AccountId: 011433970860
ContactId: f7346c36-77b1-4431-88f9-77826d65dde9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476220 ms
Total Talk Time (AGENT): 248366 ms
Total Talk Time (CUSTOMER): 190689 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/f7346c36-77b1-4431-88f9-77826d65dde9_20250305T14:06_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Find a copy.
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. I have a couple of questions if you have a couple of minutes.
[AGENT][NEUTRAL] OK, are you the insured or are you calling from a provider's office?
[CUSTOMER][NEUTRAL] Um, I would be part of an insurance plan.
[AGENT][NEUTRAL] OK, this is your policy that you're calling about?
[CUSTOMER][NEUTRAL] It's through my husband's company.
[AGENT][NEUTRAL] And you're covered under that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am. OK, so you have some questions on your policy?
[CUSTOMER][NEUTRAL] I do, um, a top line question.
[AGENT][NEUTRAL] Just now I can. OK. OK, so first.
[CUSTOMER][POSITIVE] And I do apologize. Oh, go ahead.
[AGENT][NEUTRAL] OK, so first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] Um, my name is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, and Miss [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and your policy number please.
[CUSTOMER][NEUTRAL] Well, that's the thing unfortunately, um, we looked in like my, my husband's little Dropbox section and then we're physically looking for the card but we can't seem to locate the information and I'm, I'm pretty sure my OBGYN has it, but I just, I don't have a copy with me right now.
[AGENT][NEUTRAL] OK, what is
[AGENT][NEUTRAL] OK, what is your husband's full social security number so that I can look the information up?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. So if you'll give me a moment please to locate your information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and Miss [PII], I will need to verify several things with you first, for security purposes and also any information that I do provide will be a verification of benefits and not a guarantee of payment. So first off, if you would please verify your husband's name and date of birth and then your date of birth please.
[CUSTOMER][NEUTRAL] Sure. [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then my date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. The next piece of information to verify will be your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and the phone number that we would have on file, well, actually the phone number that we're showing on file is your phone number.
[AGENT][NEUTRAL] So, and lastly,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your email address? Because that appears to be what is on file as well.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you so much, Ms. [PII] for verifying all of your information. So how can I help you today?
[CUSTOMER][NEUTRAL] I dropped the digital copy and dropbox too.
[CUSTOMER][POSITIVE] Well, first off, I'm so delighted my husband handed me a copy of the card. You got it. So, uh, we're good. Um OK. So, um,
[AGENT][POSITIVE] OK, good. OK.
[CUSTOMER][NEUTRAL] My OBGYN has ordered a hysteroscopy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I can spell that if you need me to. Um, OK.
[AGENT][NEUTRAL] No, ma'am, that's OK.
[CUSTOMER][NEUTRAL] So, um, our, our primary insurance, United Healthcare, considers that, um, toward the deductible. So the expense today is gonna be pretty high. So my question was, number one, is this a claim that I would submit that would be covered under our policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, this policy is designed and again, any information that I provide for you would be a verification of benefits and not a guarantee of payment, Miss [PII]. So this plan is designed to help you with your co-pays, deductibles and co-insurance amounts of covered services. Will you be having this done at a facility at an outpatient facility or in the doctor's office where we be having?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's in the doctor's office.
[AGENT][NEUTRAL] OK, so on your, on your policy, you do have benefits. Uh, you have an office treatment writer, and we can review your claim under your outpatient benefit maximum, which on this plan is $6000.
[AGENT][NEUTRAL] Her calendar year, her covered person for covered outpatient services with no deductible.
[AGENT][NEUTRAL] So once the claim has been filed with your primary insurance, it would then be filed with APL because we will have to have a copy of your primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now what I would recommend is to present your APL and ID card along with your primary insurance card to your provider because most providers will file both insurances for you, which would make that process simpler for you.
[CUSTOMER][POSITIVE] OK. So, then my next question, thank you so much. That's all very helpful. Um,
[CUSTOMER][NEUTRAL] If today is offered as a payment plan or they need it paid upfront, is there a preferred process for that?
[AGENT][NEUTRAL] OK, now we do not have any control over how they handle that if they want you to pay, you know, up front before it is filed um that would just be something between you and the provider that would have to be determined because we can't guarantee payment of a claim, so.
[CUSTOMER][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] OK, I just didn't know if for paperwork purposes like if they offer a payment plan that's 4 months if that complicates things for um anything.
[AGENT][NEUTRAL] No, ma'am, again, because that would be, you know, that would just be between you and the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Well, I greatly appreciate your time this morning. Um, glad to have you on board with us. OK, thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome.
[AGENT][NEUTRAL] Well, you're, you're welcome, Miss [PII], and then, um,
[AGENT][NEUTRAL] I'm going to send.
[AGENT][NEUTRAL] An email regarding setting up do you know if you all have already set up your profile in our portal?
[CUSTOMER][POSITIVE] I believe we did, but again without the card, I wasn't even sure where to look. So um I've got it now I'm thrilled, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK, well, you could check that, and if you haven't, you know, you can set up that profile, um, because the email on file is yours that way you all could have access to your ID cards and all online as well.
[CUSTOMER][POSITIVE] OK. Well, I'll go from here on. I'll just. Thank you so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, this is perfect.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Well then, thank you for calling APO Ms. [PII]. I hope you have a very nice day and I hope everything goes very well for you with your procedure.
[CUSTOMER][POSITIVE] Oh, you too. Thank you.
[AGENT][POSITIVE] Yes ma'am, you're welcome. Bye bye.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Yeah