AccountId: 011433970860
ContactId: 432fd200-8a98-4a2e-941f-22d3ed54a517
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 828140 ms
Total Talk Time (AGENT): 421472 ms
Total Talk Time (CUSTOMER): 225891 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/432fd200-8a98-4a2e-941f-22d3ed54a517_20250528T13:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to hopefully get a little bit of um help understanding my benefits and claims and all that.
[AGENT][NEUTRAL] OK, so you're the insured and you have some questions regarding your coverage, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Mr. [PII], uh, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Um, I believe it's 0246.
[CUSTOMER][NEUTRAL] 2046 ML 8.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your policy information pulled up, then I will have to verify several things with you first, for security, and any information provided will be a verification of benefits and not a guarantee of payment. So first off, Mr. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one that you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you and the last piece of information to verify will be your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK. Thank you very much for verifying your information. So, how can I help you today?
[CUSTOMER][NEUTRAL] So is there an easy way that you could explain to me exactly sort of like how you know the the APL works or I know it's got a lot to it.
[AGENT][NEUTRAL] OK, so this policy.
[AGENT][NEUTRAL] Yes, this policy that you have with APL is a supplemental policy to your primary health care insurance, and it is designed to help you with your co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So anytime you go to the doctor, always or for medical services rather, you should always present your APL card along with your primary healthcare insurance card because most providers will file both insurances for you because it has to be filed with your primary insurance company first and then with APL. Now, if for any reason the provider does not file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your supplemental coverage you can do that and if that need arises then you would just call us back and we would be happy to tell you how to go about filing your own claim because I can see you're set up in our portal, the online service center.
[AGENT][NEUTRAL] And so you can upload your claims information directly into that portal, should you have to file. Now, on this policy, office visits are not covered under your plan.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So just to go for an office appointment that, you know, for a doctor's appointment, that's not something that's covered. If you receive some type of treatment, for example, in your doctor's office, then we could review the treatment portion of it under your outpatient benefits. Or if you, for example, had to go to the emergency room or an urgent care, any type of outpatient surgery.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Or diagnostic testing that you might have done. Physical, if you had to go to physical therapy, for example, those are things that we could review under your outpatient benefit.
[AGENT][NEUTRAL] And you have an outpatient benefit maximum of $3000 per covered person per calendar day for covered services with no deductible.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you, so basically it would cover anything under $3000?
[AGENT][NEUTRAL] If you, and if you were.
[AGENT][NEUTRAL] It would if it's a covered service. Anything that also that is not covered by your primary insurance would not be covered by APL either.
[AGENT][NEUTRAL] Again, because this is only helping you with your co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Now before we get too far ahead because you said something, I understood that the office visits aren't covered, however, um, like, let's say because I, I usually go to my dermatologist, um, and so I would understand that, you know, like the office isn't covered, but there's sometimes that she technically does a procedure because she'll like inject um sort of uh some sort of a solution on some like kilos that I have and stuff like that, and I believe that goes under a procedure.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, sometimes it could.
[AGENT][NEUTRAL] Now, correct. It's that, you're right. That is, that sounds like something that we could review under your uh the treatment itself, under this outpatient benefit maximum, again, we would have to just receive your primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] But yes, that sounds like something that could be reviewed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] By any chance, and would you be able to tell me if something like that has been filed by them before because.
[CUSTOMER][NEUTRAL] That happens quite often to be honest with you, so I, I want, and I always give him my card um but again I, I don't know sort of how the, the background of it all works, to be honest with you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, give me a date, if you'll give me a date of service that you saw this particular doctor, I can check to see if we've received a claim for you.
[CUSTOMER][NEUTRAL] So I believe that let me see.
[CUSTOMER][NEUTRAL] Um, I believe that the last one was actually [PII].
[AGENT][NEUTRAL] OK, so as of now we do not have any claims on file for you for [PII]. Again, though it has to be filed and processed by your primary insurance company first.
[CUSTOMER][NEUTRAL] But let me see.
[AGENT][NEUTRAL] And then sent to APU. What's a data service prior to that one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, so let me see because I actually saw one on on their website not too long ago.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't remember.
[CUSTOMER][POSITIVE] Yeah, if you give me a minute here, I might be able to pull it up rather easily.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] No, I was.
[CUSTOMER][NEUTRAL] So my primary.
[CUSTOMER][NEUTRAL] Uh, no, let's see.
[CUSTOMER][NEUTRAL] Yeah, so my primary has one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For that, you know, that visit, um.
[CUSTOMER][NEUTRAL] And yeah, I still have some of it like, you know, some of it was covered by my primary but there's still sort of I guess like a, a co-pay left over or a patient responsibility is that they call it.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Now, as of now, we have not received anything for that data service. Do you have a data service prior to the [PII]?
[AGENT][NEUTRAL] Again, since that was only just, you know, a couple of weeks ago.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] It just may be that they have not submitted that yet, but we don't have.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] How about from.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is another one.
[AGENT][NEUTRAL] No, sir. We do for this year.
[CUSTOMER][NEUTRAL] Yes, yes, this year.
[AGENT][NEUTRAL] No, sir. As of now, we do not.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I guess my next question would be to go about I for me to submit it I would I guess have to submit it online in that portal is what you're telling me.
[AGENT][POSITIVE] Yes, that's the easiest and quickest um way to do that.
[AGENT][NEUTRAL] And you can obtain a claim form.
[AGENT][NEUTRAL] Um, [PII]'s, well, you're gonna have to have our claim form to complete in addition to your primary insurance company's explanation of benefits and an itemized bill.
[CUSTOMER][NEUTRAL] From my primary.
[AGENT][NEUTRAL] Including your diagnosis code from your provider, but that information is on our claim form as to what you would need to submit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So if you
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Mhm. Now you can print your claim form.
[CUSTOMER][NEUTRAL] Go ahead sorry.
[AGENT][NEUTRAL] From our website.
[AGENT][NEUTRAL] By going to www.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when that page pulls up [PII] at the top you would see where it says claims and forms.
[AGENT][NEUTRAL] And you would click there and scroll down the page.
[AGENT][NEUTRAL] And you will see a small box that says.
[AGENT][NEUTRAL] A filter by product.
[AGENT][NEUTRAL] And if you click on that it's gonna give you, there's a little green arrow and if you click on that, it will give you a list and you will see the word med link like is on your ID card M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would just click on the word med link.
[AGENT][NEUTRAL] And then on your screen you should see out to the right a blue button that says download form.
[AGENT][NEUTRAL] And click on that and that will open up the claim form.
[AGENT][NEUTRAL] Our claim form and again the instructions.
[AGENT][NEUTRAL] are on page one at the top for the additional information that you would also need to provide us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now I have um.
[CUSTOMER][NEUTRAL] Another
[CUSTOMER][NEUTRAL] One for it's not a dermatologist um but it's data services 5-12-2025.
[AGENT][NEUTRAL] No, sir, as of now we do not have a claim for that data service. Actually we've not received any claims for this calendar year on your policy.
[AGENT][NEUTRAL] The last claim we received was back in [PII].
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] What was that for if you don't mind me asking?
[AGENT][NEUTRAL] That was for a an ambulatory diagnostic center.
[AGENT][NEUTRAL] For a [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I, I do remember that, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, alright, let me submit these and then.
[CUSTOMER][NEUTRAL] Yeah, so I'll go from there.
[AGENT][NEUTRAL] OK. Well, do you have any other questions that I can try and help you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, that was it for now.
[AGENT][POSITIVE] OK, well, if you have anything else come up, um, please give us a call and we'll be more than happy to help you, but if that's all I can help you with at the moment, thank you again for calling APO [PII], and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, sir. Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.