AccountId: 011433970860
ContactId: 6d5f85a8-9c7b-4101-a8c9-88169992d939
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 782919 ms
Total Talk Time (AGENT): 185307 ms
Total Talk Time (CUSTOMER): 415019 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/6d5f85a8-9c7b-4101-a8c9-88169992d939_20250425T20:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm, um, I have the, the APL, um, medical benefits and I'm logged into the account and I'm, I'm just trying to figure out and just verify that.
[CUSTOMER][NEUTRAL] Um, which plan I have, I, I thought I selected a specific plan, but I'm not seeing it.
[CUSTOMER][NEUTRAL] In my profile and I was going to file a claim but I just don't know where to start with this so.
[CUSTOMER][NEUTRAL] Um, so yeah, if you could help me find that first.
[AGENT][POSITIVE] Yes, ma'am, I can assist you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. Sure, [PII]. Could I first get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] See, I think that'll be on the card. Let's see, uh, 02594192.
[AGENT][NEUTRAL] OK, thank you. Now, please verify um your full name and date of birth and, yeah, your full name and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Uh, mailing is [PII]. Email, uh, it was mail at [PII], um, but I'd like to have that updated to [PII]. I don't know if that was automatically updated. Um, I tried to update it previously, but I don't know if it did update in the system.
[AGENT][NEUTRAL] No, ma'am. I'm showing your old email address. Um, what's your new email address again? I can update that for you.
[CUSTOMER][NEUTRAL] Um it's [PII].
[AGENT][NEUTRAL] So that's [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, I've updated your email.
[AGENT][NEUTRAL] And you need to know how to file a claim online.
[CUSTOMER][NEUTRAL] Um, yes, but I, I first wanted to check and see, um, with, um, my
[CUSTOMER][NEUTRAL] Employer, there were 3 plan options, uh, I guess technically 4, and I selected one of them, but I don't see that information on my profile like where can I find that information to verify that I selected, for example, the insurer plus plan versus the insurer plus enhanced plan I like where do I find that information?
[AGENT][NEGATIVE] Mm, OK, it should be on the first page. You don't show it, it doesn't under plan type, it doesn't give you that information.
[CUSTOMER][NEUTRAL] Um, I don't see it. So I'm logged into the APL account and I'm, I see my coverage and then it just says like these are like group accident, hospital and then the voluntary dental, term life, that's all that I see.
[AGENT][NEUTRAL] Yeah, this is the hospital indemnity plan. Does it give you the option to click on it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It lets me click on the policy number. I don't know where that.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Uh, OK, PDF download.
[CUSTOMER][NEUTRAL] OK, looks like it just downloaded this book.
[CUSTOMER][NEUTRAL] Uh, certificate of insurance.
[AGENT][NEUTRAL] Yeah, and that's a list of all of your benefits, yes, ma'am. And that's where you'll find all of your policy information.
[CUSTOMER][NEUTRAL] OK. So, even though, OK, it says hospital indemnity, but on the plans I had selected, they had things that they included like physician's office, $50
[CUSTOMER][NEUTRAL] You know, like other stuff, intensive, whatever hospital, like it has these like specific prices. So is this only coverage if I'm in a hospital or does this work? Cause I just went and saw a specialist yesterday and I was gonna file a claim for that an ENT, but is that not included in this plan, like anywhere?
[AGENT][NEUTRAL] Um, yes, ma'am. It is covered. That would be covered under your outpatient benefits. It is a hospital indemnity plan, but there are some outpatient benefits. And for office visits or outpatient visits, you get $4 per calendar year and we cover up to $50 per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] That information should be in this PDF book that I just downloaded from the policy number link.
[AGENT][NEUTRAL] Um, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Let me see if I can pull it and let you know which page to go to. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing if you go to page 7, there's a list of your benefits and actually under your policy for office visits, um we cover up to $5 per calendar year and we cover up to $75 per visit.
[CUSTOMER][NEUTRAL] OK, OK, great. So when I go to these appointments, since this is, I like technically it's not medical insurance, it's like a supplemental addition. Whenever I go, I just pay out of pocket basically just self-pay or if I have the insurance, use that and then I file a claim and then I have that amount covered like I guess reimbursed after the appointment. Is that how that works?
[AGENT][POSITIVE] Yes, ma'am. It can work that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so then back to my profile when I go to.
[CUSTOMER][NEUTRAL] File a claim. So for my appointment yesterday with an ENT, they charged me 275, um.
[CUSTOMER][NEUTRAL] So then I would get I guess uh $75 reimbursed once I file a claim.
[AGENT][NEUTRAL] Right, that was an outpatient visit, right? Yes, ma'am.
[CUSTOMER][NEUTRAL] For that visit, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, um, OK, so then I would just, I see there's a button here that says file a wellness claim is that considered a wellness claim or is it a different kind of claim?
[AGENT][NEUTRAL] Let's see. It was for a sickness, right?
[AGENT][NEUTRAL] Or did you go for a screening?
[CUSTOMER][NEUTRAL] For a what? I'm sorry?
[AGENT][NEUTRAL] Was it for a sickness or did you go for a screening?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Um, I, I guess the screening, it was kind of a, a consult for him to review what was going on with my sinuses. I mean, we just talked. He didn't do an exam, like he just looked at me, we discussed the issues I've been having, so I don't know what that would fall under.
[AGENT][NEGATIVE] Yeah, that sounds like it will fall under sickness.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, so claims forms and then.
[CUSTOMER][NEUTRAL] OK, so I have to sign in and register to file a claim on this other website is taking me to?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK, I see we're in the same spot, OK.
[CUSTOMER][NEUTRAL] So just took me back to my profile. OK, so then I, I, it looks like the only button I can click is to file a wellness claim. I, I don't see anything else here to select for a different kind of claim.
[AGENT][NEUTRAL] OK, but if it's outpatient, it'll go under the $75 benefit. They're all the same.
[AGENT][NEUTRAL] Because they are outpatient um visits.
[CUSTOMER][NEUTRAL] OK, I'm so confused. OK, on this other page that there's these claim forms that you can download. Do I need to do that?
[AGENT][NEUTRAL] Um, do you see one for outpatient visits?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, let me see here.
[CUSTOMER][NEUTRAL] Cancer claim change of request, critical illness, dental direct deposit.
[CUSTOMER][NEUTRAL] There's 3 pages here.
[CUSTOMER][NEUTRAL] It might be in that other button where you can just select now I'm not seeing it wellness wellness and screening benefits claim form now that looks like the same thing OK.
[CUSTOMER][NEUTRAL] OK, well, I'll just.
[CUSTOMER][NEUTRAL] I feel like a wellness plan. Well, I don't know.
[CUSTOMER][NEUTRAL] I don't know where to go for this, so should I just file it on this button and just see what happens and see I, I guess.
[AGENT][NEUTRAL] What, what documentation do you have to file a claim?
[CUSTOMER][NEUTRAL] Well, I don't have any physical papers. I mean, would I guess they need to, what would they need to send over to you all to.
[AGENT][NEUTRAL] Yeah, because the provider
[CUSTOMER][NEUTRAL] Have that reimbursement.
[AGENT][NEUTRAL] Yeah, because, but you've already paid, so.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Do you have a receipt? Do you have your statement?
[CUSTOMER][POSITIVE] Yes, I do have that, yeah.
[AGENT][NEUTRAL] OK. You would submit that information to file your claim?
[AGENT][NEUTRAL] And your diagnosis code would have to be on there. So you can get that information from your provider and make sure you write that on there.
[CUSTOMER][NEUTRAL] OK, so going forward.
[CUSTOMER][NEUTRAL] Um, just do self-pay since I don't have like a primary insurance and then make sure that I have the, the you said the diagnosis number, is that what it is?
[AGENT][NEUTRAL] Yes, diagnosis code. Yes, ma'am.
[AGENT][NEUTRAL] It's a code for the
[CUSTOMER][NEUTRAL] The diagnosis code.
[AGENT][NEUTRAL] Right. It's the code for the illness, the reason why you're seeing the doctor.
[CUSTOMER][NEUTRAL] OK, and then the receipt of payment. OK, they looks like they do not have a diagnosis code on this receipt so I can just get that from them and then.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Write it on there.
[CUSTOMER][NEUTRAL] I guess scan this and then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And make sure that you reference your policy number, write your policy number on there also.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Policy number. OK.
[CUSTOMER][NEUTRAL] OK, is that just the typical standard procedure for how this works with, or is there a, a better way to do this?
[AGENT][NEUTRAL] No, as of now, that's the standard procedure and once we receive that documentation, um, allows 7 to 10 business days for the claim to be processed and you can always check on the status online or give us a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Um, well, thank you. I appreciate it.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, that is it. Thank you.
[AGENT][POSITIVE] OK. I thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thanks you too bye bye.