AccountId: 011433970860
ContactId: 36c12b7d-6359-437d-824f-2d5c6766e06a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621619 ms
Total Talk Time (AGENT): 261024 ms
Total Talk Time (CUSTOMER): 260726 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/36c12b7d-6359-437d-824f-2d5c6766e06a_20250520T15:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi. Um, I wanted to ask a question. I just went to the dermatologist and um
[CUSTOMER][NEUTRAL] Uh, they told me that APL, that they're not in network with APL, and I, I had not heard that before, and I think that they have used APL before. So I just wanted to find out first if you are in network with them, and second, if, if you're not in network with them, does that mean that I cannot use that insurance to cover a balance of a dermatologist?
[AGENT][NEUTRAL] OK, I can help you, um,
[AGENT][NEUTRAL] To check to see if they're in network or not. May I please get your name and your callback number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] Thank you, Miss [PII], and then what is your policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Deposit
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] It has to be the outpatient 0203.
[CUSTOMER][NEUTRAL] 52
[CUSTOMER][NEUTRAL] 68.
[CUSTOMER][NEUTRAL] M as in Mary, L 8.
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. Let me look that policy.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you, ma'am?
[CUSTOMER][NEUTRAL] My address is [PII]. My email is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you. I appreciate you verifying your policy for me. OK, so looking at this policy, this is a supplemental insurance policy. This is to verify your benefits. It's not a guarantee of payment. This
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Policy goes hand in hand with your major medical insurance. So when you go to the doctor, you give them your major medical insurance card and this one. We don't have a network, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy is based on what you what your allowable amount is per calendar year for outpatient services, um, which is $7350.
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] That goes towards deductible, co-pay or co-insurance. So your major medical insurance is billed first and this comes in second.
[AGENT][NEUTRAL] And I do see that on this policy you do not have office visits, but you do have treatment in the office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for office visits.
[CUSTOMER][NEUTRAL] So I, I went to the dermato.
[AGENT][NEUTRAL] Mhm, mhm. Go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So, on this policy, the treatment in the office is available, but the physician's office fee is, is not covered under office visits for this policy.
[CUSTOMER][NEUTRAL] So what is not covered?
[AGENT][NEUTRAL] The physician's office fee?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So I, I went to the dermatologist and
[CUSTOMER][NEUTRAL] They told me that I had met my deductible. I had the United Healthcare. That's my primary, so I always give both cards, um, and usually whatever what remaining balance I have, not including copays, um, APO will take the, the will pay the remaining balance. So today they want to charge me $197. Usually I just pay $60 copay, um, so they charged me the $60 because I was disputing it, but they.
[AGENT][POSITIVE] Yes sir, yes ma'am.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Told me, oh, we've never heard we're not in network with APL. We don't work with APR. I've never gotten that response. I thought that as a secondary or supplemental insurance, right, so that was my question because they told me that I was responsible that Humana, I mean, United Healthcare was covering 50% and I had to cover the other 50%. So I guess the doctor was billing like 398 or something, um, so typically.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My balance now like 1:30 so I would.
[CUSTOMER][NEUTRAL] I asked them to process that to APL, and they told me we're not in network with them. So my question is I can call them back and explain this to them and have them process it through you because you're saying that there's not an in network or out of network with this policy, right?
[AGENT][NEUTRAL] That's correct. As long as they accept wherever they accept your, right, wherever they accept your major medical, if they accept your major medical, then this policy will work behind the major medical.
[CUSTOMER][NEUTRAL] It just covers up to $7300.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, so they do right, so then she was wrong about that. So my thing is now, if she doesn't wanna run it through APL, could I take the invoice or the bill or whatever and process it myself, like submit it to APL, like submit that claim, or it has to be the doctor's office?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, you can do it. Um, you'll need to have the explanation of benefits from your major medical insurance.
[AGENT][NEUTRAL] And you'll also need the itemized statement from the physician's office that shows your um
[AGENT][NEUTRAL] Diagnosis codes and procedure codes. You'll need those two documents along with the claim form.
[AGENT][NEUTRAL] And I can tell you where to get the claim form. Are you signed up on the online service center?
[CUSTOMER][NEUTRAL] Um, I don't think for APL that I am. I think for United Healthcare I am, but I don't think for APL that I am.
[AGENT][NEUTRAL] OK, let me give you um that uh address to go to so you can sign up for it because you can file your claim right there through the online service center.
[CUSTOMER][NEUTRAL] OK, but I need documentation from the office to do that, right?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right, you'll need the itemized statement and the explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, so I know the explanation of benefits they refer to as the EOB. What was the first thing you said?
[CUSTOMER][NEUTRAL] The first one that I need something statement.
[AGENT][NEUTRAL] An item
[AGENT][NEUTRAL] And yes, an itemized statement.
[CUSTOMER][NEUTRAL] Oh itemized statement, OK.
[AGENT][NEUTRAL] That has your diagnosis and procedure codes on it.
[CUSTOMER][NEUTRAL] OK, OK, so I'll try calling them first and explaining this to them, see if they can do it, and if not then I'll do it.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] But, OK. Could you email me?
[AGENT][NEUTRAL] Right, and if they can.
[AGENT][NEUTRAL] If they can uh do it for you.
[CUSTOMER][NEUTRAL] With the information to log in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] If they can do it for you, if you give them the payer ID number that's on your card.
[AGENT][NEUTRAL] Which is 60801, they can do it electronically.
[CUSTOMER][NEUTRAL] Um, it's on my card you said payer ID.
[AGENT][NEUTRAL] And just
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, 60801.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't see that on my card, wait, hold on.
[AGENT][NEUTRAL] Is it on the, on the back?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, if you wanna take down the numbers 60801.
[CUSTOMER][NEUTRAL] No, I have a PO box.
[AGENT][NEUTRAL] That is a payer ID number.
[AGENT][NEUTRAL] That the facility can use to file the claim for you electronically.
[CUSTOMER][NEUTRAL] OK, so it's 60801 and that's called a what? I'm sorry because I was driving so I'm at a red light now.
[AGENT][NEUTRAL] Oh, that's OK, it's a payer ID number.
[CUSTOMER][NEUTRAL] Pay your
[CUSTOMER][NEUTRAL] And that's all they need to file it electronically?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, they don't need like my policy number or anything like that. This will be sufficient.
[AGENT][NEUTRAL] No, they'll need your policy number.
[AGENT][NEUTRAL] They'll need all the information that's on your card.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And to send the claim they can just do it through that payer ID number electronically.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if they need to call us and verify your benefits over the telephone, give them the same number that you called and we can verify the benefits over the phone for them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alright, perfect.
[CUSTOMER][NEUTRAL] OK, and it would be the same number that I just called, right? Is there a specific number for providers?
[AGENT][NEUTRAL] No, it's the same number that you just called.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, got it. I'll call him and let him know now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you so much for your help I appreciate it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye bye.