AccountId: 011433970860
ContactId: 358c71d9-7139-42f0-a901-942414e820df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1128290 ms
Total Talk Time (AGENT): 704412 ms
Total Talk Time (CUSTOMER): 441993 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/358c71d9-7139-42f0-a901-942414e820df_20250407T18:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII] and I had sent my husband to the doctor with our primary insurance card as well as our APL um supplemental.
[CUSTOMER][NEUTRAL] And um anyway he got a bill and I think there's more coming but anyway the the one I'm calling about is small but they when he called and said well what about my APL they said oh we don't take APL so I wanted to pick your brain on a couple of items. um, first is just because somebody says they don't take it doesn't mean we can't file correct?
[AGENT][NEUTRAL] OK, so first off, Miss [PII], before I can provide you any information, I'm gonna need to pull up the policy so I can verify some things with you for security, but you have some questions regarding filing claims, right? Is that correct?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Yes, OK. Alright, and Mrs. and could you give me your last name again?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] LA yeah.
[AGENT][NEUTRAL] OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And the policy number, please.
[CUSTOMER][NEUTRAL] Um, so do you want what's called the inhospi no, the outpatient, uh, or the group?
[AGENT][NEUTRAL] Either one of them will be, yes, ma'am. Either, either of those two numbers will be fine.
[CUSTOMER][NEUTRAL] OK. Um 016.
[CUSTOMER][NEUTRAL] 127.
[CUSTOMER][NEUTRAL] 89
[CUSTOMER][NEUTRAL] And then, um, M like Mary, L like Larry, and either 7 or 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so any information, Mr. [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. And as I stated, I will need to verify several things with you first, um, for security purposes. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that 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][NEUTRAL] OK, thank you. And then lastly your email address and the one we have on file does appear to be your work email.
[CUSTOMER][NEUTRAL] So that would be, it could be one of two either [PII] or [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it was the first one.
[AGENT][NEUTRAL] And is that what you want to leave on file for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It's the, yeah, oh yeah, that's fine. That's actually my favorite.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, uh, so thank you for verifying all of your information. Now I do have one question for you. Have you ever set up your profile in our portal called the online service center so that you can have access to your ID cards, policy information, claims.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Information, all of that online.
[CUSTOMER][NEUTRAL] I'm not sure what's it called?
[AGENT][NEUTRAL] It's called the online service center.
[AGENT][NEUTRAL] I can check
[CUSTOMER][NEUTRAL] No, that doesn't sound familiar. Let me.
[AGENT][NEUTRAL] OK, now I have a user guide that I could send to you that explains how to set up your portal profile and it also gives you information on the different things that you can do in the portal so for example you can submit claims via the portal.
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Excellent, excellent.
[AGENT][NEUTRAL] If you're gonna be submitting your own claim with us, that's the easiest route and you can also add in direct deposit information so that if there are benefits payable they could be electronically deposited instead of paper check being issued in mail. You can also opt in for text notification alerts once the claim's been processed. So anyway, I'll send you that when we get off the phone and the email that I'm gonna send to you. Oh, you're welcome, will come from care team.
[CUSTOMER][POSITIVE] That's awesome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] At [PII] and I will also put APL online service center in your subject line so that that's easy to recognize.
[CUSTOMER][POSITIVE] Excellent. OK, I'll look for it.
[AGENT][NEUTRAL] OK, so now the question you had regarding who had who can file the claim, yes, you can also file claims yourself if the provider will not, you can.
[AGENT][NEUTRAL] And actually
[CUSTOMER][NEGATIVE] So when they say, oh we don't take APL, they don't, I don't think they really realize it's not, it's, that's not the way APL works, is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, I mean, this is a supplement. OK, so this is a supplemental policy to your primary insurance and most providers will file both your primary and your supplement because you, they have to file your primary first because we have to have a copy of the primary insurance company's explanation of benefits as well when reviewing claims.
[CUSTOMER][NEUTRAL] It it
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But now on, on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With APL an actual office visit.
[AGENT][NEGATIVE] Isn't covered under this plan.
[CUSTOMER][NEUTRAL] Right, well, the copay is not, right?
[AGENT][NEUTRAL] Correct. If you were, anything related to an office visit would not be covered. If you were to have some type of treatment rendered in the office setting, then that is something that could be reviewed for benefits, just not the office visit charge.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said you said [PII].
[CUSTOMER][NEUTRAL] You said if there was a treatment, it might be covered.
[AGENT][NEUTRAL] That is something we could review under your outpatient benefits.
[CUSTOMER][NEUTRAL] Right, and what about labs that they took in the um in the office?
[AGENT][NEUTRAL] Now, the lab rider that's on your policy, that's for an independent lab outside.
[AGENT][NEUTRAL] Of the office setting.
[CUSTOMER][NEUTRAL] So they took blood from him, but they sent it off to, I think they sent it to like Labor somewhere, but there, but the bill.
[AGENT][POSITIVE] Well of course I like, yes, that is something that we could review.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] But they, uh, yeah, so they, they sent him the bill though. Wilmington Health doctor's office sent the bill to him for the labs.
[AGENT][NEUTRAL] OK, so yes, you can file the claim for us if he had lab work that was sent to an independent lab for studies that is something that we could review under that outpatient benefit maximum which you have of $2500 per calendar year for covered outpatient services with no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per per um participant.
[AGENT][NEUTRAL] For cover. Uh-huh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, OK, per person. What did, what did you say?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, per calendar year per covered insured. And let me see.
[CUSTOMER][NEUTRAL] Per covered insured, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And no deductible.
[AGENT][POSITIVE] That is correct, yes ma'am, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEUTRAL] So now
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Mhm. No, ma'am, you go ahead with your question.
[CUSTOMER][NEUTRAL] Um, thanks. So his primary.
[CUSTOMER][NEUTRAL] Um, ordered an MRI for him on his back, and United Healthcare said, we don't think you need that. Well, that's because the appointment hasn't happened for the back doctor yet. So I told my husband, just stay tuned, go to the back doctor, and if the back doctor thinks you need it, he'll write it and then insurance will probably be OK with that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] My question to you is then we have a big payment for the MRI because of the deductible that he hasn't met, so that's where APL really helps, correct?
[AGENT][NEUTRAL] Yes. So, OK, so first off, um,
[AGENT][NEUTRAL] If for any, anything that's not covered by your primary insurance would also not be covered by APL.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this plan only helps. OK. So that's the first thing, but yes.
[CUSTOMER][NEUTRAL] Right, I knew that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But I just, I just meant to him, I think it will be covered by United Healthcare once the proper person prescribes the MRI. I just, you know, that's a separate story, a separate issue.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] So if it is, if it is approved, exactly, I know, ma'am, I understand, I understand exactly going through all of that. I do. So,
[AGENT][NEUTRAL] Once he, if his scan is approved and he has had that done, then yes, that is something that could also be reviewed on this benefit. And I was looking at your outpatient benefit and as I mentioned to you before, it's $2500 per covered person per calendar year for covered outpatient services and there is a maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of 7500 per calendar year for all covered persons combined.
[AGENT][NEUTRAL] Cause I can see that this is, you know, as far as your coverage goes, you do have, I believe family coverage, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, and then um.
[CUSTOMER][NEUTRAL] So his goal is of course to get United Healthcare to cover his scan because then APL will um will also play.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, OK, OK, um.
[AGENT][NEUTRAL] Now, if you, with this lab work that he's already have done that he's already had that you all are getting the bills for, since I haven't sent the email to you yet with that user guide for the portal.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I will, I can also attach a claim form for this type of policy you have the Medlink claim form because it does give you the instructions on the first page, Ms. [PII] at the top of the other documents that you would also need to submit to APL if you're gonna be filing the claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and I'm a little confused. What's medling?
[AGENT][NEUTRAL] That's the type of supplemental policy you have. It should say Medin on your ID card.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, you're right, [PII] select, OK.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So the, the, the claim form that I'm gonna send to you, it's also available to you on our website, on our main webpage at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I can go ahead and include that. [PII] under claims and forms. Yeah.
[CUSTOMER][NEUTRAL] A in public.
[CUSTOMER][NEUTRAL] Yeah, send it to me anyway, but.
[CUSTOMER][NEUTRAL] OK, that's great. I, um, I went to, yeah, you know what? I went to AM Public and I was a little confused because it kept saying um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, for groups, for brokers, uh, but I was looking for just, um, for insured. I guess, I guess we.
[AGENT][NEUTRAL] OK, so don't click if you're, are you on that website right now?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] Where you say, OK, so don't click anything but if you were to click, if you were to click where it says claims and forms, that's where you can find your med link claim form in the future if you need one to the far right where it says sign in.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you actually click there, it takes you to the online service center login page.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And that's also for the first time to set up you would select new user.
[AGENT][NEUTRAL] And go through the steps in setting up your profile, but that information again will be included on that user guide as well.
[CUSTOMER][POSITIVE] Excellent.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. And do I need to do it, like, do I need to have one and my husband needs to have one or is it for the family?
[AGENT][NEUTRAL] No. You will be the only person to be able to set up the profile because you are the primary policyholder.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So all of the information used to set it up is related to you. So like your social, all that information is you. This email address that you and I verified together, that's the one you will need to use because for security, it's not gonna let you use a different email than what we have on file, but you would be able to see each person that's covered under your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] will be there. Um, and so, for example, when you're filing a claim for Mr. [PII], you're gonna select his name.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When actually uploading your documents for claim submission.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And this is for medical only, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] No, no dental, unless it's a, unless his dentist does something that he um puts under medical.
[AGENT][NEUTRAL] No, not necessarily. Um, so on dental, it is excluded under the dental or vision services, including treatment, surgery, extractions, or X-rays are excluded unless it's resulting from an accident.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Occurring while the covered person's coverage is in force and is performed within 12 months of the date of such accident or it is due to a congenital disease or anomaly of a covered newborn child. Those are the only two exceptions. Mm. So, just so you know, those are the, those are the only two that would be, you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, all right.
[AGENT][NEUTRAL] Eligible.
[CUSTOMER][NEUTRAL] It's a rare, uh, yeah.
[CUSTOMER][NEUTRAL] Um, OK, and let's see if I have any other questions for you, so co-pays or not, which I kind of knew. I had told him, um, treatments at the office might be covered depending on what it is.
[AGENT][NEUTRAL] Mhm, sure.
[AGENT][NEUTRAL] we would just have to receive the claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And if I'm not sure if something has been um covered in the last let's say year, what's what's the time frame that I can play um uh apply for a claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So with APL that's one of the best things about us we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There is no timely filing lien with us.
[CUSTOMER][NEUTRAL] Yeah, I feel like I remember hearing that.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] So as long as the policy has gone into effect, you know, as long as it was access for the data service in question, you can still file a claim with us.
[CUSTOMER][POSITIVE] That's amazing.
[CUSTOMER][NEUTRAL] Wow, and you would do that through this um service that you're about to, by the way, the the the link you're gonna send me after we hang up is that for what we just um navigated to?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it is, but the
[CUSTOMER][NEUTRAL] The a.m. public? OK. OK.
[AGENT][NEUTRAL] Well, actually, this is going to be, it's, it's my the email itself has our [PII] link in it. The port, what the attachment that I'm gonna send you is specifically for that online service center.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So it will explain, like I said, how to set up your profile and then the different things that you can do within the portal, you know, so that is going to be the, if you're gonna be submitting a claim to us, Ms. [PII], that is the most efficient and quickest way to get something to us for review.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Excellent. OK, well I'm gonna go ahead and sign up right away and um I could I could then just do it through there but I mean attach that form just in case but um I'll pro I'll probably just try to do it through the portal.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, certainly. Mhm.
[AGENT][NEUTRAL] Yeah, and you're still gonna have to do the claim form anyway so that's one of the things you're gonna have to submit when filing it yourself.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, we'll still have to have that correct. Yeah, that's just part of the required documentation that we have to have, um.
[CUSTOMER][NEUTRAL] Regardless of whether you do it online, OK, OK, all right.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] But the correct verbiage for future, the correct verbiage is to the doctor's office is, will you file my supplemental for me, correct? That's, that's.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I always, yes, I always recommend that you present your APL ID card along with your primary insurance anytime you go for medical services because most providers will take care of all of it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But in the event that they don't, you know.
[CUSTOMER][NEUTRAL] Yeah, mine always has, and I, yeah.
[CUSTOMER][POSITIVE] Yeah, yeah, that's a backup plan, um, OK, [PII], you've been awesome thank you um so if you'll send me that email I'll take it, yeah, thank you so much. I'll, uh, I'll take it from here and I'll, I'll uh I'll sign up on the online service center.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, it's so it's my pleasure.
[AGENT][NEUTRAL] OK. Well, if you will give me about 5 minutes, you should have that. I don't, it shouldn't go to your junk or spam folder, but if you hadn't seen this email, you know, within just a few minutes, check one of those folders to, because it might go there if we've never, you know, emailed you before.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, I'll look. I'll find it wherever it's at if you send it, I'll find it.
[AGENT][POSITIVE] OK. All right. Well, yeah, it will, it is on its way in just a couple of minutes, so it shouldn't be that long at all. And again, Ms. [PII], if there's any other questions, just give us a call back. We'd be happy to help you. And is there anything else though at the moment I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that's it. That was great. Thank you and have a good day.
[AGENT][POSITIVE] Oh, well, yes, ma'am. You're very welcome. It was my pleasure and thank you for calling APL. I hope you have a great afternoon as well.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Hm, thank you. Bye-bye.