AccountId: 011433970860
ContactId: f17fe992-4bc3-4a0e-a8cd-36231f9dbb1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268000 ms
Total Talk Time (AGENT): 134466 ms
Total Talk Time (CUSTOMER): 81371 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/f17fe992-4bc3-4a0e-a8cd-36231f9dbb1d_20250318T18:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I was calling to see um.
[CUSTOMER][NEUTRAL] I'm getting ready to see a doctor Thursday and
[CUSTOMER][NEUTRAL] They were telling me uh that that you guys are not in network.
[CUSTOMER][NEUTRAL] So I was trying to see um what was going on with that that you guys are not in network.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with your benefits. Um, first, let me get your name and a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your name, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, [PII], and could I get a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Could I get your policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number 02156200.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK. And please verify the email address on the policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And actually, under this policy, there is no network. This is a policy for secondary gap insurance. Um, we go by the primary insurance guidelines. So who's your primary carrier?
[AGENT][NEUTRAL] Our primary insurance.
[CUSTOMER][NEUTRAL] Uh, UMR.
[AGENT][NEUTRAL] OK, well, yes, ma'am. We go by their guidelines. So we work with our providers. There's no network with us.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[CUSTOMER][NEUTRAL] So, so you guys do work with uh UMR.
[AGENT][NEUTRAL] Yes, ma'am, with your primary insurance, yes.
[CUSTOMER][NEUTRAL] OK, so whatever, so whatever like the primary don't cover that you guys come in and take care of the rest.
[AGENT][NEUTRAL] Well, if uh your primary insurance don't cover a charge, then we automatically deny it also. But if they do cover a charge, we cover up uh to a certain amount for the type of service. You said this is for outpatient surgery?
[AGENT][NEUTRAL] Or what type of
[CUSTOMER][NEUTRAL] No, no. This, this is for, this is for PCP doctor.
[AGENT][NEUTRAL] OK, for your PCP doctor for office visits? Let's see.
[AGENT][NEUTRAL] Well, the co-pay for the office visit is not covered, but for services provided in office, the office treatments, the charges that goes towards the co-insurance and the deductible. After your primary insurance processes the claim, we cover up to
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We cover up to $2400 per calendar year and that's for the co-insurance and the deductible, but you would have to meet a $100 deductible first. And once the $100 deductible is met with us, we'll cover up again up to $2400 per calendar year.
[CUSTOMER][NEUTRAL] OK, so where, so where, where are we now as far as like the calendar year?
[AGENT][NEUTRAL] Mm, let's see, have you met anything?
[AGENT][NEUTRAL] OK, well, I'm showing for you, you've already um met your $100 deductible for this year and you've used $258 of that amount.
[AGENT][NEUTRAL] You've used $258 of the $2400.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So, so how much more do I have to go?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You have $2,142 left for outpatient services.
[CUSTOMER][NEUTRAL] 2,142. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. OK. Well, thank you so much for all of your help.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] I know you've been very helpful. Thank you.
[AGENT][POSITIVE] OK. Well, I thank you for calling APL [PII]. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too as well. Bye bye.
[AGENT][POSITIVE] Bye. Thank