTRAL] N like Nancy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] D like David, E M N I T Y.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] E N
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] TY and thenity. OK.
[CUSTOMER][NEUTRAL] Hospi oh Hospital and indemnity, it's called.
[AGENT][POSITIVE] Yes, sir. Yes sir.
[CUSTOMER][POSITIVE] Great. And, and have them call at this [PII] number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Then I shall do that.
[CUSTOMER][NEUTRAL] And see what happens. Now, uh, in the policy there, from what you can read.
[CUSTOMER][NEUTRAL] Um, what would be
[CUSTOMER][NEUTRAL] The maximum amount that
[CUSTOMER][NEUTRAL] The insurance will cover, let's say on a
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] On a small surgery or
[AGENT][NEUTRAL] Well, the max that we'll pay will be up to $2000 and a portion of that, of course, um, goes to the anesthesiologist. It depends on um the type of surgery, um, that it is. So that's why I was asking for the spinal cord stimulator and when the doctor calls, they can probably provide us with a um like a procedure code.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Procedure code, yes sir.
[CUSTOMER][NEUTRAL] Oh, OK. So, so, so the amount, uh, uh, you, we wouldn't be able to know how much they'd be willing to, to cover for the, aside from the 2000 from the surgery.
[CUSTOMER][NEUTRAL] Is, is that correct?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] It depends on the type of surgery it is.
[AGENT][NEUTRAL] It depends on, yes sir.
[CUSTOMER][NEUTRAL] OK. So, 2000 for the 2000 for the anesthesiologist and for my doctor, and then separately, they would be able to say nay or yeah or how much they would be able to cover on the surgery itself.
[AGENT][NEUTRAL] OK. $2000 is the max we'll pay this, this will be for the surgery and the anesthesia combined.
[CUSTOMER][NEUTRAL] Oh wow, OK.
[AGENT][NEUTRAL] Yes, yes, sir, combined, and that will be for the year.
[CUSTOMER][NEUTRAL] Oh, so it's only up to 2000.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Because my understanding this one is like 40 or almost $50,000.
[CUSTOMER][NEUTRAL] For the procedure.
[AGENT][NEUTRAL] Yes sir, and we'll only cover up to $2000 for the year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] So it sounds like they will not be able to cover the uh.
[CUSTOMER][NEUTRAL] The procedure because it's only $2000.
[CUSTOMER][NEUTRAL] So, uh, the, the last question, what you're saying is, with this plan, with this limited plan, uh, the, the insurance would only be able to cover up to $2000 and that would include.
[CUSTOMER][NEUTRAL] Out of those 2000, it would be for the distributed between the anesthesiologist, the doctor, and the procedure.
[AGENT][NEUTRAL] It will be distributed between the anesthesiologist. It will be distributed between the anesthesiologist and the surgeon.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] And the switch that would cover, which when you say the surgeon, it, it means the procedure as well.
[AGENT][NEUTRAL] It means the doctor who's actually performing the procedure.
[AGENT][NEUTRAL] So the surgeon.
[CUSTOMER][NEUTRAL] Uh, no, I understand.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I guess the doctor would be the one to say it's how it's, it's so much. And right off the bat, we can see based on what you're able to see, you guys only cover up to 2000.
[AGENT][NEUTRAL] Part of the policy, it will only cover up to $2000 that includes, that includes the anesthesiologist. So for the surgery and anesthesiologist combined for the, for 1 year, for a year, we only pay up to $2000 max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think that answers my question. I'll just say it like this. As of now, with this policy, uh, the insurance would cover for the anesthesiologist, the doctor, along with the procedure.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Well, the doctor will perform the procedure, which he will be then, of course, the surgeon, that's the surgeon, and then the anesthesiologist, of course, if you have any anesthesia.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, and, and let's just say uh $1000 for the anesthesiologist and $1000 for the surgeon.
[CUSTOMER][NEUTRAL] With whatever he does.
[CUSTOMER][NEUTRAL] It would include with what this when we're talking about the surgeon, we're saying, let's just say the other remaining 1000, it would cover the surgeon with the procedure.
[AGENT][NEUTRAL] It all depends. Let me see if I can get someone to explain it to you, Mr. [PII]. One moment, please. But as far as the benefit, it'll cover that includes just the surgeon or the doctor who actually performs the procedure and the anesthesiologist. It all depends on what type of surgery it is, then it goes, and then it pulls from that, that max of 2000.
[AGENT][NEUTRAL] And then a portion of that goes to the anesthesiologist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great, uh, if you can transfer me to the other person, that would be greatly appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, give me one moment please, Mr. [PII], one moment. I'm gonna place you on hold.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], hi, this is [PII]. Um, I have an insured [PII], [PII]. Oh, Kra team, OK. Oh my goodness. OK, I have an insured on the line with policy number 2332107.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Mr. [PII], um, callback number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, OK. I've given him the um benefits for surgery and anesthesiologist, which is $2000 for the max.
[AGENT][NEUTRAL] Um, I've, I've been trying to explain to him, um, it depends on the type of surgery and then a portion of that goes to the anesthesiologist. He just needs a more, I guess, detailed explanation.
[AGENT][NEUTRAL] Um, what I did do for him was give him our toll free number and he's supposed to have the doctor give us a call.
[AGENT][NEUTRAL] To give us that procedure code but.
[AGENT][NEUTRAL] Um, I've tried to explain to him the benefits, but.
[AGENT][NEGATIVE] He's not clear.
[AGENT][POSITIVE] If that makes sense, oh my goodness.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I can do my best, um, and try and help them the best I can. [PII], you can go ahead and transfer him through.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you so much sir one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thanks.
[AGENT][NEUTRAL] Secretari.
[AGENT][POSITIVE] Oh, OK, OK. Thank you so much. OK, I have [PII] on the line. She's going to um try to explain it to you in depth as well, further in regards to the surgery and anesthesia benefit, OK?
[CUSTOMER][NEUTRAL] Uh, yes ma'am.
[CUSTOMER][POSITIVE] I appreciate that. Thank you, ma'am.
[AGENT][POSITIVE] You're welcome. You're welcome, and thank you so much for calling APL and hold for the transfer. Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir bye bye.