AccountId: 011433970860
ContactId: 45b07ba5-80fb-42b7-9492-1209942dbe9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528960 ms
Total Talk Time (AGENT): 256267 ms
Total Talk Time (CUSTOMER): 214005 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/45b07ba5-80fb-42b7-9492-1209942dbe9d_20250203T19:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, um, my name is [PII], and I used to have supplemental, um, gap insurance coverage with you guys for [PII].
[CUSTOMER][NEUTRAL] And unfortunately I don't have it any longer, but um I do have uh uh I had a little bit of a medical issue in [PII] and my other my primary medical insurances didn't pay it, so I'm wondering how I can submit that claim to you guys.
[AGENT][NEUTRAL] Spell your first name for me and if you can provide your policy number please.
[CUSTOMER][NEUTRAL] Sure. Um first name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I, I have one card, um, I think it's the same card. I'm not really sure because it says the effective date is [PII]. I know I had it for several years.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] What's the policy number on the card, on that card?
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Well, I, I have a group, I have a group number.
[AGENT][NEUTRAL] OK, do you see a policy er number on the card?
[CUSTOMER][NEGATIVE] They can't
[CUSTOMER][NEUTRAL] Policy cert number, policy er number.
[AGENT][NEUTRAL] It's kind of near the bottom. Start with a 0 maybe.
[CUSTOMER][NEUTRAL] Um, yeah, I have an in in hospitals benefit cert number and an outpatient benefit cert number. Is that what you might be referring to?
[AGENT][NEUTRAL] That's it. Just give me
[AGENT][NEUTRAL] That is it. Give me the numbers before the elm.
[CUSTOMER][NEUTRAL] Before the numbers before the M. OK 01845869.
[AGENT][POSITIVE] Perfect. And what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Let me pull up the policy.
[AGENT][NEUTRAL] And [PII], what's your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Date of birth [PII]. Excuse me, mailing address is [PII].
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for verifying that for me.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And you said that you had an outpatient surgery in [PII]?
[CUSTOMER][NEUTRAL] I, I, I went to the, I went to the ER room and they really did not they did nothing but they did send me a nice fat bill.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh boy. OK. Let me pull up your policy real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I believe you have the outpatient benefit under your plan. Let me verify.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah, I, it, I believe so.
[AGENT][NEUTRAL] Yeah, I was just making a statement.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And at the time I didn't have any of my insurance information or anything with me.
[AGENT][NEUTRAL] Right, so.
[AGENT][NEUTRAL] I do show emergency room um under the outpatient benefit which is up to $1000 per covered person per calendar year. So, now, did you say that your primary, did they deny it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, they did deny it because of a deductible.
[AGENT][NEUTRAL] OK, so it was actually applied towards your calendar your deductible.
[AGENT][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Uh, no, they just, well, they just straight up denied it and said that you didn't didn't meet your deductible.
[AGENT][NEUTRAL] OK, so yeah, so when, when it, if, if they applied it towards your deductible, [PII], that's what this, this policy is with GA with American Public Life, we'll pick up any amount that your major medical applies towards your deductible amount up to $1000 per calendar year.
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] Yeah, so it's not like a true denial as in it's not covered. They're just saying you have to satisfy your deductible before we start paying out any benefits for you, but we take care of that. So we need, um, if you're sending it in yourself, we need 3 documents.
[CUSTOMER][NEUTRAL] Right, right, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the APL claim form, um, that form can be downloaded from our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A A L M
[AGENT][NEUTRAL] Um, applemy.
[AGENT][NEUTRAL] Peter
[CUSTOMER][NEUTRAL] Apple [PII].
[AGENT][NEUTRAL] Umbrella.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Bob.
[AGENT][NEUTRAL] Bob
[CUSTOMER][NEUTRAL] Oh, I'm sorry. OK, go ahead. Uh-huh.
[AGENT][NEUTRAL] Larry I see [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, they just sent me a bill, so what are the 3 documents that I'm gonna need to provide to you folks?
[AGENT][NEUTRAL] OK, so the first document is the APL claim form. The second, uh, document would be an itemized bill, not the balance due statement that you have. You'll have to contact the hospital. I'll give you the form to request.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, it's an acronym. It's U as in university, B as in Bob, 04, so you'll request the UBO4 itemized bill.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Itemized bill
[AGENT][NEUTRAL] And then who is your primary carrier?
[CUSTOMER][NEUTRAL] Um, United Healthcare.
[AGENT][NEUTRAL] OK, did they send you an explanation of benefits?
[CUSTOMER][NEUTRAL] I think they did, that's basically the denial letter, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Were they applied it towards your deductible, yes, OK, we'll need a copy of that.
[CUSTOMER][NEUTRAL] Yeah, I think they do.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Oh, OK, I don't know where that is. All right, I'll, I'll try to hunt that up.
[AGENT][NEUTRAL] You probably download it from their website if you can't locate it.
[CUSTOMER][POSITIVE] OK. OK, great.
[AGENT][NEUTRAL] And so, so that form that you download, it has to show that that $1000 was applied in the deductible column.
[AGENT][NEUTRAL] So it, it should
[CUSTOMER][NEUTRAL] Uh, I feel, I feel.
[CUSTOMER][NEGATIVE] Go ahead, I'm sorry, I just feel like I don't understand.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So when you go to the website, I don't know what their format is or how it's set up, but it would have to be claims they have to have a claims dashboard and you're gonna look for across the top it's gonna say explanation of benefits and that's just simply telling you how they process your claim it'll have uh the the date that you had the service, that where you had the the name of the facility, um, the total charge, any adjusted amounts or write off amounts.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, there's a deductible column, a co-insurance column, and a co-pay column.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so just make sure that information is on that EOB or explanation of benefits that will be the 3rd 3rd document.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, so I need the claim form, the UB 04 and then the United Healthcare.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[AGENT][POSITIVE] Perfect, yes.
[CUSTOMER][NEUTRAL] OK, and then what do I do?
[AGENT][NEUTRAL] Um, if you have you created an online account?
[CUSTOMER][NEUTRAL] I have not.
[AGENT][NEUTRAL] OK, you could create an online account and upload it online or um you could fax it over to us or mail it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so then just get it over to you as soon as possible.
[AGENT][NEUTRAL] Do you need a
[AGENT][NEGATIVE] There's no timely filing limit.
[AGENT][NEUTRAL] So, yeah.
[CUSTOMER][POSITIVE] Oh, OK. That's great.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I go ahead and pay them.
[CUSTOMER][NEUTRAL] Just because they're like, oh you need to pay us, you know, um, if I go ahead and pay them, will you reimburse me?
[AGENT][NEUTRAL] Because you're submitting the claim to us, yes, um, but our reimbursement amount is gonna be what's reflected on United's ELB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] United DLB, OK. OK.
[AGENT][NEUTRAL] Yeah, so if you pay more than that, and then your benefit is a max of 1000, so that's the maximum that we could pay up to that amount. So if they apply 500, we would, we would pay the 500. If they pay 1000, we would consider the 1000.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, all right, well thank you for your help, absolutely and I, and I will get to work.
[AGENT][NEUTRAL] Mhm. That makes sense?
[AGENT][NEUTRAL] All [PII], [PII]. Anything else?
[CUSTOMER][POSITIVE] No thank you so much I appreciate your help today.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh, bye-bye.