AccountId: 011433970860
ContactId: 1aea9245-dec2-451c-8961-a85659fdb3f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1399989 ms
Total Talk Time (AGENT): 523330 ms
Total Talk Time (CUSTOMER): 513776 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/1aea9245-dec2-451c-8961-a85659fdb3f5_20250115T20:55_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] Yes, hi [PII], uh, good afternoon.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have a couple of, I have a couple of questions on.
[CUSTOMER][NEUTRAL] My daughter, um.
[CUSTOMER][NEUTRAL] My daughter's um got insurance. I am calling to see um
[CUSTOMER][NEUTRAL] If I can ask you those questions because it's time to submit.
[CUSTOMER][NEUTRAL] Um, some deductible to you, and I wanna make sure I do it correctly because I didn't do a good job last year, so.
[AGENT][NEUTRAL] OK, I'm sorry, but I'm having, uh, I'm having just a little bit of trouble understanding you. So are you the insured? You're calling with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you hear me well?
[AGENT][POSITIVE] That's a little better.
[CUSTOMER][NEUTRAL] Is that related to the connection?
[AGENT][NEGATIVE] I, I believe your voice was very low.
[CUSTOMER][NEUTRAL] Yeah, not
[CUSTOMER][NEUTRAL] It has to be low. Let me remove my earphone and see if you can hear me better if I cannot screen. One sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you hear me much, much better now?
[AGENT][POSITIVE] That is, that is better, yes, ma'am. So could you please
[CUSTOMER][NEUTRAL] Yeah, we see we need from here for.
[AGENT][NEUTRAL] OK. So could you please repeat what you said because I, I was not able to understand, but just a few things.
[CUSTOMER][NEUTRAL] Yeah, I need to collect information on how to submit a claim.
[CUSTOMER][NEUTRAL] Um, this is for my daughter, um, coverage.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She has a deductible of $5000.
[CUSTOMER][NEUTRAL] And um uh provider starting starting to bill.
[CUSTOMER][NEUTRAL] Uh, last year I did it completely incorrectly and I ended up losing half of my deductible. This year I wanna do it very correct.
[CUSTOMER][NEUTRAL] I have already collected some documents and um.
[CUSTOMER][NEUTRAL] I just wanna confirm what is that is needed and I have a specific question if I can.
[AGENT][NEUTRAL] OK, so you, are you the insured and your daughter is on your policy?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, so yes, ma'am, and you're wanting to find out how to file a claim that your doctor would not file with APL?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Nobody takes CPL and file claims. It it's up to me to file the claim.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK, so the doctor, OK, so the provider that your doctor saw their office would not file, so you were needing to file. Is that correct?
[CUSTOMER][POSITIVE] No, no, yeah, that's correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I, what is your name?
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right. So the policy number is, can I put you on speaker cause I need to read it. Let me know if you can hear me correctly.
[CUSTOMER][NEUTRAL] It is 02458531 M as in Mary, L as Larry A.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. One moment please while I get your information pulled up.
[CUSTOMER][NEUTRAL] And if you're OK with that, I'm gonna put a third party on the phone. It's the provider, um, just in case I get lost, um, is that OK for you?
[AGENT][NEUTRAL] OK, so are you filing, yes, ma'am, if you're OK with that?
[CUSTOMER][NEUTRAL] I'm filing the claim, yeah, I just need some support in case I don't have the right question.
[AGENT][NEUTRAL] OK, so why don't you wait until let's, I need to verify your information with you first for security, and then we can move on and you can conference in anyone that you would like. So first off, uh, any information that I do provide for you today, um, will be a verification of benefits and not a guarantee of payment. And the first thing that I will need to verify with you is your date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, not a problem.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your daughter's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address, please, Msoro.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Also your phone well the phone number we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, thank you. And lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, now we have a different email on file. This may be your work email. I'm not sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I just need to verify that and then I can update change that if you would like, but I have to verify what we have on file first.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, is that the one that you want to leave on file, Ms. [PII]?
[CUSTOMER][NEUTRAL] It's OK. I, I don't wanna go ahead and do that right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And what is the date of service that you're calling about for your daughter?
[CUSTOMER][NEUTRAL] Yeah, here we go. I really need the provider to help me with this. Give me one moment so I can put them on the line.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And cats.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And I, I actually have a question.
[CUSTOMER][NEUTRAL] My too.
[AGENT][NEUTRAL] OK, so before.
[CUSTOMER][NEUTRAL] Before you ask me a question, no, before she comes on the line, she's waiting. I need to put her on the line, otherwise I'm gonna lose her. Give me one second.
[CUSTOMER][NEUTRAL] Yes, I, uh, I have [PII] on the line. She's, um, one of the provider that, um, um, my daughter goes to and I will submit the reimbursement, but I need their support on the line, um, so if you're OK I wanna ask you my first question.
[AGENT][NEUTRAL] OK, so is your question for me, Miss [PII] with APL?
[CUSTOMER][POSITIVE] Yeah, absolutely.
[AGENT][POSITIVE] OK, yes ma'am. So how can I help you?
[CUSTOMER][NEUTRAL] It's actually the reason of my call. So my first question.
[CUSTOMER][NEGATIVE] It's, uh, once I need for refund.
[CUSTOMER][NEUTRAL] Do I have to wait for all the providers?
[CUSTOMER][NEUTRAL] To bill the month or I can submit the bill one by one as long as they come.
[AGENT][NEUTRAL] So in filing on your in for filing of claims with APL.
[AGENT][NEUTRAL] There is a specific claim form that you will complete.
[AGENT][NEUTRAL] And on that claim form, it does have the instructions for you as to the other documents that you will need to submit because we do have to have a copy of your primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] For the data service that you're filing for.
[AGENT][NEUTRAL] And we also have to have an itemized bill including the diagnosis and procedure codes from the, from each of the providers.
[AGENT][NEUTRAL] If the providers are not going to file the claims for you on this supplemental policy, and this information, don't try to write.
[AGENT][NEUTRAL] All of that down this ports are on your claim form.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] That I will make sure you have.
[CUSTOMER][NEUTRAL] I'm sorry, I really didn't catch your response to my question.
[AGENT][NEUTRAL] So your physician is not filing the supplemental insurance. Is that correct?
[CUSTOMER][NEUTRAL] Mm, I'm sorry. I think it's better we write that down because this is the 6th time you confirmed that.
[CUSTOMER][NEUTRAL] The 6th time I confirm you that the the claim is gonna be filed by me.
[AGENT][NEUTRAL] OK, and the instructions.
[CUSTOMER][NEUTRAL] And this is not the question I asked you. I understand you're gonna send me instruction, but I said right now in this specific second I ask you a question. Is there any chance you could respond to that question?
[AGENT][NEUTRAL] Yes, ma'am, I did answer your question, but yes, ma'am, you can ask me again.
[AGENT][NEUTRAL] You do not have to wait. You do have to provide an explanation of benefits.
[CUSTOMER][NEUTRAL] I'm sorry, I'm not there yet.
[CUSTOMER][POSITIVE] I don't have to wait what? Can you be very specific?
[AGENT][NEUTRAL] To file a claim on this policy with APL you will need to complete a claim form.
[AGENT][NEUTRAL] And you will need to present the itemized bill.
[AGENT][NEUTRAL] With a diagnosis.
[CUSTOMER][NEUTRAL] I'm sorry. I'm really sorry, uh, um, so [PII] helping me here because she keeps repeating the same thing and not responding that question, ma'am. I feel it's like you're reading a script. We're trying to ask you a question.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] Like the, the what she's trying to ask you is, does she have to wait to get the full, the deductible rate, like the whole 5 or whatever her deductible is, I don't know, 5000 $3000 does she have to wait to have all the claims up to that, or can she submit as she's getting these bills from her provider?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Typically claims are filed when services are rendered. Once you have received the primary insurance EOB, then the claim can be filed with APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you so yes I am concerned about the typically.
[CUSTOMER][NEUTRAL] So is that not like a set?
[AGENT][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] I'm sorry, there's some music in the background. I didn't understand what you said.
[CUSTOMER][NEUTRAL] I have a child without spectrum disorder is watching the TV. Either you hear screaming or the TV.
[CUSTOMER][NEUTRAL] Um, so she said you said typically that's how it's done. I guess we're trying to make sure that what's the exception to that rule?
[AGENT][NEUTRAL] There's not a yes ma'am, there's not a timely filing limit with APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is entirely up to the member or the provider as to how they want to file the claim. Some insurance companies have a timely filing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Limit, but we do not so even correct so if there are still outstanding claims for last calendar year, those can still be filed with APL.
[CUSTOMER][NEUTRAL] OK, that's what it is. OK, so you do not, you do not, OK.
[CUSTOMER][NEUTRAL] Got it. Makes sense. Alright. And if I have a bill, can we turn the if I have a bill, um, for this week from maybe a service and then next week I have another bill for horse therapy, uh, I can just continue to submit as long as they come.
[AGENT][NEUTRAL] Along with your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's not just a bill that we have to receive, Ms. [PII]. We also have to have a copy of the primary insurance company's explanation of benefits for that data service.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And an itemized bill.
[CUSTOMER][NEUTRAL] Wait, when you say your primary insurance company is the additional benefit, you mean Aetna, right?
[AGENT][NEUTRAL] I show your primary insurance company according to our records is Aetna. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, perfect. So now you can tell me what is the need to be submitted and how do I retrieve the form.
[AGENT][POSITIVE] I can actually email you the claim form that has all of the instructions on there.
[AGENT][NEUTRAL] And then claims can.
[CUSTOMER][NEUTRAL] Can you only mail it to one email or yeah I can give you a second one sorry for the interruption.
[AGENT][NEUTRAL] Now I have to email it um for you to the email that we have on record for you.
[AGENT][NEUTRAL] For security purposes, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that's OK.
[CUSTOMER][POSITIVE] That's OK, forward to myself.
[AGENT][NEUTRAL] But I will
[CUSTOMER][NEUTRAL] And then you were saying
[AGENT][NEUTRAL] I'm sorry, go ahead. Did you have another question?
[CUSTOMER][NEUTRAL] No, no, no, no, I, I, uh, I, I, uh, uh, I, go ahead, don't worry.
[AGENT][NEUTRAL] OK, so in this email that I'm going to send to you again I will include the claim form.
[AGENT][NEUTRAL] And I'm also going to include the user guide for our online service center portal. I can see that you have set up your profile in that portal.
[AGENT][NEUTRAL] And the user guide will explain how you can upload your information directly into the portal for our review. If for any reason you're not able to upload it, you can either fax it to the fax number that's on the first page of that claim form that I'm gonna send at the bottom it gives a PO box.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] And it also gives a fax number. We just cannot accept claims via email.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I have the list of documents one more time so I can put it down?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] A com you have to complete the claim form.
[AGENT][NEUTRAL] You have to have an itemized bill with diagnosis from the provider.
[AGENT][NEUTRAL] And the primary insurance company's explanation of benefits that shows any amounts that were applied to your deductible, co-pay, or co-insurance for the charges that are listed on that itemized bill and then you make and you have to sign the claim form.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] All right. Um, um, [PII], do you have any other question? Yes, ma'am. Once we submit the claims, uh, what's the turnaround?
[AGENT][NEUTRAL] Typical review time is 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, and then after that then the funds are deposited what, 2 to 4 business days? What's the typical me a check.
[AGENT][NEUTRAL] There
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm. Now, yes, then if it, if, and I can see if you're filing in this portio when I send you this user guide, it does have instructions for how you can add direct deposit information into your portal.
[AGENT][NEUTRAL] If that is not there and we are able to pay claims, then yes, ma'am. It would be a paper check that would be mailed to you. That's the only two forms of payment.
[CUSTOMER][NEUTRAL] OK, I, when I did the last time I was on the check, but um I take a look at the online deposit, but it's not required to be online. It can be a check. And I have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. No, ma'am. Correct. It, it could be.
[CUSTOMER][NEUTRAL] For the itemized, um, what do you, what exactly do you need to see on that itemized from the provider?
[AGENT][NEUTRAL] It must include the charges and the diagnosis.
[CUSTOMER][NEUTRAL] And you want dates of service?
[AGENT][NEUTRAL] Yes, ma'am, because we do have to have the dates of service. All of that information has to match the primary EOB.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Now, Ms.orgio, I can see that we've, the most recently received claim that we were filed, excuse me, that was filed for [PII].
[AGENT][NEUTRAL] Was for data service in [PII].
[CUSTOMER][NEUTRAL] I'm not sure whether you're referring to, uh, probably the neurologist.
[CUSTOMER][NEUTRAL] Appointment, yeah. It was the night.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[CUSTOMER][NEUTRAL] Yeah, I know that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that for letting me know.
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm good, [PII], if you're good.
[CUSTOMER][POSITIVE] Yeah, so, someone they're good. I'm good. We're all good, and they're, you're gonna email her right now, the, the form correct, ma'am?
[AGENT][NEUTRAL] I am. I'm emailing two documents, the claim form with complete instructions on page 1 at the top, along with the user guide Morzio for the portal.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] With APL and that email that you're gonna receive is gonna come fro[PII].
[AGENT][NEUTRAL] And it will say APO in the subject line, and it's being sent to that email that you and I verify with each other.
[AGENT][NEUTRAL] And I have just sent it, so you should be getting that in a moment.
[CUSTOMER][NEUTRAL] Yeah I know I know uh.
[CUSTOMER][NEUTRAL] Do you want me to confirm me that while we are on the line?
[AGENT][NEUTRAL] If you would like to, that will be fine to verify that you did receive it.
[CUSTOMER][NEUTRAL] Give me 1 2nd. Yeah, give me 1 2nd.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, I'm having some trouble logging in. Uh, if I don't find the form, I'm gonna give you a call back.
[AGENT][NEUTRAL] OK, that will be fine. Oh, either, either way, I don't mind waiting.
[CUSTOMER][NEUTRAL] I don't want you to wait any additional time, yeah.
[AGENT][NEUTRAL] So that way you didn't, wouldn't have to re-verify your information again.
[CUSTOMER][NEUTRAL] Yeah, no, no, it's fine and the internet is.
[CUSTOMER][NEUTRAL] Give me one moment, I'm gonna try one more time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, is that I don't use this email a lot and I have it saved on a specific computer so it's gonna take a while before I'm able to pull it out. Don't worry, I'll call back um in case I don't find the form.
[AGENT][POSITIVE] OK, well, hopefully you do.
[AGENT][POSITIVE] Yes, ma'am. Hopefully, you did receive it, so, um,
[AGENT][POSITIVE] But if you, if not, yes, ma'am, please call us back and we'll be happy to help you and see if we can send it to you again. You're welcome. So is there anything else that I can help you all with today?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK, well thank you again for calling APO and I hope that you have a very nice evening.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Um, bye-bye. Thank you.