AccountId: 011433970860
ContactId: 2f1f555d-a031-4e23-9cbc-041cce753c10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486760 ms
Total Talk Time (AGENT): 209893 ms
Total Talk Time (CUSTOMER): 194467 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/2f1f555d-a031-4e23-9cbc-041cce753c10_20250418T15:07_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I had a question about uh my policy.
[CUSTOMER][NEUTRAL] Um, I'm not sure. Do you need the policy number?
[AGENT][NEUTRAL] Uh yes ma'am, can I get your name, your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Sure, uh, name is [PII].
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you repeat the callback number for me?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm sorry, I didn't hear the rest of the callback number my.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much, and then what is your policy number?
[CUSTOMER][NEUTRAL] 247.
[CUSTOMER][NEUTRAL] 342 5.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can I please get you to verify your policy for me for security reasons can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is your address, a phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Um, address is [PII].
[CUSTOMER][NEUTRAL] Um, email, I believe it's [PII].
[CUSTOMER][NEUTRAL] If not, it's [PII].
[CUSTOMER][NEUTRAL] And you asked me for something else.
[AGENT][NEUTRAL] Uh, that is all, um, the cell phone number, uh, that the phone number that you just gave me, is that your cell phone or is there another number?
[CUSTOMER][NEUTRAL] The same
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, all right, thank you so much.
[CUSTOMER][NEUTRAL] That's my cell phone.
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me. Alright, let me look real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and you said you had questions about your policy. Uh, what questions can I help answer for you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, so, um, does the policy cover copays? So, let's say I go to the urgent care, have a $30 co-pay, does my policy, uh, cover that?
[AGENT][NEUTRAL] Yes, ma'am, um, this is a supplemental insurance and this is to verify your benefits. It's not a guarantee of payment. Your policy does help with deductible, co-pay, and co-insurance. So you have um an outpatient per calendar day benefit of $300 to go towards your deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, and so, OK, so what I noticed is that like let's say I go to um the OBGYN and I have a $15 co-pay, my EOB doesn't state that I have uh uh payments.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Old, which is weird, but I did pay $15. But then when I go to the urgent care, my EOB shows that I have a $30 co-pay. So would APL cover for in both cases and um.
[CUSTOMER][NEUTRAL] How, what would I submit for each um to get reimbursed?
[AGENT][NEUTRAL] OK. OK. So, um, the plan is based on what your primary insurance carrier covers.
[AGENT][NEUTRAL] So what you would need to submit is the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] And then the itemized statement from the office that you went to.
[AGENT][NEUTRAL] And the itemized statement will need to include the uh diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] And then, um, what's the amount that's reimbursed? Is it up to what I pay, or is it a, a fixed amount?
[AGENT][NEUTRAL] No, it's, it's up to $300 per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per day of service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so regular visits, um, preventative care visits to the OBGYN but is covered as well, right? You're saying, so I can submit all of those claims.
[AGENT][NEUTRAL] You can submit it um for uh reimbursement for your only your deductible co-pay or co-insurance. Any other procedures are not covered under the policy, just the deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so again, let me just ask because I, I'm not sure if I understand. The, my explanation of benefits from Blue Cross Blue Shield for my wellness visits or preventative care does not show that I owe anything to the provider. However, when I go there, it shows a $15 co-pay or I pay a $15 co-pay or a $35 co-pay for specialists.
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] What would I do I, mhm.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] It goes by facility settings. Is, uh, is it in a doctor's office or is it an urgent care center, MRI imaging center, or an ambulatory center?
[CUSTOMER][NEUTRAL] So for those for those in particular with a wellness, it's in a doctor's office setting.
[AGENT][NEUTRAL] OK, so let me check to see if you have office visits.
[AGENT][NEUTRAL] On your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so office visits are not covered under your policy, so you would need to go to an urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Got it. OK. So I, so I do have the ones for the urgent care and those show a copy. So those I can submit. OK, perfect. And, and then, how far back can I go because I wasn't aware of this. So I do have
[AGENT][POSITIVE] Good. Yes. Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] A claim from.
[CUSTOMER][NEUTRAL] Uh, let's see, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so on [PII], you would file that claim under, let me give you the policy number.
[CUSTOMER][NEUTRAL] Is it the 229-2245?
[AGENT][NEUTRAL] Yes, yes, that's right, that's right. And we don't have a timely filing limit, so as long as you had coverage on the date of service, you can file your claim any time you want to.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][POSITIVE] That sounds good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is that everything I can help you with today?
[CUSTOMER][NEUTRAL] Yes, that's everything.
[AGENT][POSITIVE] OK, well you have a wonderful [PII] weekend, ma'am, and we thank you so much for calling APL.
[CUSTOMER][POSITIVE] You as well. Thank you.
[AGENT][NEUTRAL] Mm bye bye ma'am.
[CUSTOMER][NEUTRAL] Bye.