AccountId: 011433970860
ContactId: 6d6a774e-906c-4d53-8c77-82b8f3e86036
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472029 ms
Total Talk Time (AGENT): 311961 ms
Total Talk Time (CUSTOMER): 162884 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/6d6a774e-906c-4d53-8c77-82b8f3e86036_20250501T14:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. Um, I just left the hospital and they did some MRIs on me today, um, but the, the man that did the MRI, his name is [PII]. He was the radiology technician.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He said, even though I had the order for the MRI for some reason there was no pre-authorization granted. So I'm trying to figure out why that is. The other ones had a pre-op, but one, the lumbar spine that he did on me, and he's already done the test, um, for some reason didn't have a pre-authorization, and I just don't quite understand that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So [PII], you said that you've had some MRI's done today, but there was not a prior authorization approved on one of them for the lumbar, is that correct?
[CUSTOMER][POSITIVE] Correct. Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] OK, yes, ma'am, I can take a look at that, um, for you and just once I can see what type of policy you actually have with APL. So first off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your policy number please, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, it is 002609935.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get your information pulled up. Once I do, I will have to verify several things with you, Miss [PII], for security and then also any information provided would be a verification of benefits and not a guarantee of payment. So first off, if you will please verify your date of birth.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. And lastly, I do need to add an email address for you on file. So what email would you like to have added?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it's [PII].
[AGENT][NEUTRAL] OK, so [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, thank you. Alright, so first off, Miss [PII], um, I'm going to email you once we get off of our call I'm going to email you the user guide for our portal here at APL so that when you have an opportunity you can set up your profile because when you set up your profile that's gonna give you access to your ID cards, policy information and claims and claim status explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That type of thing with APL so the the email that I will.
[CUSTOMER][POSITIVE] Wonderful. Yeah, that would be very helpful, yes.
[AGENT][NEUTRAL] OK, and if you were to ever have to file your own claim with us too, Miss [PII], you can actually upload all of your information into that portal, but the user guide will explain that to you, OK?
[AGENT][NEUTRAL] So this is a supplement to your primary insurance. So, for APL there is not a prior authorization ever required. That would be something that would be done through your primary healthcare insurance.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, as far as that, well, yeah, no, I wouldn't say the wrong people because you do have coverage with us. But yes, ma'am, if it's regarding why a prior authorization either wasn't done or wasn't approved, that is something that you would have to speak to your primary healthcare insurance about, because, again, that's not something that this policy requires.
[CUSTOMER][NEGATIVE] So I'm talking to the wrong people.
[CUSTOMER][NEUTRAL] Got you and I got that card.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I got that card right here, yeah.
[AGENT][NEUTRAL] OK. So just always present, make sure to present your APL card though along with your primary insurance card when you go for medical services because most providers will file both of your insurances. But as I stated before, in the event that they would not file your supplemental coverage, then you could do that and you could call us back if that need arises and we could tell you how to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And they, and, and
[CUSTOMER][NEGATIVE] And I promise you, I have, I have done that and they look at that car, and say that's not medical insurance and they don't even bother with it. And I try to tell them, uh it's no, it's not, it's a supplement plan. And I try to explain it to them and they act like I'm from Mars or something.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh, well, I'm sorry to hear that because most, most will file for you, but like I said, in the event that they don't, you can file your own claims and um we do not have a timely filing limit, Ms. [PII], like a lot of insurance companies do. So as long as your policy is active for the data service, you know, for your treatment, the claim can be submitted with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so the ones that that the in-law I did, I just sit at the hospital, the supplement payment can kick in on that, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, that is something that you would have to file a claim for if they're not, are they not going to do that for you?
[CUSTOMER][NEUTRAL] I don't know uh that hospital is they call it Killer Pine for a reason. I'm just gonna be honest with you, yeah, so, uh, yeah, if, if they send me the bill, then I will certainly send it to you, yeah, because I did present my card and they did make a copy of the front and back of the card, but that don't mean they're gonna do what they're supposed to do either.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh oh.
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] I understand. So what I'll do.
[CUSTOMER][NEUTRAL] I'm just being, I'm just being honest.
[AGENT][NEUTRAL] So what I'll go ahead and do as well, Miss [PII], since I'm gonna email you that user guide, I'm also gonna go ahead and include the claim form which this claim form could be gotten from our public website, but I'll go ahead and include the claim form just in case you were to need one you would have it.
[AGENT][NEUTRAL] And it does give you the instructions for what other documents you would have to provide in addition to the claim form if you end up having to file your own claim.
[CUSTOMER][POSITIVE] OK, that'd be wonderful, yes.
[AGENT][NEUTRAL] OK. Well, is there anything else at the moment that I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Not at the moment thank you you've been so very kind. I appreciate it.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Well, you're welcome, Miss [PII], and I don't think that I told you this, but the email that you're gonna receive will come from care team at [PII] and I will put APL in the subject line so that that's easy to recognize as not being junk mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You, you must know how my brain works. I like that. Thank you.
[AGENT][NEUTRAL] Well, you're very welcome. Yes, so we get so much of that this day and time, and sometimes this might go to your junk or spam folder since we've not emailed you before. Most of the time it doesn't, but if you haven't seen this email from from care team, um, within I would say 5 or 7 minutes in your inbox, you might just wanna check that folder, one of those junk or spam folders.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well then again.
[CUSTOMER][POSITIVE] Got it, thank you.
[AGENT][POSITIVE] You're welcome and have a wonderful day. Thank you again for calling APL.
[CUSTOMER][POSITIVE] You're welcome. Have a blessed day.
[AGENT][POSITIVE] Yes, ma'am. You too. Thank you.
[AGENT][NEUTRAL] Papa.
[CUSTOMER][NEUTRAL] Bye.