AccountId: 011433970860
ContactId: 3c0c0a54-858d-4dc5-aee8-88b10a3470bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 806599 ms
Total Talk Time (AGENT): 459718 ms
Total Talk Time (CUSTOMER): 363889 ms
Interruptions: 17
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/3c0c0a54-858d-4dc5-aee8-88b10a3470bf_20250328T21:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, [PII], I was calling because um I was just kind of confused with the um with uh authorization, so I am scheduled to go into um to patient first, um, for lab work to um fill my prescription and I was trying to look at the booklet that you guys sent me to see if that's covered because for some reason I don't know why, but nothing's been covered by your insurance.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I was just trying to figure out, I mean, how does that work?
[AGENT][NEUTRAL] Sure, OK, we can get that policy pulled up, um, and you said for prescriptions, is that correct? prescription coverage?
[CUSTOMER][NEUTRAL] Do y'all, mhm.
[CUSTOMER][NEUTRAL] Right, because I have to get my prescription filled, so that's the only, so when I go to patient first, they have to do lab work to make sure I can continue to get my prescription refilled, so um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Since I have to go, I mean, how does that work?
[AGENT][NEUTRAL] Sure, yeah, we can get your policy pulled up.
[CUSTOMER][NEUTRAL] So it's not like I'm just calling just to go to, to pay, OK.
[AGENT][NEUTRAL] No, no, you're perfectly fine um a lot of our policies can be a bit confusing as to what is and is not covered, um, so I'll get that pulled up and we'll take a closer look at that. um, what was your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then um can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. uh, do you have your policy number?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02596030.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty and then just gonna verify some information really quick. Uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like is a Gmail account.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that information. OK, give me just a moment let me get this pulled up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and if you need, um, before I go any further with this, um, I know you said you were referring to um the pamphlet were you needing a copy of your actual policy, [PII]?
[CUSTOMER][NEGATIVE] Um, no, because you guys sent me a, a booklet and I was just trying to figure out how that worked as far as because I'm not requesting, you know, uh, go to go to the doctor. I have to go in order for them to fill my prescription. So with that said, I mean, is that something that's covered because for some reason nothing's covered. I mean, every time like I just went to the doctor to get a mammogram and they didn't cover that, so I had to pay everything out of pocket.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, and then like the doctor called in a prescription and they didn't pay any of that. So I'm like, what, I don't know what's paid. I mean, it's, it's like I'm paying these, you know, the, the money, but nothing's being paid, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right and again these kinds of policies can be a bit confusing, especially as this particular kind is a part of a multi plan so this is one part of a big plan that you've got with multiple different kinds of policies. This particular one is your hospital indemnity, um, and so it is very specific as to what is and is not covered, pays a set dollar amount uh per covered procedure and office visit and all of that fun stuff.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, if you wanted more information on what other coverages you might have outside of this particular plan, you can get with um multi plan or uh benefits in a card. They're the ones who handle all of that, but I will say just looking at this, um, I have your ID card pulled up and I do see that your prescriptions are handled through Pharma Vale and I've got that information for you as well.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, because I have that, um, it's that 1800-933-3734, is that correct?
[AGENT][NEUTRAL] Correct, yes, so for all questions regarding prescriptions, yes, so that would be their ballpark. OK, so you do have the card that shows the bin number and all of that?
[CUSTOMER][NEUTRAL] Right, OK, because that's on the actual card.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, well, it says, yeah, it does, it has all that on there, but you know, and right, so I have to get a prescription refilled. So they are not gonna do it unless I go to patient first. So that's gonna be the first thing I have to go to patient first, so I'm kinda scared to go because for some reason nothing's ever covered.
[AGENT][POSITIVE] OK, awesome OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, yeah, and again that's where.
[CUSTOMER][NEUTRAL] you, cause I, now I, you know, I have to.
[AGENT][NEUTRAL] Yeah, so [PII]n I know that this is extremely confusing. So regarding anything specifically to do with prescriptions that would be through Pharmavale. Now as for the visit itself to um patient first, I'm sorry, what kind of facility is it? Is it an actual like an independent lab?
[CUSTOMER][NEUTRAL] It's um no, so it's actually um like urgent care, but that's my primary care physician. Yeah. So I go there that because they are my primary care physician, so it's not like, you know, instead of going to a doctor's office, I do see a doctor for anything there.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Sure, yeah.
[AGENT][POSITIVE] OK, I see. OK, I appreciate you for clarifying that, yes.
[CUSTOMER][NEUTRAL] So like most people have like their own physician, but I do have, right, so I do have them listed as my primary care physician. So anytime there's an issue, I go to them instead of going to a regular doctor because they have different hours that, you know, so it's hard for me to take off. Whereas I go to, I'm not being treated as a, you know, as like urgent care, I happen to go there, right? OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Right, I completely understand. Absolutely, yes, OK, so, and I thank you for clarifying that. I understand much better now. So for this particular plan you do have benefits for office visits and that includes urgent care facilities and regular physician's office.
[AGENT][NEUTRAL] Uh, and it certainly sounds like that would fall under that category. uh, so for those that benefit is $50 per day, so that's gonna be regardless of what you're being seen for that's the visit, $50 per day for a maximum of 4 days, um, per calendar year, and those are separate so if they're considered more of an urgent care, that would be 4 days for urgent care and then there's a separate 4 days for like a physician's office and so there you've also got.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Prescription drug benefit that falls outside of Pharmavale through this particular policy that's $10 per day maximum of 15 days per calendar year that can be used with the benefits you get from Parmavale.
[CUSTOMER][NEUTRAL] OK, but I'm not gonna be there, but, you know, of course, one day, cause they're just gonna, you know, make sure, you know, if you take medication for a while, you know, they have to check to make sure your liver, as far as your liver function, everything is OK before they
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Do that. So I'm just going over there, they're just gonna, you know, check my blood pressure, check my, my vitals and um also check my blood to make sure that I can continue with my medication. So that's just gonna be that one visit, which is that $50 is that correct?
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][POSITIVE] Correct, that's correct, yes ma'am. And if there's any confusion.
[CUSTOMER][NEUTRAL] OK, and then for them to.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead. I'm sorry.
[AGENT][NEUTRAL] I'm sorry, no, just so that you were aware, um, they are the providers wherever you go for treatment. They are more than welcome to give us a call as well. So if they had, uh, particular questions or, you know, we do kind of get they've never heard of us before or they don't know how the policy works, they can absolutely call us.
[CUSTOMER][NEUTRAL] And that's what I was gonna say cause everybody is like, what is that? Yeah, cause everybody's calling like what is that? Is that an insurance company? I'm like, well, yeah, this is the card she gave me, so, OK.
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, and especially since this one is a bit different it's not like traditional major medical um so the best thing about this policy as well is even if for some reason they won't file the claim for you, you can file the claim yourself of course it would be much, much easier on you if they were to do it for you and that's why I do encourage you if there's confusion or anything have them give us a call so we can explain it to them but if not there's nothing to stress about you can still file those claims.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, alright, so I just want to make sure before I went, you know, that because everybody's like, well, what is that, you know, and they just, you know, OK.
[AGENT][NEUTRAL] Absolutely, yes, um, for your policy it does explicitly state urgent care facility and physician's office $50 per day.
[CUSTOMER][NEUTRAL] Mhm. But then my claim was denied, I guess when I filed um to go to OBGYN doctor, then they didn't pay for anything.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So I'm not showing that you have any active claims with or any claims at all with us. I'm not showing that there have been any claims filed, so I'm not sure if maybe again there might have been some confusion on their end as this is a multi-plan what we get a lot is people calling um 90 degrees which is um more of a wellness benefit um I I believe for this kind of plan.
[CUSTOMER][NEGATIVE] The insurance doesn't pay for anything.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but of course that's not us, so I don't know if there was confusion regarding that, but I would definitely again have them reach out to us but just know that we've not received anything, so there hasn't been anything denied or approved on our end at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so because
[CUSTOMER][NEUTRAL] I guess I'm just confused with that because if it's an annual visit.
[CUSTOMER][NEGATIVE] I they should have just went on and filed it so now I have to file it, is that correct?
[AGENT][NEUTRAL] If they haven't, yes, um, but before they do that, if it's a wellness visit, especially I would get with, um, and I can give you these phone numbers if you need them. I would get with, uh, 90 degrees or, um, benefits on a card because I do believe you have separate benefits through this multi-plan for wellness exams that are outside of this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][MIXED] I know I'm so sorry. Any time I get there, don't get me wrong, I mean it's, it's nice that you have all these different kinds of coverages, but from what I've experienced with the people that have it, it's, it's a headache.
[AGENT][NEUTRAL] Trying to figure out what's what and who's where and
[CUSTOMER][NEUTRAL] It's, yeah, it is. It, it really is because
[CUSTOMER][NEUTRAL] Yeah, it's, it's, it really is because normally, you know, I just go in and give the card and you know the company knows the insurance company and they're just like, oh OK, I'll just go ahead and file it and they send me if there's a bill, which normally happens not, you know, especially when it comes to wellness and stuff, but um, so who should I call for the claim?
[AGENT][NEUTRAL] Right, yeah, and that's all she wrote. Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, exactly.
[AGENT][NEUTRAL] OK, I will give you a couple of phone numbers, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So benefits in a card is the first one I'm going to give you they essentially handle all of this and they'll be able to see any and all um policies that you have who they're with and what they cover so very broad, they've got all of that information. Let me know when you're ready for that number.
[CUSTOMER][POSITIVE] OK, so I'm ready.
[AGENT][NEUTRAL] OK, that is 1800.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] 94997.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4856.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] OK, and then you've got a 90 degree which is also can also be called IMA. I'm sorry to add to the confusion, um, but so that phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4296.
[AGENT][NEUTRAL] And to get to them you would select option one for that number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The prompts can be a bit confusing with that as well.
[CUSTOMER][NEUTRAL] Option one.
[CUSTOMER][NEUTRAL] OK, not a problem. OK, alright, because yeah, because I already paid that one for um the OBGYN doctor, so I just gotta submit the information to them and then that way they would take it from there. Is that correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, yes, and uh benefits and a card will be able to point out um where to send that claim information to as well, so you're not running around trying to figure everything out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, great. All right, thank you so much for your help. And they're, and they're open like um what are their hours? Are they 9 to 5?
[AGENT][POSITIVE] All right, you are very welcome.
[AGENT][NEUTRAL] I'm really not sure what their hours are actually.
[AGENT][NEUTRAL] I'm not 100%. I'm sorry about that.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] OK, that's no problem. That's OK. All right. So thank you so much for your help.
[AGENT][POSITIVE] You are very welcome. I know that was a lot of information. Did you have any other questions for me?
[CUSTOMER][POSITIVE] Uh, uh, that is it. Thank you.
[AGENT][POSITIVE] Alrighty, yes ma'am thank you I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too thank you. All right, bye bye.
[AGENT][POSITIVE] Thank you, bye bye.