AccountId: 011433970860
ContactId: 0b43da07-9272-44a8-84f8-8eb37cc55839
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329869 ms
Total Talk Time (AGENT): 154110 ms
Total Talk Time (CUSTOMER): 158311 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/0b43da07-9272-44a8-84f8-8eb37cc55839_20250103T17:19_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I'm trying to, um, add my account to, um, to, um, this pharmacy, the special pharmacy, and they're asking me for a BIN number and a PCN number.
[CUSTOMER][NEUTRAL] They said you would be able to.
[AGENT][NEUTRAL] Can I have your name and the policy number?
[CUSTOMER][NEUTRAL] Sure, [PII], and one of the policies is 021 9.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] 2322 ML 8
[AGENT][NEUTRAL] Could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] Sure, um, [PII], mainly is [PII].
[AGENT][NEUTRAL] Thank you. So this policy is a gap insurance that only assists with services, medical services that you go to a facility and receive services or a doctor's office or something.
[AGENT][NEUTRAL] Um, pharmaceutical is not covered under this policy, so I'm not sure if you're trying to reach your primary insurance company, but this is the gap insurance.
[CUSTOMER][NEUTRAL] Correct, yes, um, there's a it's a specialty pharmacy and the claim was put in as medical.
[CUSTOMER][NEUTRAL] And they left a copayment.
[CUSTOMER][NEUTRAL] So for them, um, for us to to get that co-payment paid, that's what they're asking me for.
[AGENT][NEUTRAL] So is your callback number [PII]?
[CUSTOMER][NEUTRAL] So call me from.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So is this for medicine? What, what are you getting from the pharmacist?
[CUSTOMER][NEUTRAL] It's for an injection, but the, the, um, the procedure was sent in as medical, but medical left a co-payment because we haven't met our deductible.
[AGENT][NEUTRAL] But see, pharmacy is not covered is what I'm stating to you it's not covered under your policy, so anything that goes to a pharmacist is not, it won't be covered, but they could submit a claim here to verify if it would be covered, but there's no PCN number or BN number for me to provide you with because we don't cover drugs, pharmaceutical drugs.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Am I explaining it to you that good?
[CUSTOMER][NEUTRAL] OK, let, let me let them know. Yes, yes, yes, it's just they put it in as a medical claim, so that's what confused me, um, cause they're like, OK, this is medical, but you owe this deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, where did you get the, um, where did you receive the shot?
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] It's for my husband. um, he received it at a doctor's office and the medication was sent into the doctor's office directly but through United Insurance, it went as uh
[CUSTOMER][NEUTRAL] As a medical, so it's kind of strange.
[AGENT][NEUTRAL] Oh, did the doctor submit a claim here to his secondary insurance?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, no, because I did, I did tell you the truth.
[AGENT][POSITIVE] Yeah, cause treatment, he has treatment received in the office covered like anything he receives in the office, the treatment will be covered. So I would ask them to submit that to my secondary insurance to see what they will actually pay on it.
[CUSTOMER][NEUTRAL] We've had it since 22.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna have them them do it because.
[AGENT][NEUTRAL] This is considered as medical.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If you just give them your policy number or a copy of your card and let them submit the claim.
[CUSTOMER][POSITIVE] I'm gonna have them take care of it.
[AGENT][NEUTRAL] Because you've had this policy since 22 and we only have claims for 2022, 1 for 23, and one for 24.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] For 24 when was that the other day.
[AGENT][NEUTRAL] Oh, that's just for your spouse, but you have a lot of them. You have a couple of them, but we haven't received the claim for you since [PII].
[CUSTOMER][NEUTRAL] Yeah, I, I, I thought we didn't even have it anymore. So, OK.
[AGENT][POSITIVE] Yeah, we still have it.
[CUSTOMER][NEUTRAL] OK, and let me ask you if if I've paid um several copayments since then.
[CUSTOMER][NEUTRAL] Um, well, the, well, I guess no, but I would be reimbursed?
[AGENT][NEUTRAL] So for services at a like a doctor's office or a facility or something of that matter?
[CUSTOMER][NEUTRAL] Yes, for a specialty doctor, the $50 copay.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Let me see. So the treatment received in the office is covered, but the office visit itself is not covered. So say like you went to the doctor's office and they treated you, they performed.
[AGENT][NEUTRAL] Different services on you, that will be covered, but the office visit won't be covered because it does your policy doesn't offer benefits for that.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, that, yeah, that's fine. I've had some, some spine.
[AGENT][NEUTRAL] But yes, so you can submit those claims, you can submit those with your ELBs, so you submitted with the ELB from the primary insurance company, which is the explanation of benefits and make sure you have the diagnosis code, which is the ICD 10 code for each data service that you're submitting.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And would that be in my, in my um explanation of benefits?
[AGENT][NEUTRAL] No, you'll have to request that from the facility where you receive your treatment f[PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too bye bye.