AccountId: 011433970860
ContactId: f806bdca-d3d5-4ee8-aafe-87a2c81dd3dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508480 ms
Total Talk Time (AGENT): 251362 ms
Total Talk Time (CUSTOMER): 204938 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/f806bdca-d3d5-4ee8-aafe-87a2c81dd3dc_20250409T15:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling to see about um some um co-payment or um to see if you cover this, because I have a Blue Cross Blue Shield for this treatment and they uh already approved it, but I have.
[CUSTOMER][NEUTRAL] I have to pay an amount and I have the code for the treatment, so I want to know if you cover this.
[AGENT][NEUTRAL] OK, well, I can take a look at your policy um and let you know of your coverage. And may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] 3059685701.
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] Uh, I have to, um, I'm gonna give you the outpatient first. It's um 02478776.
[CUSTOMER][NEUTRAL] M. like Moon. L like Larry, number 8.
[CUSTOMER][NEUTRAL] Um, the other one is.
[AGENT][POSITIVE] Thank you for that. And I just
[AGENT][NEUTRAL] The numbers are the same. The ML 7 or 8 at the end is different, but those numbers are your policy number. So I'm in there. Um, I just need you to verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and the mailing is [PII].
[AGENT][POSITIVE] Thank you for that. And um Ms. [PII], just your, um,
[AGENT][NEUTRAL] Email address, sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so you, you're saying that you're having a um primary has already paid and there's still a balance and you wanted to know if you can submit it to us.
[CUSTOMER][NEUTRAL] No, no, the thing I haven't got the pro the thing yet. Uh, they approved, they pre-approve then so I I had to pay like a $230 and I have with me the code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, he's, um.
[AGENT][NEUTRAL] Well, the colds.
[CUSTOMER][NEUTRAL] I have a guy.
[AGENT][NEGATIVE] So our policies are broken.
[CUSTOMER][NEUTRAL] Yeah, the codes for [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] The policy is broken down into the place, like if it's going to be inpatient or outpatient, so I can't really use the codes. I'm more so just asking the questions, trying to see what it's for, so I know how to, which benefits are going to be used. So, the primary insurance has already approved it. What, what is happening? Like, is this a surgery? Is it a doctor's office visit?
[CUSTOMER][NEUTRAL] No, I say a week, um, I have the diagnostics.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] So you're having like imaging done?
[AGENT][NEUTRAL] Like diagnostic testing?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, no, the, the week and the diagnostic.
[CUSTOMER][NEUTRAL] For the week.
[AGENT][NEUTRAL] OK, so it's still, so are you going to be admitted to the hospital or are you going there and then coming home the same day?
[CUSTOMER][NEUTRAL] No, no, I, it's just for a
[CUSTOMER][NEUTRAL] They wanna provide me a week.
[CUSTOMER][NEUTRAL] And they wanna do the um the majors and everything the same day.
[AGENT][NEUTRAL] And you're going home the same day?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that's outpatient. So your outpatient benefits are up to $300 per calendar day. So each day you have $300 that you can use towards your outpatient expenses. So what you'll do is when you go to the facility, you can even give them a call because they already have your primary insurance information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just make sure they have your secondary, so that after you have everything done, after you have the service, they're gonna bill your primary and then they're going to bill us directly after because we're second to your Florida Blue.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, well I want to make sure is you cover this type of um of service. That's what I have the numbers here.
[CUSTOMER][NEUTRAL] So we can verify.
[AGENT][NEUTRAL] So the answer to your question is yes, you have outpatient benefits. If you give me the codes, I can't do anything with it because we don't go by codes, we go by where it's done. So if it's outpatient, you have $300 per day to use.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me one second please hold on.
[CUSTOMER][NEUTRAL] I have a question is this outpatient?
[AGENT][POSITIVE] If you're there, I can speak to them and give them the benefits.
[CUSTOMER][NEUTRAL] Because I have the 300.
[CUSTOMER][NEUTRAL] OK, hold on, can you speak to him to me.
[CUSTOMER][NEUTRAL] Uh, uh, you, uh, yeah, I wanna transfer to one of the ladies here, OK.
[AGENT][POSITIVE] OK, sure. No problem.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][POSITIVE] Hi, good afternoon.
[AGENT][NEUTRAL] Hey, my name is [PII]. I'm with APL. Um, so it sounds like she's trying to verify benefits. So you're just wanting to know her outpatient benefits for the procedure that's being done?
[CUSTOMER][NEUTRAL] Yeah, so she's doing a consultation. What she is calling in reference to is to see whether the specific code for the wig that she's taking is listed under um her covered benefits. She does have authorization from her primary insurance, which is Blue Cross Blue Shield, to take the wig. She would just like to know whether you guys would pay the remaining balance for whatever Blue Cross Blue Shield doesn't cover.
[AGENT][NEUTRAL] You're saying a wig like for like hair? I thought she was saying a wig.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] No, a wig.
[AGENT][NEUTRAL] OK, so this is her secondary insurance. So I was explaining to her the codes really won't help me because it's, we go by place of service. So this is it um like our cancer policy that has wig coverage. This is more so if if there's a service done inpatient, we have inpatient benefits. If it's outpatient, we have outpatient benefits. So the best thing to do would be to just, we're second to her Florida Blue.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just go ahead and submit the claim to us and we'll process it because there's no like.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Specific, um, there's no specific coverage for this secondary policy, it's just place of service.
[CUSTOMER][NEUTRAL] OK, bear with me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and when you say um submit the claim, you mean once she does take the wig home, whatever, um, gets billed to Blue Cross Blue Shield, um, that will automatically be sent to you guys or does Blue Cross Blue Shield send it to you at that point?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, so you all, um, once you build to Blue Cross, they'll apply and then if there's anything left over or if she has a co-pay, she can be reimbursed for, um, you'll send the explanation of benefits from Blue Cross, your itemized bill and your itemized bill to us as second, and then we'll either reimburse her or if there's something still owed to you all, we can pay up to that $300 per calendar day if it is a covered.
[AGENT][NEUTRAL] Uh, charge on the secondary policy because the secondary has its own coverage.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's, that's all. Thank you.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you all have a good day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Bye-bye.