AccountId: 011433970860
ContactId: 48d573c8-47b9-4ed9-8769-e60adb4b7e2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843820 ms
Total Talk Time (AGENT): 335541 ms
Total Talk Time (CUSTOMER): 366721 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/48d573c8-47b9-4ed9-8769-e60adb4b7e2a_20250317T17:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm trying to create a new password, um, to log in to like because I'm [PII], I'm a I'm a new.
[CUSTOMER][NEUTRAL] Uh, I haven't, I'm not a new client. I'm just, I haven't, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I haven't done the new user thing yet.
[CUSTOMER][NEUTRAL] So, and I'm not.
[AGENT][NEUTRAL] The registration, OK.
[CUSTOMER][NEGATIVE] Yeah, so I'm not being able to, I'm trying to log in as a new user and it tells me every time that there's a problem. I don't know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, sure, I can assist you and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, I have the group number and the payer ID. Sorry, I have, I'm, I'm holding a card, an APR card.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's fine. And do you see the uh the policy number is gonna be in the bottom where it says in hospitals, outpatient surgery. It's gonna be in, yeah, one of those two. It's OK.
[CUSTOMER][NEUTRAL] 00, OK, [PII], yeah, it's 02024.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 554
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] OK, before the ML, what is the two digits after the 4?
[CUSTOMER][NEUTRAL] 58.
[AGENT][NEUTRAL] 58. OK, thank you one moment.
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email address for verification, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my email is my first name, [PII].
[AGENT][NEUTRAL] OK, so that's what we have. And when you're going in to the um system are you going uh clicking on I'm a new user and you do the individual?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I tried both. I was part of the group. I'm, and also I'm, I'm an individual, and I put, I put my last name, then I put, I tried, which you want me to put the member ID the 0244?
[CUSTOMER][NEUTRAL] The 024 sorry.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No, no, the, the, it's gonna be your social, um.
[CUSTOMER][NEUTRAL] OK, so, OK, I tried, but, yeah, I tried, but let me see.
[AGENT][NEUTRAL] Mhm. Under individual.
[CUSTOMER][NEUTRAL] Again.
[CUSTOMER][NEUTRAL] Residential zip code.
[CUSTOMER][NEUTRAL] My email, date of birth is month, day, year.
[CUSTOMER][NEUTRAL] Ah, no, it did. Let me, oh my [PII], I don't know what I did wrong. OK.
[AGENT][NEUTRAL] OK, it's OK.
[CUSTOMER][NEUTRAL] Username that's I make it.
[AGENT][NEUTRAL] Yes, go ahead and create a user name.
[CUSTOMER][NEUTRAL] OK, I'll do it with this uh.
[CUSTOMER][NEUTRAL] Can I make it like uh something like my my email or not?
[AGENT][NEUTRAL] It cannot be the email. It could be the first part of your email, but not the full email. It doesn't take an email as a um username.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I submitted.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Submit it says submitting but it's still not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Um, my account was successfully.
[CUSTOMER][NEUTRAL] Let me see that I can log in.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just did.
[CUSTOMER][NEUTRAL] OK, um, now my question for you is that I have no idea what this insurance gives me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's the truth. Like, it covers, yeah.
[AGENT][NEUTRAL] Cover
[AGENT][NEUTRAL] OK, that is fine. Um, if you double click that blue number that you have in front of you on the policy.
[CUSTOMER][NEUTRAL] The new number?
[AGENT][NEUTRAL] Yeah, mhm. Are are you in your account?
[CUSTOMER][NEUTRAL] Yeah, oh, I see policy number, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Can you double click that number and it's gonna give you a PDF.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, if you open that PDF you're gonna see the same information I'm gonna give you.
[AGENT][NEUTRAL] So let me go ahead and pull that really quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage. And this is your secondary policy, and you have an inpatient maximum of 2000 per occurrence. The inpatient is if you're in the hospital 18 hours or more, either observation or hospitalized. That's gonna be inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then you have an outpatient maximum of 750 per day, and that is to use like in a hospital emergency room, urgent care facility, office treatment, cancer treatment, labs, diagnostic center, uh, doable medical.
[CUSTOMER][NEUTRAL] So this is the only things that I I'm trying to scroll down and see where is the all those.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now I see it. So, um, these are all related to hospital costs?
[AGENT][NEUTRAL] No, it's gonna be for urgent care, for hospital, and it's gonna be the office treatment. It doesn't cover the co-payment for the visit, but it does cover the office procedures like if they do a, an ultrasound, if they do X-ray, if they give you an injection, um, then those are the ones covered, but it doesn't cover the copay co-payment for the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So, let's say I, I went to a spine, uh, I went to a spine doctor, the cost was $80 for the co-pay for the visit, but then now they sent me um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, $61 that my insurance, my, my main insurance didn't pay for the X-rays that they didn't cover. Can I send it to you then?
[AGENT][NEUTRAL] If it's the X-rays, um, yes, because we do cover office treatments. So yes, you can either have them submit the claim directly to us for payment, or you can submit your own claim. If you submit your own claim, we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, I'll tell them to submit, yeah.
[AGENT][NEUTRAL] Yeah, OK, I'm sorry. OK.
[CUSTOMER][NEUTRAL] I'll ask them. Yeah, it's, it's easier. Another question about blood work also?
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Blood work, do you, do you cover whatever my insurance doesn't cover?
[AGENT][NEUTRAL] OK, so this one, it looks like it does have the lab work. Let me go ahead and double check one moment. Let me pull another document.
[CUSTOMER][NEUTRAL] Because I'm, I'm in page, I'm on page 20.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] Oh no, that's the
[CUSTOMER][NEGATIVE] The premium, no, so that's not worth, no.
[AGENT][NEUTRAL] OK, the policy covered.
[CUSTOMER][NEUTRAL] If you tell me what, what page to look at, then I'll go to it.
[AGENT][NEUTRAL] OK, so it's usually on the page, uh, let's see, what page is this one.
[CUSTOMER][NEUTRAL] 30
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] So I'm saying.
[AGENT][NEUTRAL] 34. Yes. That's it. 34.
[CUSTOMER][NEUTRAL] Diagnostic testing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you do have independent lab facility um if they do send it to an independent lab like Laborp or um any of those then quest, yeah, quest is an independent lab. those are considered under this benefit, yes. Mhm.
[CUSTOMER][NEUTRAL] Quest.
[CUSTOMER][NEUTRAL] Where do you see it? And also on page 34?
[AGENT][NEUTRAL] Page 34 on outpatient rider.
[CUSTOMER][NEUTRAL] Oh, OK. Independent lab facility. OK. So I have to reach out to the, to Quest, give them your insurance, give them this insurance too, and also to the spine doctor that I was at and for the X-rays.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, what about, what about um retroactive reimbursement because there was a bill, a lab bill, a small one that wasn't covered, and then when I went again last January, they quite said I have to pay the previous one before they could take the next lab, so I did pay it out of pocket that whatever was left on the July, I think it was in July that I was um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] In in July that bill was from July and then I came again in January 6 months later, so I had to pay the July leftovers. Could this be reimbursed?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, you can always send in a claim for reimbursement. Um, what you're gonna need to send, let me give you the list of what you're gonna need because it's a little bit different, so it, it has a lot more stuff that you need to send in. Um, so the first thing, yes.
[CUSTOMER][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Um, the first thing you're gonna say.
[CUSTOMER][NEGATIVE] If it's a longer then I'll skip it because it's only $40. I'm not gonna, you know, work for it.
[AGENT][NEUTRAL] Oh, yeah. Well, I can give you the instructions and you, you decide if you want to send it or not, but yeah. So the first, um, the first thing we're gonna need is an itemized bill with the diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK. OK. OK.
[CUSTOMER][NEUTRAL] With diagnosis, you said?
[AGENT][NEUTRAL] Yes, diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The second document is an explanation of benefits from the primary insurance indicating how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] estimation and benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, of the insurance, of the main insurance, right?
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] Mhm, yes, from primary insurance. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And the 3rd, the 3rd and last document is the claim form. And the claim form you can find it on our website.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. I'll consider it because I think the 1 and 2 I can get from Quest directly, you know, if I ask them for the information or from my, or from my website, the or from if I go if I log in to my myuest information, I think those are things I can find there.
[AGENT][NEUTRAL] You.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Probably um just whenever you go into your uh a chart, just make sure that it does have a diagnosis code. If you don't see a diagnosis code, then you probably need to call them to have them to send it to you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I see. OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it. I appreciate your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye