AccountId: 011433970860
ContactId: f5afc5ed-ebfb-468a-a6ca-1d80bec42a2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418359 ms
Total Talk Time (AGENT): 201950 ms
Total Talk Time (CUSTOMER): 171447 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/f5afc5ed-ebfb-468a-a6ca-1d80bec42a2c_20241231T15:16_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm just calling about a benefit that I'm gonna need. I wanna know if you guys covered or not.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] Um, it's [PII], but it's under my husband's name, [PII], the primary.
[AGENT][NEUTRAL] OK, spell your spell your first name for me.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII], OK, and what's the policy number?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Uh, I don't have my card on me. I'm at work, but the surgery center called me and I said I would call you guys.
[AGENT][NEUTRAL] And spell your last name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] And [PII], what's your date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying the information and you're calling to verify.
[CUSTOMER][NEUTRAL] Um, I, so I'm supposed to get a tonsillectomy and I wanna know if you guys cover those or not.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Uh, that can be considered under the outpatient benefit of this policy. Did you want that benefit?
[CUSTOMER][NEUTRAL] Um, well, I get it, I get it [PII], so my primary will cover a portion and then they said what's left over is $2000. And, but they said they, um, to contact my secondary insurance to see how much would be left over after that cause I got to pay it upfront.
[AGENT][NEUTRAL] OK, so you have under this policy, your benefit is your outpatient benefit is up to $6800 per calendar day, but there's also a $1000 deductible under this policy that you have to satisfy first as well. Have you had any services done this year?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, because this is gonna be the [PII], so it's gonna be [PII].
[AGENT][NEUTRAL] So I'm only showing, I do show an outpatient claim for you, but it looks like of the $1000 deductible you have met $419.33 of that amount.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] Once you satisfy the total 1000 and we are then able to pay out a benefit because your benefit is per calendar day, which is a good benefit, 6800 per calendar day.
[CUSTOMER][NEUTRAL] OK, OK, so do I, do we just pay them the 1000 upfront and then they would send everything to you? How does that work?
[AGENT][NEUTRAL] So you said that and so.
[AGENT][NEUTRAL] So I think the best thing would be, let me see if they've called us to verify your benefits.
[CUSTOMER][NEUTRAL] OK, it's Landmark Surgery Center.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Just as outpatient. Do you have, did you have another surgery earlier this year?
[CUSTOMER][NEGATIVE] No, my son had one in June. He had um surgery on, he broke his humerus bones.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so that call may be due to him, but let's so.
[AGENT][NEUTRAL] Um, you're correct in saying that this policy will pick up what the prime, what's applied, um, to the primary's deductible co-insurance and or co-pay amounts only. So of that $2000 if that's applied towards your deductible, then we would have to satisfy your $1000 deductible first and then pay out a benefit. So you've all you, you, you've met $419 of it so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we just pay you guys the 1000 then?
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] It's so confusing. I'm sorry.
[AGENT][NEUTRAL] Yeah, yeah, you don't have to pay us out of pock you don't you unless they're requiring that you pay something out of pocket, but I think the best thing would be is to have them call us to verify what your benefits are.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Well, that's what they said. They said that they, well, if I, cause I secondary that sometimes that they just go out to the primary and then secondary, but then like, OK, and then I would just get a bill in the mail.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So, so ask them if, tell them what your benefit is first. Tell them that you your benefit is up to $6800 per calendar day.
[AGENT][NEUTRAL] But then there's also an outpatient deductible of 1000 and let them know how much of that deductible you've already met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which was, I'm gonna write that down, um.
[AGENT][NEUTRAL] It's $419.33.
[AGENT][NEUTRAL] And so 4 1933.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm trying, I'm.
[CUSTOMER][NEUTRAL] 419.
[AGENT][NEUTRAL] So once
[AGENT][NEUTRAL] So 1000 minus 419.33, so you have $580.67 to meet that $1000. Once that's met, then we can pay out a benefit.
[CUSTOMER][NEUTRAL] OK, so, and you, and then my benefit was per calendar day was what?
[AGENT][NEUTRAL] $6800.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna read this to make sure I got it right. We've met $419.33 out of the $1000 that comes out of pocket, OK? And then for me and then benefits per calendar year is 6 or per day.
[AGENT][POSITIVE] You've met that mhm just for you.
[CUSTOMER][NEUTRAL] Per calendar is 6800.
[AGENT][NEUTRAL] It's per calendar day.
[CUSTOMER][NEUTRAL] OK, per calendar day. OK, I got it all that way I'll I'll call them later and I will let them know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. And then, um, did you present your ID card to them?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I did. Well, it's strange cause it's, it's the doctor's office, they do the surgery like up, it's not in a hospital. They do it upstairs and they have like their own surgery center. And um yeah, I sent that over to her, but she's only ran, she's only went through.
[AGENT][NEUTRAL] Sure you did.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your primary.
[CUSTOMER][NEUTRAL] The United Healthcare so far.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it would be um a good suggestion if you would, you know, just ask them to call to verify your benefits.
[CUSTOMER][NEUTRAL] OK, I will do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I appreciate it.
[AGENT][NEUTRAL] Oh, you're welcome, [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK, well thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a good [PII].
[AGENT][POSITIVE] Uh, you too. Have a [PII] as well.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.