AccountId: 011433970860
ContactId: 185074fa-3bad-4bd0-8ce2-e208e8242baf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357690 ms
Total Talk Time (AGENT): 110050 ms
Total Talk Time (CUSTOMER): 214928 ms
Interruptions: 4
Overall Sentiment: AGENT=-1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/185074fa-3bad-4bd0-8ce2-e208e8242baf_20250410T21:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh yes, I need the help on knowing what my plan covers like on lab work and stuff.
[AGENT][POSITIVE] I'd be happy to assist with your benefits. May I have your first and last name, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mr. [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is let me see 1462947.
[AGENT][NEUTRAL] OK, and if you can verify your date of birth and email address.
[CUSTOMER][NEUTRAL] Yes, it's [PII] and [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] And you said for labs, so labs will be covered under your outpatient benefit. So, and the outpatient benefit has a calendar year maximum of $1000.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do I have to have that done at special places or like say I go to a doctor's office and they give me orders, can I take it to like say the little hospital that I work at and have it drawn?
[CUSTOMER][NEUTRAL] Will it cover it that way? I mean, I know it used to. I'm just making sure nothing's changed.
[AGENT][NEUTRAL] Another change is covered whether it's done at the doctor's office, the hospital, or an independent lab like Quest Diagnostic Lab or
[AGENT][NEUTRAL] Or any of, any of those. So it's, it's covered no matter where you go.
[CUSTOMER][NEUTRAL] OK, so it doesn't matter.
[CUSTOMER][NEUTRAL] OK. Well, let me ask you this. I had an ultrasound done in a gynecologist's office, but since it is billed through the hospital, I think they told me that APL wouldn't cover it. Why is that?
[AGENT][NEGATIVE] That doesn't sound right. What's the date of service that you had it?
[CUSTOMER][NEUTRAL] I just had it yesterday.
[AGENT][NEGATIVE] Oh, OK, we haven't gotten a claim yet well no that doesn't sound right.
[CUSTOMER][NEUTRAL] But when I was asking.
[CUSTOMER][NEUTRAL] Yeah, when I was asking them, they said if it would have been done in the office that
[CUSTOMER][NEUTRAL] APL would cover it, but since it was like not actually done as a procedure in the office that y'all wouldn't cover it and I was like, well, they've always covered like X-rays and labs and stuff like that.
[CUSTOMER][NEUTRAL] I, I was confused. That's why I want to know about the lab work is there a special way I have to get labs drawn for that to kick in and cover or?
[AGENT][NEGATIVE] No, there's no special.
[CUSTOMER][NEGATIVE] So see, I don't even know if they're gonna send this through on my APL on that ultrasound because they, they tried to tell me that APO wouldn't pay for it, that I would be responsible for it.
[AGENT][NEGATIVE] That's not true.
[AGENT][NEUTRAL] The only way we would not pay is if, oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, so if I get a bill on.
[CUSTOMER][NEUTRAL] OK, go ahead, go ahead and tell me what you was gonna tell me.
[AGENT][NEUTRAL] The only way we would not pay is if it was not a covered expense by your major medical. But an ultrasound, regardless of if you get it done in the hospital, surgical center, diagnostic center, or an office, it would still be covered under your outpatient benefit.
[CUSTOMER][NEUTRAL] OK, so like I have the Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] It's a very, it's weird this year. So I don't know if that's why they were saying, but they told me because it wasn't.
[CUSTOMER][NEUTRAL] Like an uh out how do they say if it because it wasn't a procedure done in the office like it was in the office but it's because there.
[AGENT][NEGATIVE] They didn't tell you the truth. They didn't tell you the truth, Ms. [PII]. They did not tell you the truth. I'm sorry. They did not tell you the truth.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I don't think so either because I'm young.
[CUSTOMER][NEUTRAL] OK, so if I get this bill on this ultrasound, what do I do? Do I need to contact y'all or?
[CUSTOMER][NEUTRAL] How, how, because I really.
[AGENT][NEUTRAL] Now if they're not gonna submit, I'm sorry, go ahead.
[CUSTOMER][NEGATIVE] I really think they're gonna bill me for it.
[CUSTOMER][NEUTRAL] It's what's gonna happen.
[AGENT][NEUTRAL] That's fine and you can just send the bill to us and file the claim yourself if they won't file it.
[CUSTOMER][NEUTRAL] OK, so it doesn't matter like.
[CUSTOMER][NEUTRAL] Because on our Blue Cross Blue Shield this year for it to cover really anything we have to meet our $3500 deductible.
[CUSTOMER][NEUTRAL] So I don't know if because of this this Blue Cross Blue Shield is why they're saying that.
[CUSTOMER][NEUTRAL] APL won't cover it?
[AGENT][NEUTRAL] I can't speak for why they said that or what they meant.
[CUSTOMER][NEGATIVE] I'm like, I am so confused.
[AGENT][NEUTRAL] You'll have to call them and get verification on what they meant by that by not covered.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Because I
[AGENT][NEUTRAL] I don't, I don't know what they meant by that, um.
[CUSTOMER][NEUTRAL] OK, so when, when, and I'm sure I'm gonna get a bill. I mean, I'm, I'm assuming they said I would. So when I get it, I can just contact y'all and see what to do about it.
[CUSTOMER][NEUTRAL] And see if we can process it through and if if y'all will pick it up.
[AGENT][NEUTRAL] Correct. If they want, right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause I'm like, I don't know. This year I've been so stressed out with this insurance stuff, it's not even funny.
[CUSTOMER][NEUTRAL] So, OK, that's what I want to find out about labs because I need to have labs done, but I was like, OK, maybe there's a special way that I'm supposed to be doing this this year.
[CUSTOMER][NEUTRAL] I just wanna make sure y'all none of y'all stuff had changed.
[AGENT][NEUTRAL] No, no, we're still the same.
[CUSTOMER][POSITIVE] OK, OK, alright, that's what I thought. All right, well I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, anything else I can assist with today?
[CUSTOMER][POSITIVE] Alright thank you ma'am.
[CUSTOMER][NEUTRAL] Um, I think that's it.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.