AccountId: 011433970860
ContactId: f0a4ecd2-2259-41f1-b4ee-2e4ae3093822
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 832219 ms
Total Talk Time (AGENT): 429672 ms
Total Talk Time (CUSTOMER): 221200 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/f0a4ecd2-2259-41f1-b4ee-2e4ae3093822_20250226T18:14_UTC.wav
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[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] Advice, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I have a question about our, um, our benefits on our insurance here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was wondering if you could just answer them for me real quick.
[AGENT][NEUTRAL] Sure. Let me get some information from you and get your policy pulled up. Could I get your uh first name and a callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] is my first name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And a callback number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It is area code [PII].
[AGENT][NEUTRAL] Thank you. And what is your policy number?
[CUSTOMER][NEUTRAL] And that's the group number, is that right?
[AGENT][NEUTRAL] The er the certificate number.
[CUSTOMER][NEUTRAL] Oh, certain number, OK, I have 02493493.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima 7.
[AGENT][NEUTRAL] OK, and if you could verify last name and uh date of birth, please.
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's.
[CUSTOMER][NEUTRAL] [PII]. And this is gonna be for my wife as well, and she needs to get surgery.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, hold one moment and I'll get your policy pulled up for you.
[CUSTOMER][NEUTRAL] She's on the phone.
[AGENT][NEUTRAL] OK, hold one moment.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for waiting. I do apologize for the wait.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see, so you said this is gonna be for your wife and she is having surgery?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. And is this gonna be an outpatient or inpatient surgery?
[CUSTOMER][NEUTRAL] Is it impatient?
[AGENT][NEUTRAL] Inpatient, OK, and if you could verify one more piece of information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I, uh, I think it's outpatient. I'm sorry.
[AGENT][NEUTRAL] Oh, that's OK. Uh, if you could verify your mailing address and
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, I don't show you have an email address on file. Would you like to add one?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, if you could first verify your mailing address.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] In [PII], and we recently moved. You might have our [PII] address still.
[AGENT][NEUTRAL] Yeah, I do. OK, so I need to update that. So [PII] you said [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct, [PII].
[AGENT][NEUTRAL] Is that all one word or two separate?
[CUSTOMER][NEUTRAL] Read
[CUSTOMER][NEUTRAL] It's 2 words or 3, I guess, [PII].
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then the city again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Did [PII]
[CUSTOMER][NEUTRAL] ZIP code is [PII].
[AGENT][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] [PII] OK and what is the email address you'd like to
[CUSTOMER][NEUTRAL] It is like, uh, my first name, it's like [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me do that one more time. [PII] and then what's after that?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. OK, I have [PII].
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, I have that updated. OK, and I will get your, put in a request to have your um mailing address updated. Uh, OK, and so this is in reference to outpatient benefits for outpatient surgery for your wife. Uh, please be advised verifying benefits does not guarantee payment.
[CUSTOMER][NEUTRAL] Request
[AGENT][NEUTRAL] Um, so for outpatient benefits, I show that your policy pays up to $1500 a calendar year.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Which makes sense and then.
[CUSTOMER][NEUTRAL] OK, and for outpatient is it the same or inpatient I believe?
[AGENT][NEUTRAL] Yes, inpatient is a separate $1500. Yes, sir.
[CUSTOMER][NEUTRAL] Is it the same?
[CUSTOMER][NEUTRAL] OK, and nothing else on top of that though, like if like United Healthcare does like that some 80/20 thing, the 20% isn't covered by this, correct?
[AGENT][NEUTRAL] No, it is. So your policy with us covers deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] For covered services. So let's just say sometimes with the hospital, if it's outpatient, there may be an outpatient co-pay. You can use the $1500 towards the copay, uh, the 20% would be the co-insurance, and so you can, uh, the 20% that will be billed to you can be billed to American Public Life under the $1500.
[AGENT][NEUTRAL] And then of course, if you have a deductible.
[CUSTOMER][NEUTRAL] This doesn't include the deductible though, right? If I have like a um.
[AGENT][NEUTRAL] It does. It, it's deductible. If you have uh patient responsibility applied to your deductible, if it's applied to a co-pay or if it's applied to co-insurance, you can use your American public life.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, it will not cover non-covered charges. So if you're UnitedHealthcare denies the claim stating they do not cover the charge, you would not be able to use American Public Life to pick it up. They have to consider the charges and apply patient responsibility to deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] No, I'm, I'm just confused because they had called and they said that we still owed like $1400.
[AGENT][NEUTRAL] To your deductible.
[CUSTOMER][NEUTRAL] Yeah, after it's.
[AGENT][NEUTRAL] Is this not him.
[CUSTOMER][NEUTRAL] Yeah, or the hospital did.
[AGENT][NEUTRAL] OK. So that, that is probably what you still owe to United Health UnitedHealthcare, um, deductible. That's probably what's left of your deductible. So let's just say she has the hospital charges and they apply the full $1400 to your responsibility.
[AGENT][NEUTRAL] That claim can be submitted to us to cover the
[AGENT][NEUTRAL] $1400 because she has $1500 available.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So they probably have not called us. They probably just called um United Healthcare.
[CUSTOMER][NEUTRAL] OK, because there's.
[AGENT][NEUTRAL] Uh, if they call us to verify your benefits, we will let them know that you have $1500 available, uh, as a secondary payment, so they would know, OK, we can file to United Healthcare and then once UnitedHealthcare processes their claim, shows what the patients, uh, what the patient owes, then we can send that to American Public Life.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] To
[CUSTOMER][NEUTRAL] That's what I thought, yeah.
[AGENT][NEUTRAL] Yeah, so they, uh, let me check your notes and see.
[AGENT][NEUTRAL] If any, and that may be why they.
[CUSTOMER][NEUTRAL] Because we gave them all that information and that's what I, I'm sorry, I didn't mean to cut you off, yeah.
[AGENT][NEUTRAL] Oh, no, you're fine. Let me see.
[CUSTOMER][NEUTRAL] That's what I told her, and they're like, no, you still owe this. I'm like the numbers aren't adding up right. Let me just call and make sure. I don't, so I just wanted to verify.
[AGENT][NEUTRAL] OK, so no, they did, uh, someone by the name of [PII] called, uh, earlier today, uh, and it be advised that for outpatient, for your wife, um, she has $1500 a calendar year.
[AGENT][NEUTRAL] So I don't know if, do you know what, what you're gonna be responsible for? The only other thing that I can think is after, even after we pay $1500 there may be still a $1400 balance. Maybe that is what
[AGENT][NEUTRAL] They're telling you.
[AGENT][NEUTRAL] But they did verify the benefit.
[CUSTOMER][NEUTRAL] That's what the
[CUSTOMER][NEUTRAL] Yeah, but they're saying it was part of like the 20% co-insurance is what they said it's, it is.
[AGENT][NEUTRAL] OK, so that is all gonna be based on what that amount is. So has United Healthcare giving, like, do you know of the total amount that they're saying you're responsible for?
[CUSTOMER][NEUTRAL] Which would, this would be covered.
[AGENT][NEUTRAL] Because, for instance, that's the total amount you're responsible for.
[CUSTOMER][NEUTRAL] like 1450.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so that should be, I mean, you have the $1500 that they can apply the $1,4502. So the only other reason I, I could, would say that they're saying that you owe it, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Now, every doctor does not have to, you know, it is their right to not file the claim if they don't want to. Um, that's the only thing is if they're, if they're
[CUSTOMER][POSITIVE] And I have the patience.
[AGENT][NEUTRAL] You know, if they're not going to file with us for you and they may want the payment upfront.
[CUSTOMER][NEUTRAL] I, I think.
[CUSTOMER][NEGATIVE] And then I'd have to turn around and do. Cause they don't think they're gonna get paid.
[AGENT][NEUTRAL] And then you'll have to
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that may be the issue. If that is the case, um, make sure that you ask them for an itemized statement, and if you write this down, they'll know exactly what you need, therefore, you know, if you have to pay upfront and file yourself, you'll already have that part from them.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And then you'll just wait till you get your explanation of benefits from United Healthcare back, and then you can submit the itemized bill along with the United Healthcare explanation of benefits to us and then we'll reimburse you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK, get the itemized statement along with EOB and then submit that.
[AGENT][NEUTRAL] Yes, and part of the itemized statement, make sure that they, they, you let them know uh you need the itemized statement and also the ICD pin code.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh yeah, OK. I see the 10 codes OK.
[AGENT][NEUTRAL] And uh you can submit it yourself.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I, I'm, I'm have a good feeling that's probably what it is then. OK, well thank you so much for your time and getting that cleared up.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, no problem. Is there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No, that's all you've been more than helpful.
[AGENT][POSITIVE] OK, you have a wonderful day. Thank you for calling APL, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.
[AGENT][NEUTRAL] Bye bye.