AccountId: 011433970860
ContactId: fb4efae7-9053-40bb-825e-607cc7d22bb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376519 ms
Total Talk Time (AGENT): 172184 ms
Total Talk Time (CUSTOMER): 152499 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/fb4efae7-9053-40bb-825e-607cc7d22bb5_20250127T13:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was, I'm a member and I was wondering if it's, um, I'm going to a dermatologist today, and I'm wondering if it covers the co-payment or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, well, I can definitely look at your benefits for you. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And Ms. [PII], may I have your um policy number?
[CUSTOMER][NEUTRAL] Did you want my phone number too or no?
[CUSTOMER][NEUTRAL] Just the policy number.
[AGENT][NEUTRAL] I'm sorry, yes, the policy, um the phone number and the policy number, my apologies.
[CUSTOMER][NEUTRAL] OK, the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The policy number, are you there?
[AGENT][POSITIVE] Mhm, I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Oh, it's 02272.
[CUSTOMER][NEUTRAL] 790 ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Alright, and I have you here, Ms. [PII]. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Um, my address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So for
[AGENT][NEUTRAL] OK, so your policy is broken down into like in hospitals and outpatient. So in hospitals would be like when you're admitted, outpatient would be like hospital emergency room, urgent care. So the policy itself doesn't have any coverage, but you do have the office treatment rider, which comes out of your outpatient per day, which is $500.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that any um procedure, treatment, anything done in the office as long as it's not like cosmetic, could be covered up to that $500 per day and that does go towards your co-pay, your deductible, and the co-insurance after primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it doesn't count for a consultation just if I have something done.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, or it doesn't cover an office, is it just.
[AGENT][NEUTRAL] Right, it won't cover the
[CUSTOMER][NEUTRAL] Procedures.
[AGENT][NEUTRAL] Yes, any treatment.
[CUSTOMER][NEUTRAL] OK. Even a dermatologist.
[CUSTOMER][NEUTRAL] Like I think my plan, um, they said it didn't cover dermatology, but when I called they said they do pay for like a consultation.
[AGENT][NEUTRAL] No, so anything.
[CUSTOMER][NEUTRAL] But my deductible.
[AGENT][NEUTRAL] Anything, well, now, if you're speaking of your major insurance, they have different benefits, but for your secondary, for your metallink policy, it doesn't cover in office at all. So some places might charge you for a facility charge and then charge you for all the treatment. If they charge a facility charge, it won't be covered, but any treatment done could
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, I'm just wondering if do you go along with my health care insurance or they, you don't care what they do, you're just gonna pay my deductible up to my deductible and whatever.
[AGENT][NEUTRAL] We're 2
[AGENT][NEUTRAL] We're second to them, so if they don't apply, if they don't pay out to a claim, we don't pay out, but we, they have their own benefits and we have our own benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I'm kind of confused on that one, so if they don't pay anything, you're not gonna pay a deductible.
[AGENT][NEUTRAL] Right, so if you go to the, if you go to the dermatologist and you're having your visit, if your primary insurance says this is not covered, you then can't go to your second because the 1st didn't pay. If your first pays, then you can use your 2nd.
[CUSTOMER][NEUTRAL] Or do you pay?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, that's what I was wondering.
[CUSTOMER][NEUTRAL] Oh OK, yeah, that's what I was wondering.
[CUSTOMER][POSITIVE] OK, I think I got it now.
[AGENT][NEUTRAL] Well, was there anything else? OK, go ahead.
[CUSTOMER][NEUTRAL] I'm also going for it. uh, can you, can you look at my records at all? I mean, I think they've paid for things. I get a CT scan every 6 months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my insurance does pay some of that, so you all pay the other I guess, but every time I tell them that they always have a problem with it, but they never bill me after that.
[CUSTOMER][NEUTRAL] But they usually try to bill me and then I tell them about the APL which they already know.
[CUSTOMER][NEUTRAL] And then they, they don't bill me but is there any way of you checking to see if they've paid towards CT scans?
[AGENT][NEUTRAL] Um, do you have like a, a data service or anything I can try to search with because you have, I will have to go through each claim to see what this claim is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I don't have that many claims it would be the last one.
[AGENT][NEUTRAL] The most recent claim?
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, it was 6 months ago, so.
[CUSTOMER][NEUTRAL] Um, it was probably in July.
[AGENT][NEUTRAL] July, OK.
[CUSTOMER][NEUTRAL] Or June
[CUSTOMER][NEUTRAL] June or July?
[CUSTOMER][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] Would it be from the Florida cancer specialist?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so yeah, we have 123 claims from July, and yes, they were all paid on.
[CUSTOMER][NEUTRAL] OK, good, because I'm going tomorrow again and I guess I'll have to pay that again.
[AGENT][NEUTRAL] Mhm. As long as your primary applies, we, so your primary charges you the co-pay, we help you pay it. So as long as primary does not deny the claim, we would help with the charges.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] If it's covered on your policy.
[CUSTOMER][POSITIVE] Alright, great.
[CUSTOMER][POSITIVE] OK, alright, thank you, you you answered all my questions.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][POSITIVE] All right, well, thanks so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.