AccountId: 011433970860
ContactId: 08cdd87c-c2a3-4420-824c-605b865b1629
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643640 ms
Total Talk Time (AGENT): 282736 ms
Total Talk Time (CUSTOMER): 309209 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/08cdd87c-c2a3-4420-824c-605b865b1629_20250320T16:34_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm a broker.
[CUSTOMER][NEUTRAL] And um I'm calling for a [PII], who I also have on the line for his son, [PII].
[CUSTOMER][NEUTRAL] Um, and we had filed claims, uh, actually for [PII] and for, um.
[CUSTOMER][NEGATIVE] [PII], right? [PII] and [PII], we have several claims we filed in [PII], and they've all been denied. He's had the gap plan for several years and we were just trying to find out exactly what you need because we're trying to read through all these EOBs and I've sold the American public for 25 years and I still don't know exactly what you're looking for.
[AGENT][POSITIVE] I can help you with that. It would be my pleasure to assist you. Let me ask you, what is a good callback number, Mr. [PII], just in case we get disconnected I can get right back to you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That would be
[CUSTOMER][NEUTRAL] Uh, you want my number or [PII]'s number?
[AGENT][NEUTRAL] Whomever I need to get back with just in case the call drops.
[CUSTOMER][NEUTRAL] I can give you
[CUSTOMER][NEUTRAL] Yeah, me, me, I'm best [PII].
[AGENT][NEUTRAL] All right, thank you. And what, do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, I do, um, I got claim numbers if that's better, so he's got two policies.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, these are all last year though, [PII], we hadn't filed for the new plan year yet, right? OK, yeah, that'll be a different claim because we had had to change policies, um.
[AGENT][NEUTRAL] If you have a claim number, I can pull everything up by that claim number.
[CUSTOMER][NEUTRAL] I think we have a few. I'll start with the first one.
[CUSTOMER][NEUTRAL] Um, is 354-563-9.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And this one is for [PII] had brain surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] And was hospitalized, uh, quite a, quite a long time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm pretty sure this is the maximum benefit just a matter of y'all getting the right medical records and we just didn't know who to go get that from.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Well what you're
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me just take a quick look.
[AGENT][NEUTRAL] And then, um,
[AGENT][NEUTRAL] Bear with me just one second.
[AGENT][NEUTRAL] So actually,
[AGENT][NEUTRAL] So any, you know, this, the methane gap policy pays towards sickness or injury, so we have to have a diagnosis code from the provider.
[AGENT][NEUTRAL] And that, that indicates to us if it is in fact for sickness or injury and benefits can be considered. Now, if he was in the hospital and this is an inpatient, um, if you, Mr. [PII], if you happen to have and I wouldn't have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] From a year ago, but if you happen to have the discharge papers from the hospital, that could possibly have the diagnosis code.
[AGENT][NEUTRAL] Or you can contact the hospital and request a form. It's called a U as in umbrella, B as in Bravo, 04 for that hospital stay.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, 04 OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] And they, they should provide that to you with no problems.
[AGENT][NEUTRAL] And then you can just um do you have that active online account where you can just upload that claim information?
[AGENT][NEUTRAL] With APL?
[CUSTOMER][NEUTRAL] I do not, no, um.
[AGENT][NEUTRAL] OK, so there's always an option to create that online account and then you can just upload the claim documents and you can check claim status online as well as well as print additional cards if needed, all that is available on our website.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] OK, and how did you set up that account?
[AGENT][NEUTRAL] So you would go to [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And go in as a new user.
[AGENT][NEUTRAL] And then, um Mr. [PII], if you're creating that account, you're gonna choose the first option. You are an individual with an APL policy.
[AGENT][NEUTRAL] And then the next page you would enter enter your information to create that login and password and it will require your social as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I see one problem.
[AGENT][NEUTRAL] So that's an option.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I see one problem with this. So he had been on a plan for about 5 years through a PEO organization, uh, which I am not the agent on, which is these claims here, but then he's also
[CUSTOMER][NEUTRAL] Bought a policy through me when they left the leasing company, we had to go back to APL and rewrite the gap policies, uh, and then those will be a different policy number. Well he set up two different logins, or will they be able to see all the policies from one login? Do you know?
[AGENT][NEUTRAL] Now he's gonna have to create the account under that active policy but he should be able to see all policies and claims. Now we only keep claims online I think it's 2 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So anything past the 2 year time frame, he may not be able to see those claims, but that's an option for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This is all
[CUSTOMER][NEUTRAL] I believe all of these dates of service you filed were [PII], right, [PII]?
[CUSTOMER][NEUTRAL] Uh, now, the surgery itself was in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's right. [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But that's within 2 years.
[AGENT][NEUTRAL] Yeah, and he should, he should be able to view that but um and you can also set up a direct deposit payment for your claims that you submit if you would prefer that go to your bank that's an option as well.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I would do that, [PII], because you get your money a lot faster.
[AGENT][POSITIVE] A lot faster. And if we pay a check, it may it go to [PII] before it gets to you. You never know these days.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] So definitely.
[CUSTOMER][NEUTRAL] So the UP 40, um, some of the other claims were they all hospital claims [PII] or do any of these others maybe for [PII].
[AGENT][NEUTRAL] You be
[CUSTOMER][NEUTRAL] Um, they're.
[CUSTOMER][NEUTRAL] I think a couple of things may have been for.
[CUSTOMER][NEUTRAL] Urgent care doctor visits, but the.
[AGENT][NEUTRAL] Mhm. I see that for [PII].
[CUSTOMER][NEUTRAL] that we would have been.
[AGENT][NEUTRAL] And, and that
[CUSTOMER][NEUTRAL] And for those we can get a HIA form, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] So from hospitals, you would request the UBO4 and from.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Um, just doctor's offices or urgent care facilities or doctor's fees, you can request that HIPAA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're, you're right, [PII].
[CUSTOMER][NEUTRAL] OK, so yeah, so we'll get those HIPA forms. So as soon as they go, I mean the American public's really good about paying claims once they have everything they need. It's just making sure they have everything they need so that they can satisfy their auditors and get them paid, but uh as soon as we can get those, [PII], they'll probably pay them pretty quick and then um I don't know if we have any claims to file since October.
[CUSTOMER][NEUTRAL] But if we do, we can start that claim, but I would resolve this before even muck mucking the waters with the the new policy claim, and then we'll try to file before the end of the summer for the new policy.
[AGENT][NEUTRAL] Yeah, and
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And I was checking on [PII] on the new policy. He does have a claim and we're still needing that diagnosis code. Looks like we're getting everything but the diagnosis code.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] In the future, um, if you show your APL card with your primary insurance card, then providers can file the claims for you and we can pay them direct, so that's just an option as well.
[CUSTOMER][POSITIVE] Yeah, so like for your therapy, I can't remember if his new policy covers therapy. I probably have it within arm's length here. I think it does actually it was a better policy than the one they had previous.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you see if it covers physical therapy cause that's one of his biggest expenses.
[AGENT][NEUTRAL] It does.
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] OK, so it covers physical therapy. You can give your card to your physical therapist.
[CUSTOMER][NEUTRAL] And then if they start paying them, you may not have to pay them, it'll cover some of that cost.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Now, it won't cover once his therapy visits run out on his health insurance because it's gap. It's only going to cover what the insurance company covers, correct?
[AGENT][NEUTRAL] That is correct. So anything, it'll cover what was applied to his deductible, co-pay or co-insurance when the primary processes the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so it should cover all your out of pocket until the until the coverage on him maxes out.
[CUSTOMER][NEUTRAL] For for outpatient.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] OK, very good. Well, [PII], I appreciate your help, um, and I appreciate y'all answering pretty quick. If you run into an issue, we'll call you back, but otherwise we're gonna try to track down QBO4s and HIPA forms from everyone we can get and just submit that and then that should give you what you need to hopefully pay these clients.
[AGENT][POSITIVE] Such a pleasure.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, sir. And we, you know, we're gonna be happy to take care of Mr. [PII] and his dependents. And if there's ever anything y'all need, please don't hesitate to give us a call. We're here to help you.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] OK, thanks, [PII].
[AGENT][POSITIVE] My pleasure and thank you also, Mr. [PII]. Anything else I can help you with before you go?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] I think that's it. Thank you.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.