AccountId: 011433970860
ContactId: fbecae58-ecfc-433b-b631-740ed5477c02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340500 ms
Total Talk Time (AGENT): 167213 ms
Total Talk Time (CUSTOMER): 132807 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/fbecae58-ecfc-433b-b631-740ed5477c02_20250225T20:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Tesla MRI in regards to um see if you guys would pick up a patient's copay. I called before and I spoke with, um, [PII], and she told me that you guys wouldn't, that the treatment would be covered, but the patient would have to pay for the office visit co-pay. But, um, the patients just refusing, so I just wanted to see if you can confirm that for me. I don't know if I got the right information or if I got the wrong information.
[AGENT][NEUTRAL] OK, so first off, did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're needing to verify some benefit information for a member, is that correct, [PII]? Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] The member's policy number is going to be.
[CUSTOMER][NEUTRAL] 02555995
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So he is the subscriber on the supplemental policy. It is active, effective [PII].
[AGENT][NEUTRAL] This is a supplement that helps with his co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, for an MRI outpatient.
[AGENT][NEUTRAL] OK, so his outpatient benefit maximum is $7500.
[AGENT][NEUTRAL] Per covered person per calendar year for covered outpatient services with no outpatient deductible.
[AGENT][NEUTRAL] Now, office visits, you mentioned office visits a while ago, they are not covered under the supplemental policy.
[CUSTOMER][NEUTRAL] Yes, the
[CUSTOMER][POSITIVE] Perfect. So the patient would have to pay for the co-pay, right?
[AGENT][NEGATIVE] For office visits, yes, there is no benefits under this supplemental policy for office visits.
[CUSTOMER][NEUTRAL] OK, is there a way that um you would be able to confirm that with the patient on the line?
[AGENT][NEUTRAL] Uh, yes, I do see that he has recently called, but yes, I can, that, that's fine. Yes.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEGATIVE] Cause he's just like really upset and I'm like, sir, I know like it's hard and like, you know, you have your supplementary to pick up co-pays, but if it, you know, if it's not covered, there's like really nothing I can do, so.
[AGENT][NEUTRAL] This will cover the, we will, we, we will, and again, nothing that I have told you today is a guarantee of payment. We'll have to review the claim along with the primary insurance company's explanation of benefits, but this policy does not have visit, office visit benefits. We can review the MRI or treatment in the office, but not the visit itself.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][POSITIVE] Yeah, got it. OK. So I'm gonna merge the call now. Thank you so much.
[CUSTOMER][NEUTRAL] Hey [PII] I have [PII] here on the line with APL, and she did confirm with me what the first representative said so you are covered for MRI, but they do not cover the office visit payment. She just also confirmed that with me if you wanted to speak with her.
[CUSTOMER][NEUTRAL] So I understand that.
[CUSTOMER][NEUTRAL] So does, doesn't United Health take, take care of the office, is it?
[CUSTOMER][NEUTRAL] No, they're charging you a $500 office visit.
[CUSTOMER][NEUTRAL] So who, who's supposed to pay the office visit?
[CUSTOMER][NEUTRAL] If your secondary doesn't cover it, um, I suppose you.
[CUSTOMER][NEUTRAL] So what is the health insurance cover?
[CUSTOMER][NEUTRAL] UnitedHealth.
[CUSTOMER][NEUTRAL] Oh, give me one second, so, um, do you not need the representative on the line because I have her on the line, but.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] I was gonna say, I'm with, yes, I'm with APL Mr. [PII]. This is [PII] with APL and I was um just confirming that office visits are not covered under your supplemental policy, but was there anything else I could help you with or your other questions just related more to what [PII] can help you with with your primary insurance questions?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I, I'm good. I, I, I'm, I'm just trying to figure out, you know, what's.
[CUSTOMER][NEUTRAL] I'll let you go and I'll deal with [PII].
[AGENT][NEUTRAL] OK, well, you're both very welcome. So thank you again for calling APL and I hope that you do have a, a nice afternoon and [PII], if you all will be filing a claim for him for the MRI, we will also have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] To review with that claim, um, and then we do have our portal that you can create a profile in to check claim status for us by going to [PII].
[CUSTOMER][POSITIVE] Got it, no problem.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] You are certainly welcome. Yes, you are too, and thank you again for calling APL.