AccountId: 011433970860
ContactId: 49e3b430-6b1a-4585-9956-c3e21dcba351
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751109 ms
Total Talk Time (AGENT): 266654 ms
Total Talk Time (CUSTOMER): 241378 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/49e3b430-6b1a-4585-9956-c3e21dcba351_20250407T18:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling because I had a specialist, um,
[CUSTOMER][NEUTRAL] appointment over the weekend and um I was charged for the co-pay, and she specifically said that they don't accept the American Public Life coverage for co-pays. And I just wanted to verify that or um confirm, you know, if my plan.
[CUSTOMER][NEUTRAL] Uh, is only covered on certain areas.
[AGENT][POSITIVE] OK, I can definitely um give you some clarity about your policy. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], phone number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Sure, um.
[CUSTOMER][NEUTRAL] Is that on my APL card?
[AGENT][NEUTRAL] Yes, it should say inhospital or outpatient policy er number.
[CUSTOMER][NEUTRAL] OK. Outpatient benefit cert number.
[CUSTOMER][NEUTRAL] 02450023 ML 8
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify?
[AGENT][NEGATIVE] Hold on one second. It just skipped on me.
[AGENT][NEUTRAL] Can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] 21083. Address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And let me see.
[AGENT][NEUTRAL] OK, so there's a few things. So the Metlink policy, so we pay towards the copay, the deductible and co-insurance after primary, but everything we do is on the back end once we receive the claim. So if there's a co-pay or deductible that's required for you to pay to get the services, you will have to pay that upfront and then once we get the claim, you could be reimbursed or if something is still owed to the provider, we can pay them, um.
[AGENT][NEUTRAL] It it just depends on the paperwork, but
[AGENT][NEUTRAL] If they accept your primary, they accept your secondary, we're second to them. Um, they might have
[AGENT][NEUTRAL] Just not been familiar with APL and just said that, but no, if you want, if you wanted to, I can call and speak to somebody if you need me to, but um.
[AGENT][NEUTRAL] Like this doesn't even have a network, so they can't say, you know, we're not in network or it's a secondary insurance, so it goes with your primary.
[CUSTOMER][NEUTRAL] OK. So if I wanna get reimbursed um for this particular specialist that I'm seeing, um, how do I go by that?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, to be honest, they're supposed to build Cigna. Cigna will apply and then after Cigna gives the, you know, the exponential benefits after they go through their process.
[AGENT][NEUTRAL] Then the provider is supposed to then send us yus explanation benefits and the provider's bill and then we apply.
[AGENT][NEUTRAL] If that's why I'm saying if you want me to speak to somebody, I can, so you don't have this problem going forward, but you do also have the choice, the option to um file the claim on your own as well. So it's
[AGENT][NEUTRAL] Whatever I can do to help, whichever you prefer.
[CUSTOMER][NEUTRAL] OK, so yeah, I, I can give you the name of the specialist and then you can tell me if that's been initiated, um, you know, as far as the uh explanation of benefits, and then we can take it from there.
[AGENT][NEUTRAL] What do you mean by that? Like, see if they filed a claim with us?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But they turned you around. Do, do they have our information? Are they, did they take it or they didn't take it at all?
[CUSTOMER][NEUTRAL] Well, they took my insurance information and they charged the insurance for the visit, but then I also paid a co-pay, and I mentioned that I don't necessarily have to pay a co-pay because of the secondary insurance, and they weren't familiar or they said that they didn't accept it, so I had to pay, which I did, but you mentioned, you know, I might get I could get reimbursed for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Right, like you're going, anything, anytime, what I tell my patients, if you give your Cigna card, give your APL card. The problem is they they've now said that they don't accept it or blah blah blah, they're giving you pushback, which
[AGENT][NEUTRAL] Should not be. So there's no claims here on file. They haven't filed any claims with us. Do you, do you have their phone number? Do you want to like reach out to them and I kind of explain what we are so that you don't, cause are you going to keep going to them? I don't want you to keep having this issue.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][POSITIVE] I, I, I no longer have to go with them. Um, I've already gotten my results back with a specialist, um, but, you know, the two, the 2 or 3 visits I did go to, um, they were about $70 each. So I was, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Each time,
[AGENT][NEUTRAL] Oh, I would definitely file the claim.
[CUSTOMER][NEUTRAL] Yeah, so I wanted to.
[CUSTOMER][NEUTRAL] File a claim then, OK.
[CUSTOMER][NEUTRAL] Alright, so how, so that's the thing, I don't know how to file a claim.
[AGENT][NEUTRAL] OK, if you, so which route do you want to take? Do you want them to file everything and handle the paperwork or do you want to do it yourself?
[CUSTOMER][NEUTRAL] I think it'd be easier if you guys did it because I don't know what I'm doing to be honest.
[AGENT][NEUTRAL] OK, what's the specialist phone number?
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][POSITIVE] And I can get a phone number for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and do you mind if I place you on just a brief hold while I call on the other line? I'm gonna put this all together.
[CUSTOMER][POSITIVE] Yeah, I'd appreciate it thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling the office of Doctor [PII]. At the moment we're unable to answer your call because we're assisting other patients are on the phone, but please leave your name and number, and we will get back to you by the end of the day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you for calling the office of Doctor [PII]. At the moment we're unable to answer your call because we're assisting other patients are on the phone, but please leave your name and number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you for holding. So, I don't know, do you think this might be lunchtime? because I called twice, but it's going to voice like to their answering machine.
[CUSTOMER][NEUTRAL] OK, um, I don't know, it's for lunch time, but I can maybe look into.
[CUSTOMER][NEUTRAL] Hold on, let me see if I have another phone number you can dial.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] OK, I gave you.
[CUSTOMER][NEUTRAL] What number did I give you? [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, that's the, that's the number I have on my receipt and um.
[CUSTOMER][NEUTRAL] The first two visits were $60 and then for some reason it increased now to $70. So the third and last visit was $70.
[AGENT][NEUTRAL] Yeah, no. So, let's do this. You, if you like, um, I'm the only [PII] here.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] I would say that let's maybe give it an hour just in case it is a lunch hour because I, I can try to call again.
[AGENT][NEUTRAL] Um, but I know it's like around that [PII] time I'm central, so that could be it. But um I can try to give them a call again if they don't answer, uh, if you want to give me a call back later on today, when we can try again. Um, like I said, I'm the only [PII] here, so it won't be hard to get me.
[CUSTOMER][NEUTRAL] OK, [PII], um, do you have a direct line or should I call that [PII] number?
[AGENT][NEUTRAL] You want me to try to call him again?
[AGENT][NEUTRAL] Um, the [PII], I don't have a direct line, but did you want me to try to call them again?
[CUSTOMER][NEUTRAL] Yeah, if you can, um, and then I'll reach out to you within an hour and, and see if we can, you know, uh, do another attempt.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Get them
[AGENT][NEUTRAL] OK, um, well, hold on one moment, I'm gonna call him on the other line.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling the office of Doctor [PII]. At the moment we're unable to answer your call because we're assisting other patients are on the phone, but please leave your name and number, and we will get back to you by the end of the day. This is [PII] and it's the.
[AGENT][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Hello, [PII]. Hey, so they, they didn't answer again. um, so we can definitely call um later if you'd like. I'm here until [PII] central time, so [PII] Eastern.
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][POSITIVE] OK, that's great. I'll reach out again. I appreciate your help, [PII]. I'll talk to you soon.
[AGENT][POSITIVE] Alrighty, well, thank you for calling APL and I'll speak with you soon.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] All right, bye bye.