AccountId: 011433970860
ContactId: 38c4d66f-170a-4205-a0dd-2f001b153097
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734130 ms
Total Talk Time (AGENT): 239939 ms
Total Talk Time (CUSTOMER): 348753 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/38c4d66f-170a-4205-a0dd-2f001b153097_20250204T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, my name is [PII]. I am calling because I am trying to go on your website and it won't let me.
[CUSTOMER][NEGATIVE] Um, keep saying it can't find me and I'm trying to figure out. I gave my information from this APL card to my doctor's office and they keep sending me a bill for a co-pay which I was under the impression you guys would cover.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm trying to find out why that's happening.
[AGENT][NEUTRAL] OK, [PII], I can help you with the online.
[AGENT][NEUTRAL] Yes, I can help you with the online service center and your claim um can I please get your call back number sir just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Um, my personal number is [PII].
[CUSTOMER][NEUTRAL] Uh, oh, I'm sorry, no, [PII]. 0 [PII], I can't remember my phone cell number.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh, because I'm on my work phone now, um.
[CUSTOMER][NEUTRAL] Let me just give you my work phone number. Uh [PII] is my work number. You can just call me on that.
[AGENT][NEUTRAL] OK, thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Uh, the policy certificate number on the card says 02559255.
[AGENT][NEUTRAL] OK, let me pull that in.
[AGENT][NEUTRAL] OK [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and for security reasons can you please verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] OK, not sure what email you have for me. My phone number is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][POSITIVE] OK, thank you so much and the email address is looks like a um work email address possibly?
[CUSTOMER][NEUTRAL] Oh, if it's work it would, oh excuse me just one moment, let me grab my kettle.
[CUSTOMER][NEUTRAL] OK, uh, the work email would be [PII].
[AGENT][NEUTRAL] OK, thank you and one more time I'm gonna ask for your personal email I'm sorry, your personal phone number. I think that's why I'm not able to get into the online service center because we don't actually have it on the policy.
[CUSTOMER][NEUTRAL] Uh, it's, uh, my, my phone number is [PII], my personal, my cell number.
[AGENT][NEUTRAL] OK, let me add that in and see if that will help you.
[CUSTOMER][NEUTRAL] And when I go on your portal and ask for my social security or member ID but not the policy number. I don't know what my member ID is. I don't see it on the card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so your policy number would be your member ID and it is.
[AGENT][NEUTRAL] 2559255
[CUSTOMER][NEUTRAL] Uh, I'm sorry, you went out on me.
[AGENT][NEUTRAL] 25592555
[CUSTOMER][NEUTRAL] OK, so no 0 in front of it?
[AGENT][NEUTRAL] You could put a 0 in front of it that that would be fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then looking at um your social security number, can you just verify it for me because everything that we have on your policy needs to match the online service center. I wanna make sure that your social security number is put in correctly.
[CUSTOMER][NEUTRAL] Um, my social is [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, now I just did it and it's letting me in just with what you told me.
[AGENT][NEUTRAL] Yeah, OK, good. I added that phone number and I believe that was the culprit why you couldn't get in.
[CUSTOMER][NEUTRAL] OK, OK, so.
[AGENT][NEUTRAL] And then let me look at your
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And I don't show that you have any claims that have been submitted on this policy.
[CUSTOMER][NEUTRAL] Yeah, that's what I am trying to.
[CUSTOMER][NEUTRAL] Uh, now let me ask you this while I'm in here trying to set up my user account, it's asking me for an email. Can I give them my personal email or do I have to give them my work email?
[AGENT][NEUTRAL] You'll have to give the email that we have on the policy for you which was that um team postop, yeah, yes sir.
[CUSTOMER][NEUTRAL] OK, so the work, the work email, OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, uh, OK, now how, how is it that the then if I
[CUSTOMER][NEUTRAL] OK, now it's telling me that that I already have an account with you folks.
[AGENT][NEUTRAL] OK. Let me look and see.
[CUSTOMER][NEUTRAL] When I hit next.
[CUSTOMER][NEUTRAL] It says the user name already exists. Please use a different user name. OK, let me try just logging in and see what happens I guess.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] OK, so you'll have to go in, yeah, you'll have to go into your account as, as, as with your original user name.
[AGENT][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Do you remember that? I can look at that for you.
[CUSTOMER][NEUTRAL] Um, I'm assuming it's [PII]. Uh, I, that's what pops up when I try to put something in.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] Did you go in as a manager?
[CUSTOMER][NEUTRAL] No, I went as just individual for.
[AGENT][NEUTRAL] Instead of an individual.
[CUSTOMER][NEUTRAL] No, I went in as an individual.
[AGENT][NEUTRAL] OK, because it showed me that you're trying to go in as a manager.
[CUSTOMER][NEUTRAL] Oh really? Oh, OK. Well, let me back that up then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me go back in.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright, let me just close this.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I'm an individual.
[CUSTOMER][NEUTRAL] OK, yeah, for some reason it, it just when I go to [PII]og in it just asks me right away and then when I put it in it, it says, yeah, I know what it says here password.
[CUSTOMER][NEUTRAL] OK, I did forget my password I guess let me see.
[AGENT][NEUTRAL] Yeah, you'll have to reset that.
[CUSTOMER][NEUTRAL] See this
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that doesn't exist.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so yeah, I guess I had my, I guess I had my username wrong there, um, so then let me ask you how how.
[CUSTOMER][NEUTRAL] The information I gave my my.
[CUSTOMER][NEUTRAL] Doctor was what I have what I have on the card.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So if if they tried to submit a claim.
[CUSTOMER][NEUTRAL] And they're still sending me a bill. What is there something they're missing? I mean, I gave them the claim address, the information on my card, the phone number.
[CUSTOMER][NEUTRAL] On the back of my card.
[AGENT][NEUTRAL] Right, what's missing is the claim itself. The claim has not been sent in. We don't have any claims reported.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK, let me see if I can.
[AGENT][NEUTRAL] Now I can do did you give them the electronic your the payer ID number so they can send it electronically?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Cause usually that's the way they do it.
[CUSTOMER][NEUTRAL] I don't know if I see a payer ID on here. Oh, there it is the 60801.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Oh OK, um, you know, I don't know if I did or not.
[CUSTOMER][POSITIVE] Very true.
[CUSTOMER][NEUTRAL] Um, I guess I'll have to contact them and now let me ask how this works too. I was under the impression that if, if I understood it correctly this.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Pays up to.
[CUSTOMER][NEUTRAL] It pays up to.
[CUSTOMER][NEUTRAL] $200 per visit, am I understanding that right?
[AGENT][NEUTRAL] Let me look and are you talking about outpatient visits? is that correct?
[CUSTOMER][NEUTRAL] Um, well, the outpatient visits labs.
[AGENT][NEUTRAL] OK, so, um, it's all based on the diagnosis of procedure code from the uh explanation of benefits and the itemized statement from your primary insurance and this is just to verify your coverage. It's not a guarantee of payment. You do have an outpatient per calendar day maximum of $500.
[CUSTOMER][NEUTRAL] Anything really.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And that's per day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, providers patient now I'm, I am on your portal. What is it? I'm just looking, I know you said there's no claims. I just want to see how it looks. What is a provider's patient account number? Is that the, the 2559255?
[AGENT][NEUTRAL] Uh, the provider's patient account number is going to be the number that.
[AGENT][NEUTRAL] The facility that you went to, they will give you a patient account number that they use.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Oh, I see. OK, OK, I got you. I got you. OK, so there are no claims for me just like, OK, I did manage to get in there, so, OK, so that's that. Alright, so I need to call them back, I guess, and give them the electronic payer ID and see what the issue is as far as why they keep sending me, uh, now, now let me ask this per day let's say, um, I went to the my doctor, my primary care, and I have a co-pay of I don't know, $40 let's say.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then they, the same day they sent out lab work for me, I get back a bill from the labs for $50. Do you cover both of those?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, up to $500 per day.
[CUSTOMER][NEUTRAL] Up to 500 per day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or up to 200 per day.
[AGENT][NEUTRAL] Your policy says 500.
[CUSTOMER][NEUTRAL] I thought it was
[CUSTOMER][NEUTRAL] Oh really?
[AGENT][NEUTRAL] Uh-huh, per per calendar day maximum is 500.
[CUSTOMER][NEUTRAL] Oh, I thought, I thought they said 2.
[CUSTOMER][NEUTRAL] So, and just to make sure I understand it correctly, so if I see a doctor today, uh, you would cover up to $500. If I see a doctor next week, you still cover up to $500 and, and so on. It's per day, not per month, not per year.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and that's for deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so for any deductibles, copays, or co-insurances you would cover those items up to $500 per day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, alright, I will reach back out again to my provider and find out what the problem is. Thank you very much for your help.
[AGENT][POSITIVE] You're so very welcome [PII]. I hope you have a great day and we appreciate you calling APL.
[CUSTOMER][POSITIVE] Well thank you very much you're quite helpful.
[AGENT][POSITIVE] Thank you, sir. I appreciate it. I'm glad I was able to help you. Bye-bye. Thanks for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] All righty. Bye-bye now.
[CUSTOMER][POSITIVE] Me too thanks bye bye.