AccountId: 011433970860
ContactId: 6f5c13ff-db02-4ab4-ac69-54326b739779
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2476209 ms
Total Talk Time (AGENT): 1213764 ms
Total Talk Time (CUSTOMER): 878330 ms
Interruptions: 11
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/6f5c13ff-db02-4ab4-ac69-54326b739779_20250217T16:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII].
[CUSTOMER][NEUTRAL] And I've been a member.
[CUSTOMER][NEUTRAL] According to this since [PII] or something like that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I haven't been able to.
[CUSTOMER][POSITIVE] Really use this because I forgot that I had it.
[AGENT][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] This past year, in October, I had surgery on my left um hands. I've been going in and out of hospitals and so on.
[CUSTOMER][NEUTRAL] I'm wondering how can I use this to help me pay for some of those um bills.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] OK. Group number. OK. And hospital benefit, outpatient, group number?
[AGENT][NEUTRAL] Either one in either the inpatient or outpatient.
[AGENT][NEUTRAL] Cert number.
[CUSTOMER][NEUTRAL] It was out outpatient 01.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 699
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 394
[CUSTOMER][NEUTRAL] M L 8
[AGENT][NEUTRAL] All right. Thank you, Ms. [PII]. And can you verify your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I, uh, was staying with my son because, um, in [PII], the flood in [PII].
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] Took my house.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And um I just came down here in [PII], so the address that you guys have should still be.
[CUSTOMER][NEUTRAL] OK, but I'm down here now.
[AGENT][NEUTRAL] And what is that address?
[CUSTOMER][NEUTRAL] OK. The address, uh, my son's address is [PII].
[CUSTOMER][NEUTRAL] One mileage drive.
[CUSTOMER][NEUTRAL] Orlando, Florida.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you. Yes, ma'am. Do we need to update that for you?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I'm in
[CUSTOMER][NEUTRAL] Yeah, you may have to, but if you're gonna, um, communicate with me, I'm gonna be here. I'm staying at a friend's condo, and I will be here for like 3 months. That's why I don't want to change my address totally.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So if you need to send me paperwork and stuff like that, you can um email them, I guess would be the the quickest.
[AGENT][NEUTRAL] So any um.
[AGENT][NEUTRAL] Communications sent by mail would go to the address on file. They don't really have an option, but let me check something because we can create an account online for you.
[CUSTOMER][NEUTRAL] On file, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can always communicate that way you can submit claims that uh claims information and we can do that online and that way you can always check online what's going on. I will need an email for you. I can add that for you. What is that email address?
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You can send it um here at work.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] At nova.edu.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] I know what that is.
[AGENT][NEUTRAL] Alright, and what is a good, what is your phone number in case we need to contact you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, I've got that information updated. If you've got a moment, I can help you create an online account and that is going to give you full access to your policy information, uh, cards if you need updated cards, you can submit claims, you can check claim status.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Yes, I need that.
[AGENT][NEUTRAL] There's a direct deposit.
[AGENT][NEUTRAL] For benefits to be paid directly to your bank account, all that's available on our portal if you.
[CUSTOMER][POSITIVE] Good. Oh, awesome.
[AGENT][NEUTRAL] If you want to go to secured and that's SEC.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Say that again, [PII] [PII]
[AGENT][NEUTRAL] [PII] [PII] [PII] [PII] secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and the word [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] A M
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're going to go in as a once you get there you're just gonna choose new user.
[CUSTOMER][NEUTRAL] Let me see if I can get to it.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And you just take your time, Miss [PII]. I, I'm here to help you, so don't worry about rushing.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I always get flustered when I'm trying to rush to set up an account and.
[CUSTOMER][NEUTRAL] OK, I'm there.
[CUSTOMER][NEUTRAL] new user.
[AGENT][NEUTRAL] OK, and you're gonna choose the first option, you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] I need to
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Actually I need to create um the username and so on first.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] This way it opens to OK.
[AGENT][NEUTRAL] And you're gonna just put in your um.
[AGENT][NEUTRAL] Your last name and you're gonna use your social and then the your other information.
[CUSTOMER][NEUTRAL] Oh, just my last name, not my first name.
[AGENT][POSITIVE] That's correct
[AGENT][NEUTRAL] Because it ask for your last name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And then she'll pass with my social?
[AGENT][NEUTRAL] So, yes, ma'am, we'll need the full social.
[CUSTOMER][NEUTRAL] All of it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Invalid user name or password it says.
[AGENT][NEUTRAL] Oh, are you going in as a new user?
[CUSTOMER][NEUTRAL] You user.
[AGENT][NEUTRAL] Or did you go to log in?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it just came up.
[CUSTOMER][NEUTRAL] I'm an individual with an APO insurance policy.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Mm, OK, next.
[CUSTOMER][NEUTRAL] Uh-huh, I didn't follow the direction. I'm sorry.
[AGENT][POSITIVE] That's all right.
[AGENT][POSITIVE] Not a problem. It's all new to you, so not a problem.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Residential zip code I have to give you [PII].
[CUSTOMER][NEUTRAL] OK, email.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEGATIVE] There seems to be a problem. So what's wrong with the information that was entered.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] They, they don't have me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] You said your zip code is [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Let me make sure I updated that uh email correctly.
[CUSTOMER][NEUTRAL] OK. It's not taking, yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] R O S E L I X.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] No, it's [PII].
[AGENT][POSITIVE] Oh, gotcha. That's gonna be a problem. Now you, now it should work. I'm so sorry.
[AGENT][NEUTRAL] I thought it was your ROS for rose and [PII] for Felix.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] No, just raw Felix. Yeah, raw Felix.
[AGENT][POSITIVE] I got you. I do apologize.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Try it now, that should.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, create your account.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] And you said use my last name as the user, right?
[AGENT][NEUTRAL] Whatever you want to use for your username, your username will never change, so whatever is best for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so I, um, I use my social for my password or?
[AGENT][NEUTRAL] Your password is going to have to contain um one lower case letter, one uppercase, one number, and one symbol.
[CUSTOMER][NEUTRAL] So how long does it have to be?
[AGENT][NEUTRAL] 8 characters at least.
[CUSTOMER][NEUTRAL] 8, OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let's try that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] When I
[CUSTOMER][NEUTRAL] It gives me my personal email. I could leave it as that or?
[AGENT][NEUTRAL] Uh, the only email we have on there is the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I might have done this before.
[AGENT][NEUTRAL] So I would just use that one, yeah.
[CUSTOMER][NEUTRAL] OK, I see like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next
[CUSTOMER][NEUTRAL] Oh, that seems to be a problem. What's the problem?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We're gonna find out.
[CUSTOMER][POSITIVE] I like that.
[AGENT][POSITIVE] We gonna get you taken care of. I'm gonna do everything I can to take care of you.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oops, OK, let's see what.
[AGENT][NEUTRAL] And the marketing on it.
[CUSTOMER][NEUTRAL] It doesn't give you where the mistake is, so.
[CUSTOMER][POSITIVE] [PII] looks good.
[AGENT][NEUTRAL] OK, I'm gonna try something else.
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] Uh, maybe I have.
[CUSTOMER][NEUTRAL] So many
[CUSTOMER][NEUTRAL] 36, [PII]. I have [PII].
[CUSTOMER][NEUTRAL] As a password, is that too long?
[AGENT][NEUTRAL] No, it shouldn't be a problem.
[AGENT][NEUTRAL] What um what are you using for your username?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] She likes
[AGENT][NEUTRAL] OK, I'm gonna see if I can create a temporary password.
[AGENT][NEUTRAL] And get you in, hang on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] See what I can do for you.
[CUSTOMER][POSITIVE] Mm, I appreciate your help.
[AGENT][POSITIVE] Yeah, it's my pleasure.
[AGENT][NEUTRAL] Now on the phone number are you using the [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It says
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can we do a different user name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] What would you like to have for a different user name? It said that there was already a, uh, a name, mhm, yeah.
[CUSTOMER][NEUTRAL] A [PII].
[CUSTOMER][NEUTRAL] OK, alright, let's use [PII].
[CUSTOMER][NEUTRAL] My granddaughter's name.
[AGENT][NEUTRAL] Oh, so [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] I do apologize. I have had this stuff in my head and it makes it hard to hear. I apologize.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, so I've got [PII]
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] See if that works.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][POSITIVE] That works.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so if you will log in.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Go back to log in and put in username.
[AGENT][POSITIVE] Cameras. I love that and I just put it's all lower case.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um, so, the kids, um.
[AGENT][NEUTRAL] I typed it in, I typed it in all lower case, so I apologize.
[CUSTOMER][NEUTRAL] Uppercase
[CUSTOMER][NEUTRAL] Oh, OK, let's see.
[AGENT][NEUTRAL] And then I'm gonna give you your temporary password.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can update it just tell me when you're ready.
[CUSTOMER][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] OK, I'll just submit and see if it will take user name.
[AGENT][NEUTRAL] I've got to give you your temporary password, yeah.
[CUSTOMER][NEUTRAL] OK, you said now, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Temporary, OK.
[AGENT][NEUTRAL] So your temporary password is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then lowercase oDay.
[AGENT][NEUTRAL] 123.
[AGENT][NEUTRAL] Exclamation point.
[CUSTOMER][NEUTRAL] 123
[CUSTOMER][NEUTRAL] [PII], OK. [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, no, [PII] like today.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] With a [PII]
[AGENT][NEUTRAL] And then [PII]
[CUSTOMER][NEUTRAL] Today, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 123.
[AGENT][NEUTRAL] Exclamation point.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it should, you should go to Europe.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] Yeah, you can receive claims.
[CUSTOMER][NEUTRAL] Blah blah blah.
[AGENT][NEUTRAL] Now you can reset your password to any password you want. Just make sure that it has one upper case and one lower case and one number and one symbol and at least 8 characters, but you'll need to reset that password. um, now on there if you click on your policy number.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll upload your policy document and you can view all your benefits there to see what to file for.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, my coverage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Why is this to the labs.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] What does it say?
[CUSTOMER][NEUTRAL] So that's it.
[CUSTOMER][NEUTRAL] Um, on the cover attendants, this is [PII] she likes lap.
[AGENT][NEUTRAL] OK, do you see
[CUSTOMER][NEUTRAL] The med links like group med.
[AGENT][NEUTRAL] Yeah, that is your older policy that was active from [PII] to [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then there is an active policy, which you should see under policy number 247.
[AGENT][NEUTRAL] 2975 that started on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which is uh
[AGENT][NEUTRAL] So if you, if you need an updated card, you can get that updated card for that active policy.
[CUSTOMER][NEUTRAL] New Year.
[CUSTOMER][NEUTRAL] OK. Yes.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Those, yeah, mhm, and if you click on the policy number.
[CUSTOMER][NEUTRAL] OK, I see it.
[AGENT][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you go in your policy, it's going to be.
[CUSTOMER][NEUTRAL] Mhm, I see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] In the policy, there's a page called a schedule of benefits page.
[CUSTOMER][NEUTRAL] Section certification schedule.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Definition
[AGENT][NEUTRAL] Mhm you should see a page called the schedule of benefits page.
[CUSTOMER][NEUTRAL] OK, not yet. I can termination of coverage.
[CUSTOMER][NEUTRAL] Section 9 claim.
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] American public.
[CUSTOMER][NEUTRAL] Schedule of benefits, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that will show you what is covered and also the benefit amount that we could pay. Now, with this being your secondary policy, it will depend on what your primary insurance pays towards your deductible, co-pay, or co-insurance. That's what this policy pays towards.
[AGENT][NEUTRAL] Who is your primary insurance with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Blue Cross and Blue Shield I Cuba.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I know that Blue Cross Blue Shield of Florida has what's called a health statement, H E A L T H statement.
[CUSTOMER][NEUTRAL] H E A L.
[CUSTOMER][NEUTRAL] The each statement.
[AGENT][NEUTRAL] And with that health statement,
[CUSTOMER][NEUTRAL] I don't think I've ever seen that.
[AGENT][NEUTRAL] You can upload that directly on your.
[AGENT][NEUTRAL] Portal
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so with this secondary policy, we also always have to have the diagnosis code.
[AGENT][NEUTRAL] The procedures and charges and what's applied to your deductible, co-pay or co-insurance. And on the Florida Blue, I'm not sure if Blue Cross or Blue Shield of Cuba has that listed.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I, I've never seen it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if they don't, we will still have to have the explanation of benefits from them for each data service.
[AGENT][NEUTRAL] And then we'll have
[CUSTOMER][NEUTRAL] From the insurance company or?
[AGENT][NEUTRAL] From, from Blue Cross. Yes, ma'am.
[CUSTOMER][NEUTRAL] From the grass.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] And then if they do not have a diagnosis code or procedure code listed, we'll have to have an itemized bill from the facility.
[AGENT][NEUTRAL] You said you had, did you have surgeries on your hand?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I had surgery on [PII].
[CUSTOMER][NEUTRAL] Been going through therapy for a while. I went to the emergency room one night.
[AGENT][POSITIVE] Oh, bless your heart.
[CUSTOMER][NEUTRAL] And um I had so much. I had an epidural done.
[CUSTOMER][NEGATIVE] And that kind of put me down, really put me down cause I haven't been the same ever since.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Yeah, I'm still going to, oh yeah.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, the last 3 years have been nothing but.
[CUSTOMER][NEUTRAL] Pain and um
[AGENT][NEUTRAL] I am
[AGENT][NEGATIVE] Oh, that sounds so miserable. I'm so sorry you're going through that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Oh my goodness.
[AGENT][NEGATIVE] And I'm telling you, pain, it just makes.
[AGENT][NEGATIVE] It, it makes it hard to do anything, doesn't it?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Exactly. Exactly. And I could tell you I've been in pain since June.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] [PII], 2024 until now.
[AGENT][NEUTRAL] Well, I'm
[CUSTOMER][NEUTRAL] It is no joke.
[AGENT][NEGATIVE] I, I was thrown off a horse and hurt my back and I'm.
[AGENT][NEGATIVE] You know, that all I had to do is go through therapy and, and I know what that constant pain feels like. And you can't think, you just can't move. It just
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh two herniated discs.
[AGENT][NEUTRAL] It just makes you want to sit, sit down and be a just, just a nothing, doesn't it? Just don't move.
[CUSTOMER][NEGATIVE] Some days, some days you can't even function.
[AGENT][NEUTRAL] Exactly. That's fine.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] It, uh, and luckily that I can.
[AGENT][NEGATIVE] I have been through a misery like that, so.
[CUSTOMER][POSITIVE] Oh my [PII]. You know, thank [PII] I'm working from home, so.
[AGENT][POSITIVE] Oh, that's good.
[CUSTOMER][POSITIVE] That alleviates some of the really problem that I could have had because in the office I wouldn't be able to apply cold um press or what whatnot so I'm thankful that I have that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And then with that pain and having to drive with the pain.
[AGENT][POSITIVE] Oh, I'm glad that's such a blessing you're able to work at home.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's great, um.
[CUSTOMER][NEUTRAL] Yes, uh,
[AGENT][NEUTRAL] So with
[AGENT][NEUTRAL] If you, if the [PII].
[AGENT][NEUTRAL] Explanation of benefits from [PII] Blue. If it does not have the diagnosis code.
[AGENT][NEUTRAL] And the CPT codes, which are the procedure codes, we will need an itemized bill from the facilities and let me ask you, are you, do you still owe them or have you already paid them in full?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh yes. Oh yes.
[AGENT][NEUTRAL] If you still owe them, you can give them your policy information.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] As a secondary policy.
[AGENT][NEUTRAL] And they can file claims with us and we can pay them direct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that way you don't have to.
[CUSTOMER][NEUTRAL] I would like to pay them because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sometimes what they do, like, let's say for instance, the last um surgical center that I went to where they did the um
[CUSTOMER][NEUTRAL] epidural.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I had to pay out of pocket up front.
[CUSTOMER][NEUTRAL] $350 was um the difference my 20% um deductible that I had to pay.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, this course is gonna help.
[CUSTOMER][NEGATIVE] And um I'm still getting bills.
[CUSTOMER][NEUTRAL] I'm still getting bills from them, so I'm a, I'm like, wait a minute, I pay this.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And now they're sending me bills.
[AGENT][NEUTRAL] Yeah, if you, if you file the claims and then we reimburse you, then you can keep up with everything that, you know, you I, I understand you got to stay on top of it, on top of it with those medical bills because.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just when I'm done with you, I'm gonna call all of them.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] And ask them.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you, the physical therapy is covered too under your policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Oh my God, I pay $35 every time I go.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, that's covered also.
[CUSTOMER][NEUTRAL] 3 times a week for 3 weeks.
[AGENT][NEUTRAL] we
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] We need to get that reimbursed for you also.
[CUSTOMER][NEUTRAL] OK, I'm gonna call them and just, oh yeah, OK.
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] Oh, I feel so much better.
[AGENT][POSITIVE] I'm so glad. Now on your policies, you know, one of those did you have anything prior to April the first?
[AGENT][NEUTRAL] Of last year.
[CUSTOMER][NEUTRAL] Uh, I was going to, um.
[CUSTOMER][NEUTRAL] Well, not really.
[CUSTOMER][NEUTRAL] Other than, you know, my regular routine checkups, um, and stuff like that.
[AGENT][NEUTRAL] OK, so your checkups are the routine, um.
[AGENT][NEUTRAL] Actually, anything in a doctor's office is not covered unless it's cancer treatment.
[AGENT][NEUTRAL] So as, if you're looking.
[CUSTOMER][NEUTRAL] OK then no I did.
[AGENT][NEUTRAL] Yeah, if you're looking on that schedule of benefits you see you've got your emergency room.
[AGENT][NEUTRAL] You've got an urgent care facility, outpatient surgery, diagnostic testing.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If it was performed in a hospital outpatient facility or an MRI facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, you have physical therapy.
[CUSTOMER][NEUTRAL] You don't have a MRI, do you?
[AGENT][NEUTRAL] If it is
[CUSTOMER][NEUTRAL] You don't cover MRI.
[AGENT][NEUTRAL] Was it performed in a doctor's office or did you go to like a hospital or a diagnostic?
[AGENT][NEUTRAL] Center
[CUSTOMER][NEUTRAL] They have, um, they have their own diagnostic center, but in the same building.
[AGENT][NEUTRAL] We would, um,
[AGENT][NEUTRAL] It's gonna depend on how they bill it when we get that itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From them
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] When you call to get those itemized bills, let me tell you exactly what to ask for and it's gonna help you a lot.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, when you call them, just tell them that you have this secondary policy and you need either.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A U as umbrella.
[AGENT][NEUTRAL] B as in Bravo, 04, that's UB04 or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] C as in Charlie.
[AGENT][NEUTRAL] M as in Mike, S as in Sam, 1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's a CMS 1500.
[CUSTOMER][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] And that's just 200.
[CUSTOMER][POSITIVE] OK. I'm gonna get them right now.
[AGENT][NEUTRAL] That way.
[AGENT][NEUTRAL] They'll either give you, they should give you either that UBO4 or CMS 1500. The physical therapy facility should give you the CMS 1500, but just when you call them, tell them that you either need the UBO4 or CMS 1500, and then that way,
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You've got it covered what to ask for.
[CUSTOMER][NEUTRAL] OK, and I'm gonna tell them to go ahead and bill you guys, but we do not pay them because.
[AGENT][NEUTRAL] Well, if they
[CUSTOMER][NEUTRAL] Some of those, I
[AGENT][NEUTRAL] Yeah, if they send us the claims now, um, Ms. [PII], we're gonna pay them.
[AGENT][NEUTRAL] So if you want the payment benefit payments to come to you, then that's why you're gonna call and request those forms from them and then you're gonna call the Blue Cross Blue Shield and get those explanation of benefits for each data service.
[CUSTOMER][NEUTRAL] Oh this
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can upload it on the portal.
[CUSTOMER][NEUTRAL] But then, um, I could get the EOBs. Would you accept the EOBs from um Blue Cross and Shields?
[AGENT][NEUTRAL] If they have the diagnosis codes and procedure codes listed.
[AGENT][NEUTRAL] Now, your diagnosed, see, I'm not sure about the Blue Cross Blue Shield of
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Cuba. I know the Florida Blue has health statements, and those health statements do include the diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I'm not sure about the Blue Cross explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know if they have the health statement if you know if you call Blue Cross Blue Shield and ask them if they have the health statements.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For those data service, if they don't ask them if they have an explanation of benefit with diagnosis codes.
[CUSTOMER][NEUTRAL] With diagnosis.
[AGENT][NEUTRAL] That's where I would start. And if they don't have the explanation of benefits with diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're still gonna need those explanation of benefits, but you'll have to go further to the providers, to the hospitals, to your physical therapy facilities, um, to get the CMS 1500 or the UBO4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will do that.
[AGENT][NEUTRAL] Now that's the documents that we need to process a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then when you have those documents on your computer, save them to your computer.
[AGENT][NEUTRAL] And then you can upload it on the portal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Automatically it will upload on that portal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And when you're doing that there's options you can choose to have those benefits go directly to your bank account via direct deposit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I think you can um there's.
[CUSTOMER][NEUTRAL] Is there a place here where I can actually upload my bank information or?
[AGENT][POSITIVE] There is a place um I believe it's gonna be on your payment options up top.
[CUSTOMER][NEUTRAL] OK, oh yeah, it says set up direct deposit.
[AGENT][POSITIVE] Yeah, you can go ahead and set that up.
[AGENT][NEUTRAL] You don't have to wait till you file the claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's just ask you to
[CUSTOMER][NEUTRAL] OK, I will do that.
[AGENT][NEUTRAL] Into your bank information.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, good.
[AGENT][POSITIVE] And then if you ever have any questions, there is a contact us you can type it out.
[CUSTOMER][POSITIVE] Good, good, good.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And if you want
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you, that will contact our care team.
[AGENT][NEUTRAL] And we'll be able to answer your questions via email, but if you prefer calling please call us because we don't mind. Sometimes those phone calls are a little, you can ask.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You may, you know, you
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] What you need to, I, I'm old school. I like phone calls.
[CUSTOMER][NEUTRAL] I, I do too.
[CUSTOMER][NEUTRAL] I'm, I'm clearer when someone like, I find someone like you who really talked me through those um
[CUSTOMER][NEUTRAL] Steps.
[AGENT][NEUTRAL] Yeah, me too.
[CUSTOMER][POSITIVE] It, it, it is so much better.
[AGENT][NEUTRAL] Me too.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] But at least you can, you know, submit those claims online and you can view your policies to see what's covered and if you need that new card.
[AGENT][NEUTRAL] For your new policy you can print that new card out to.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Oh perfect. OK.
[AGENT][NEUTRAL] So in the future, when you go for medical assistance is something that's covered under your policy, or even if you don't remember if it's covered or not, always show your APL card with your, your Blue Cross Blue Shield card.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they'll they can file claims and we can pay them direct and you shouldn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Directly.
[AGENT][NEGATIVE] Yeah, and then whatever you pay out of pocket should be less.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It just depends on what your Blue Cross Blue Shields applies to your deductible or co-insurance.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Now I know you're probably sitting there with a lot of questions and I'm ready to answer what you got.
[CUSTOMER][NEUTRAL] No, no, um, my boss just sent me an email. I'm trying to send an answer.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yeah, better take care of that, right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, what's important, um, you've answered for me what I need. Blue Cross and Blue Shield, the diagnosis code.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The um
[CUSTOMER][NEUTRAL] The forms to get from the hospitals, the UBO4 and the CMS um CMS 115, 1500.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] That's right. And just uh tell them that you need either the UBO4 or the CMS 1500. They'll just give you one. Yeah, the UBO4 is for facilities like hospitals.
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] 4, OK.
[AGENT][NEUTRAL] And the CMS 1500 is for like physical therapy or it might even include your MRI. I'm not sure what they bill on, but the providers always either bill on a UBO4 or CMS 1500. So that's why I said it's just always best to ask them for either or.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Either UBO4 CMS 1500.
[CUSTOMER][NEUTRAL] I will do that.
[AGENT][NEUTRAL] And then you got it covered.
[CUSTOMER][POSITIVE] Thank you so very much. Yes, ma'am.
[AGENT][POSITIVE] But it's been such a pleasure to assist you and don't forget to update your password on that portal too.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Because that's just a generic temporary password for you.
[CUSTOMER][NEUTRAL] I will.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] And if you have any questions along the way, Ms. [PII], don't hesitate to give us a call. I hope your hand gets to feeling better.
[CUSTOMER][NEUTRAL] I would
[CUSTOMER][NEUTRAL] Uh, it is, it's my back.
[AGENT][NEUTRAL] Oh, your back is hurting now? Oh my goodness, bless your heart.
[CUSTOMER][NEUTRAL] Oh my [PII], that's 22 herniated discs.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm telling you, when your back hurts, you just can't move.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] It hurts to get up, it hurts to sit down. It hurts to lay down.
[CUSTOMER][NEUTRAL] The one thing, yes.
[CUSTOMER][POSITIVE] Yes, yes, and yes.
[AGENT][NEGATIVE] It hurts to walk.
[CUSTOMER][NEUTRAL] Oh my [PII]. There's one thing that took me to the emergency room that night.
[AGENT][POSITIVE] Oh, I'm so sorry.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know when you have those Charlie horses in the back of your calf?
[AGENT][NEUTRAL] Oh, yeah. Yes.
[CUSTOMER][NEUTRAL] I had them all over my body. My body, my whole body.
[AGENT][NEGATIVE] Oh no.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] And I breathe, it contracts. Oh my, I had to go. I thought I was gonna die.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh my God. I've never had so much pain.
[AGENT][NEUTRAL] Uh, you know, that's what I told my daughter. I said, childbirth was easier than this back pain.
[CUSTOMER][NEUTRAL] Like those things.
[CUSTOMER][POSITIVE] Oh yes. 00 yes.
[AGENT][NEGATIVE] I was always told that there was nothing worse than childbirth and I'm like, they lied.
[CUSTOMER][NEUTRAL] Oh, it
[CUSTOMER][NEGATIVE] Yup. Yup. But, oh my God. This, it, it just takes your breath away and it comes so frequent.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] That you can't read.
[CUSTOMER][NEUTRAL] And you try to stay in that position, and the more you stayed in that position, the cramps gets harder and longer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Oh my God. No.
[AGENT][NEUTRAL] Are you still going to physical therapy?
[CUSTOMER][NEGATIVE] Um, right now I ran out of money.
[AGENT][NEUTRAL] Yeah, that's.
[CUSTOMER][NEGATIVE] I ran out of money. $35 every, every time I go, I used to go 3 times a week.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] I exhausted everything I had and all the medication, and when you see the doctor, you have to pay a co-pay.
[AGENT][NEUTRAL] All right. So, does she, do you still have a deductible for your um Blue Cross Blue Shield for physical therapy?
[CUSTOMER][NEUTRAL] It's crazy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I think I'm pretty much caught up.
[CUSTOMER][NEUTRAL] With, with that.
[AGENT][NEUTRAL] But they, did they still charge a copay for your physical therapy?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, I always, um, pay, we always pay every time we go.
[AGENT][NEUTRAL] So you know this policy covers your physical therapy.
[AGENT][NEUTRAL] And it's a per calendar day benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of $300 that we can pay copay or deductible or co-insurance.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For physical therapy.
[AGENT][NEUTRAL] So if you call, if, if you're gonna call uh Blue Cross Blue Shield, ask them if you started up your physical therapy.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Again
[AGENT][NEUTRAL] Ask them if they would if they would cover in a plot, you know, if it would be covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if they would apply anything to your deductible or co-pay or co-insurance for your future physical therapy benefits, you know, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Future physical therapy appointments?
[AGENT][NEUTRAL] And if they say yes, then you know your APL has those benefits available for you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am, thank you so much.
[AGENT][NEUTRAL] So we could possibly cover your, your co-pay for your physical therapy. I mean, I can't guarantee payment until we have the claim on file, but your benefits are on your policy and that physical therapy is probably gonna help you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] I just want you to get better cause I know how bad it hurts.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you, and I really appreciate you.
[AGENT][POSITIVE] Oh, it's been my pleasure. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, ma'am. If I do have questions, I will make sure to call you. Thank you.
[AGENT][POSITIVE] Yes ma'am, and my name is [PII] and I'll be happy to assist you any way I can.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][POSITIVE] All right, [PII], it was nice talking to you.
[AGENT][POSITIVE] Nice talking to you too, Ms. [PII]. Thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you and to you the same.
[AGENT][POSITIVE] Thank you, ma'am. Take care.
[CUSTOMER][NEUTRAL] Uh-huh. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.