AccountId: 011433970860
ContactId: f9be2015-1c1f-482c-8914-f36079f27c55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421720 ms
Total Talk Time (AGENT): 235723 ms
Total Talk Time (CUSTOMER): 159484 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/f9be2015-1c1f-482c-8914-f36079f27c55_20250115T22:20_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh, hello. Um, I was calling because I needed to ask a question, um, regarding the procedure I was going to have.
[CUSTOMER][NEUTRAL] So, or do I need to give you my information to look at my policy? I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, please. Go ahead with the policy number.
[CUSTOMER][NEUTRAL] I'm sorry, I don't have that with me.
[AGENT][NEUTRAL] Oh, OK. Um, may I have your name and a callback number?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] My name is [PII]. Yes, my name is [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Callback number is area code [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. All right, let me see if I can find your um policy with your name, OK? You're welcome. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have your address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And may I have your date of birth and the email address on file for verification?
[CUSTOMER][NEUTRAL] It's [PII]. I have no email on file.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect. Thank you. All right. And what type of procedure are you having done?
[CUSTOMER][NEUTRAL] Uh, colonoscopy?
[CUSTOMER][NEUTRAL] And then something else. I don't know what it's called.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] Is it a diagnostic colonoscopy or preventative colonoscopy, diagnostic colonoscopy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is it, is it, is it what? I'm sorry?
[AGENT][NEUTRAL] Preventative or diagnostic?
[CUSTOMER][NEUTRAL] Oh, there it is.
[AGENT][NEUTRAL] Oh, it's preventative, OK.
[AGENT][NEUTRAL] All right. What else are they having done? It's just the colonoscopy?
[CUSTOMER][NEUTRAL] It's the endoscopy, I think it's called.
[AGENT][NEUTRAL] Endoscopy. And the endoscopy, is it gonna be uh also preventative or is it diagnostic? So they're both um preventative. OK.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Uh, and this is not a guarantee of payment, just a verification of coverage. Ms. [PII], this particular policy is one of our secondary supplemental plan to the major medical, and this one doesn't cover preventatives because preventatives are usually covered 100% by your major medical. We only cover if it's a diagnostic test.
[AGENT][NEUTRAL] And if it's if it's a diagnostic test, it's gonna be um subject to the outpatient maximum which is 2550 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you only cover diagnostic and preventative.
[AGENT][POSITIVE] Correct, yes, that's correct.
[CUSTOMER][NEUTRAL] OK, because when I called earlier, they didn't say anything like that and they just told me, so preventative is covered 100% by my insurance?
[AGENT][NEUTRAL] More than likely it's gonna be, yeah, um, all preventative services usually pay 100% by your major medical. I'm not sure which one you have and I'm not sure if they pay 100%, but um that's why this one doesn't cover preventative because.
[CUSTOMER][NEUTRAL] For the colonoscopy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Most of all, they pay 100% for the preventative service.
[CUSTOMER][NEUTRAL] OK. OK. And um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So let's just say that it's diagnostic. I'm not sure, but if it is diagnostic. And I go, they want me to pay $2,296.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the jaw of the pug bucket right there, boom, I don't have that.
[AGENT][NEUTRAL] I understand, yeah.
[CUSTOMER][NEGATIVE] So they, yeah, so they want me to, and they won't let me even just put a deposit and still have the procedure, and they won't let me wait until it gets processed to determine whether it's going to get paid or not. So they're asking me that if I don't leave the money down completely, the full amount, then
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can go into credit care and have it done with them and then get, and then pay them on a monthly basis. So my question is if, let's say that it's diagnostic.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you all should be paying.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But they want me to go to this credit thing, can I still process the claim with you all to pay that since I'm gonna have to go that route because I can't pay it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, correct. If, um, they don't, if, if they need this upfront, and it's a diagnostic testing, which is something that we do cover, then you will send the claim in for a reimbursement. The reimbursement will go to you.
[CUSTOMER][NEUTRAL] For the full amount, even though it's being financed by a credit care company?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. We go by the amount that the major medical applied towards the deductible co-payment and co-insurance. An example. Um, if, uh, you go to do an MRI, and that's just an example, you go to do an MRI to an outpatient facility, and they say you have to pay the $2300 that is applied for your deductible. You go ahead and pay that amount out of pocket and um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you will submit the claim. The amount, the 2300 needs to be applied towards your deductible from your major medical, and then that's what we're going to pay. So basically, even if you put it in a credit card, you put it in a loan, and you put it, um, just any, any place that you put that amount that you pay um is gonna be considered as long as is uh applied towards the deductible from your major medical and it's a covered service.
[CUSTOMER][NEUTRAL] OK, so then I just submit the bill and then you all pay for it and I pay whatever I need to pay over here how I use what I use to assist me in paying.
[AGENT][NEUTRAL] Correct. Well, you're gonna submit to us is the itemized bill with the diagnosis code and procedure codes that you're gonna get from the place of service and then you're gonna send us a copy of the explanation of benefits showing how much they apply towards the deductible. As long as it's a cover service and it's a diagnostic service, not a preventative, then it will be um applied and it will be paid, but it has to be diagnostic and we cannot process. We don't pay for preventative, OK?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I think, I think that's all. OK, thank you. Appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today? Any other questions or concerns?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too. Bye-bye.