AccountId: 011433970860
ContactId: 6901a366-2ff7-486d-aaef-58e50128b50b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 910919 ms
Total Talk Time (AGENT): 391741 ms
Total Talk Time (CUSTOMER): 364046 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/6901a366-2ff7-486d-aaef-58e50128b50b_20250509T18:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Hey, I, um, I'm trying to do anything possible to to get APL stuff paid for with my doctors and my MRI's and all of that stuff. And so I'm just trying to call and maybe get a clear idea of how to get some of this stuff covered or what's covered. Um, I've, I've done a little bit last year with the uh doctor uh liver doctor, and they
[CUSTOMER][MIXED] Did the procedure and y'all took care of it and that was awesome but I'm with a rheumatologist now that's trying to check stuff and when I go into them, they, you know, I, I don't know who's affiliated with who technically, but I have Aetna insurance and I have APL for the supplemental, and they will go Aetna but they used to send you guys a bill which I don't know if that's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because y'all wouldn't cover it anyway or because they just don't know how to do their job and, and whatever and I don't know if I can get receipts somehow when I pay and send it to y'all and see what's covered. I just, I, I don't even know where to start, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's pretty much most of it.
[AGENT][NEUTRAL] OK, so, alright, so you're the insured and you're needing to find out about how to go about filing your own claims since the provider is not filing them for you with APL is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and, but I mean I am under the understanding that like administrative fees and stuff aren't covered even though you know technically my Aetna insurance is a 100% covered besides the deductible and then APL covers the deductible amount, but I know that there's gonna be administrative fees and stuff, right, that I'm just out of pocket still, but.
[CUSTOMER][NEGATIVE] I have, I like right now I have an MRI scheduled. Well, Aetna is just beating me up on, they don't wanna do it and then they're telling me, well, you're gonna be 700 out of pocket, and then they're telling me you should change locations and they keep doing stuff to try to prevent me from even getting treatment and I, I wanted to see that's the main one is I don't know if an MRI procedure, a scanning procedure is considered something that the deductible side is covered by APL.
[AGENT][NEUTRAL] OK, so yes, sir, I can help you with some of these questions, but before I can, I'm gonna need to pull up your policy information, verify some things with you for security, and then we can go from there, OK?
[CUSTOMER][NEUTRAL] That's, that's
[CUSTOMER][POSITIVE] Yes ma'am, thank you.
[AGENT][POSITIVE] All right. You're welcome.
[CUSTOMER][NEUTRAL] What information do you need from me to pull that up?
[AGENT][NEUTRAL] And first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and your policy number, please?
[CUSTOMER][NEUTRAL] Uh, it is 02506284.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], as I stated before, I will have to verify several things with you first for security and then also any information that's provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you and your home mailing address please.
[CUSTOMER][NEUTRAL] Yes, it is. I hope this is all set right. It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that 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 thing to verify is your email address please.
[CUSTOMER][NEUTRAL] Uh, yeah, so my my work email is probably what it's under [PII].
[AGENT][NEUTRAL] This is personal. Actually, no, this, this appears to be a personal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, then it's [PII].
[AGENT][POSITIVE] OK, perfect. Thank you so much for verifying everything. So give me one moment.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I can see that you are also set up on the online service center where you can log in and have access to your information online as well.
[CUSTOMER][NEUTRAL] Yeah, I think I, I think I can. I, I've had to log into that before.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you don't remember your username [PII] I could provide that for you but if you don't remember your password you would just have to do the forgot password and set a new one because I would not have access to that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, yeah, I, I'm, I'll be fine reset my password and stuff if I need to do that.
[AGENT][NEUTRAL] OK, do you remember your user name that you created?
[CUSTOMER][NEUTRAL] Oh, that's a good question. Let's see here.
[CUSTOMER][NEUTRAL] Um, it probably be [PII].
[AGENT][POSITIVE] I can check it for you.
[CUSTOMER][NEUTRAL] So do you need me to log into this for you? Is that what you're asking me to do?
[AGENT][NEUTRAL] No, sir, uh uh, no, I'm just wanting to make sure that you know how to log in, so yes, it's, that is correct, that is your username that you had created for your profile.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so first off, on this policy that you have with APL, Daniel.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, office, that is correct, office visits.
[AGENT][NEGATIVE] are not covered.
[AGENT][NEUTRAL] We can review treatments and outpatient testing and things like that under your outpatient benefit.
[AGENT][NEUTRAL] But the an office visit isn't covered. Now, if your primary insurance company.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Is not covering a procedure, this policy would also not provide any benefits.
[CUSTOMER][NEUTRAL] Well, my, my primary.
[AGENT][NEUTRAL] If it's not covered by your primary, it would not be covered by your secondary either.
[CUSTOMER][NEUTRAL] So my primary is covering the MRI.
[CUSTOMER][NEUTRAL] They're covering it. They're just not covering it like I mean I have a deductible, right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so they're covering it my deductible.
[AGENT][NEUTRAL] So on this on this plan that you have with APL you have an outpatient benefit maximum on this policy. Give me one sec.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Your outpatient benefit is $7500 per calendar year for covered outpatient services.
[CUSTOMER][POSITIVE] Yes, yes, perfect, and that's my deductible amount of money.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if you are if the facility is not going to be filing the claim for you.
[AGENT][NEUTRAL] And you're gonna have to file that is that what you're saying they're not gonna file your secondary?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, I know my rheumatologist won't. The MRI place might.
[AGENT][NEUTRAL] What's your rheumatologist's name?
[CUSTOMER][NEUTRAL] Oh, let me get it for you here. They, that lady at the front of that desk needs new jobs. Sorry, let me look.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean just, I, you know, people don't know how to do stuff. Let me see who it is. Um, it is.
[CUSTOMER][NEUTRAL] [PII]. There you go.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Um, the
[CUSTOMER][NEUTRAL] Yeah, it's, it's called rheumatology, oh.
[CUSTOMER][NEUTRAL] Try to find the name of it.
[CUSTOMER][NEUTRAL] They're with Providence.
[AGENT][NEUTRAL] The only reason I'm asking that is I can see that we've received a couple of claims for you just today. They haven't been reviewed yet, but one is for Doctor [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Or [PII]
[CUSTOMER][NEUTRAL] Oh yeah, Kirk Kirk Teman, that's my PCP that's my primary care physician.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, but again that has not yet been reviewed. Let me see if what the other one is for.
[AGENT][NEUTRAL] Because we received 2.
[CUSTOMER][NEUTRAL] And [PII] does the most recent thing I did with him was an X-ray, and so that's probably what he's sending to you. They're very good at billing you guys, which I know that I have, like you said, doctor's visits. I'm not naive to the fact that I have to pay something whenever I have those doctor visits, or even the rheumatologist, it's a specialist, and if it's just a visit, I'm sure I have to pay 100 and something bucks or whatever it is, but.
[CUSTOMER][NEUTRAL] When it comes to this MRI procedure, I guess my point is, is if, if Aetna covers it, then y'all do cover it, or is there still.
[AGENT][NEUTRAL] Well, we can't, well, we, I cannot guarantee payment of any claim. We have to receive that, but that an MRI is something that we could review under your outpatient benefits.
[CUSTOMER][NEUTRAL] Where you
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's good enough for me. Yeah, I'm not, I'm, and I know when it comes to medical it's we can't do, we can't guarantee nothing, but I mean, and I'm not I, I, I get that if everything follows right and it's covered right, it'll be done right, I guess I'm more of a these, you know, administrative fees are pointless. This is something I should submit kind of situation, right? So that's, that's what I'm going for is just trying to, trying to do what I can to make sure it's paid right so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure, now, since you have this one provider that said they will not file for you with a PO.
[AGENT][NEUTRAL] You can file your own claim through your portal now I can email you.
[AGENT][POSITIVE] The user guide if no one has ever emailed you that before [PII], in addition to telling you how to set up your profile, it also gives you instructions on uploading files like adding in your direct deposit information, your policy things like that, um, so I'll be happy to send that to you. I can also include.
[CUSTOMER][NEGATIVE] They they're not.
[AGENT][NEUTRAL] One of the Medin claim forms.
[AGENT][NEUTRAL] That you would need to use when filing on this policy and [PII] on the first page of the claim form, it does have instructions at the top that tells you about how to complete the claim form and then what other documentation is also required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you contact your providers, you'll know what to ask for.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Alright, so give me just a moment, I'm gonna go ahead and send you this information.
[CUSTOMER][NEUTRAL] Of course, while, while you're doing that, if you have a second, I was gonna ask you, did you happen to see the name of that other claim that was requested if it was a they haven't.
[AGENT][NEUTRAL] They're both for the same doctor. Mm, they're both for the same doctor [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] The imaging place has not called me yet, and so I kind of know their name because of Aetna calling me trying to
[CUSTOMER][NEUTRAL] Switch me around and stuff anyway, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], so I have just sent you that email, so give it a minute and then you should have it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that email is gonna be coming to you from care team.
[CUSTOMER][NEUTRAL] I've got
[AGENT][NEUTRAL] Uh-huh. Do you see it? It did come through?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I have it thank you.
[AGENT][NEUTRAL] OK, so yeah, you're welcome so it has the user guide and the claim form included and again on page one of that claim form it does tell you what other documentation you always need to submit if you're having to file this claim, you know, or any claims on this policy, that is the information we would always have to have for each claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So were there, do you have other questions? Is there something else that I can help you with today or try to help you with today?
[CUSTOMER][NEUTRAL] No, I think that's good that kind of lets me know I can I can do it on my own if I need to, I guess if, if I pay them and they won't bill you and then I claim it and it somehow it does get approved, y'all would send it to me or do I ever need to worry that y'all would send it to the original doctor and then they would have to.
[AGENT][NEUTRAL] If it is
[AGENT][NEUTRAL] It typically, whomever files the claim is who the benefits would be paid to if, if they were, you know, if we were able to pay benefits, it would be to whomever filed the claim unless there was an, an assignment of benefits stating otherwise.
[CUSTOMER][POSITIVE] OK perfect all right well that lets me know kind of how to prep whenever I go talk to these imaging people and maybe I can give them this information and they'll pay it properly. That works thank you very much I.
[AGENT][NEUTRAL] And, well, yeah, you're welcome. Always try to give them your primary insurance card and your APO information. Again, you know, most, most of them will take care of everything for you, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] It just makes it a lot easier. That the, there's not as much leg work.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If they will do it.
[CUSTOMER][NEUTRAL] Of course, yeah.
[CUSTOMER][POSITIVE] That'll work yeah thank you very much I appreciate it.
[AGENT][POSITIVE] OK. Well, you're certainly very welcome. So if that is all that I can help you with at the moment, thank you again for calling APL and I hope that you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Yes, sir. Thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.