AccountId: 011433970860
ContactId: 4f5c8294-756d-4b9a-92eb-8be88f23d2d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457359 ms
Total Talk Time (AGENT): 235835 ms
Total Talk Time (CUSTOMER): 144990 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/4f5c8294-756d-4b9a-92eb-8be88f23d2d0_20250408T14:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning, [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] Good. Listen, uh, I have a quick question for you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Because, um, uh, I'm on my way to see a specialist and then my premium insurance, uh, I have a co-payment of $60.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, will I be covered with you guys for those $60?
[AGENT][NEUTRAL] I can definitely see this is a specialist office visit you're going to?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we can get your policy pulled up and I will see if that's going to be covered. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I happen to work for the city of [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Do you need the group number?
[AGENT][NEUTRAL] Um, first, if you don't mind, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, in hospital benefits or outpatient benefits?
[AGENT][NEUTRAL] Either one of those.
[CUSTOMER][NEUTRAL] OK, it.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] 5850
[CUSTOMER][NEUTRAL] M as in mom.
[CUSTOMER][NEUTRAL] L as in leader and then [PII].
[AGENT][NEUTRAL] OK, thank you for that. And then let's see, just gonna verify some information really quick, uh, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII] and then the zip code will be [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. Looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying that information. Alrighty, give me just a moment let me pull these benefits up some of our policies do cover office visits, some of them do not, um, so give me just a moment and I will be able to verify that with you.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] Of course, one moment please.
[AGENT][POSITIVE] OK, I appreciate your patience. Thank you. So you do have a benefit for office visits and specialist office visits, as well as treatment received in office. So for a specialist office we would pay up to $50 per visit and that's a maximum of 4 visits per person per calendar year.
[CUSTOMER][MIXED] Awesome, but the thing is that these places, and I know it's not, it's not you guys because it's not the first time that something like this happens to me. It's them that they don't wanna take the secondary insurance.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh I see. OK, so you can in that case you can absolutely still file this yourself um yeah unfortunately some of them just do not want to mess with any sort of secondary or supplemental, um, but you can absolutely file that claim yourself.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] How do I do that?
[AGENT][NEUTRAL] OK, so do you have access to a desktop or a laptop computer, [PII]?
[CUSTOMER][NEUTRAL] Well, right now I'm driving.
[AGENT][NEUTRAL] Well, right, OK, I mean, and there's no timely filing limit, so that's not like there's a specific time frame you have to get this information to us. It's just whenever is convenient for you. Uh, the reason I ask is that that's our, our, excuse me, our online portal is typically going to be the quickest and easiest way to get claim information to us. However, it does have to be accessed through a desktop or a laptop computer.
[AGENT][NEUTRAL] So whenever you would probably have to wait a little bit to get the documentation anyway from the provider as we need the explanation of benefits showing what your primary insurance uh did pay so once that's gone through they can send you that information um as well as the itemized statement that shows diagnosis and procedure codes. So if you'd like, of course I know you said you're driving, if you need to give us a call back uh whenever you're ready we can go over that with you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And how you can get that to us just know that you can still file that claim.
[CUSTOMER][NEUTRAL] Yeah, because this is the 2nd time that we go to this place and then I remember that probably like 2 or 3 years ago we, they, they, they were taking the APL insurance and now out of the blue they don't wanna take it and then same thing it's happening to me in the urgent cares because places that we had gone to, they used to take this insurance and then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ah,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know, it's them it's not you guys because most of the time we wanna blame you guys for that, but it's not you. I know it's not like clinics and all that.
[AGENT][NEUTRAL] Well, and that's
[AGENT][NEUTRAL] Sure, well, and again I know it's a little bit inconvenient for you but just know you can still file those claims. So if there were any instance, I mean this policy's been effective since [PII], uh, so if there was anything in the past that you've had to pay out of pocket for and they would not file these claims, you can still file them again there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, I have now the thing is I don't know if I have the records or how do I prove that.
[AGENT][NEUTRAL] Sure, so you can contact um wherever you went for treatment, you can contact that facility and then ask them again that explanation of benefits from your primary insurance and then the itemized statement that shows diagnosis and procedure codes. That's going to be all that we need.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, I
[CUSTOMER][NEUTRAL] I might be able to put that on the primary insurance, uh.
[CUSTOMER][NEUTRAL] Cell phone app because I have it there.
[AGENT][POSITIVE] It is definitely possible.
[CUSTOMER][POSITIVE] And I have the explanation of benefits, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I remember even one time they charged my primary insurance when I wasn't even, I didn't even go to that place.
[AGENT][NEUTRAL] And again, whenever
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Are you surprised?
[AGENT][NEUTRAL] Oh, well, I guess I shouldn't be, huh?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] No, well, whenever you're ready, obviously I know you're on your way, but um if there was a better time where you could write this information down, definitely give us a call back and we'll be able to walk you through how you can get all of that done.
[CUSTOMER][POSITIVE] Thank you for your help, my dear. You were very helpful.
[AGENT][POSITIVE] You are very welcome, of course, was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, no, no, no, that'll be all. Thank you for your help.
[AGENT][POSITIVE] Alright absolutely thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You have a blessed day, my dear.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye.