AccountId: 011433970860
ContactId: 75cbdfbb-58fe-41c9-8db8-e12c82060c0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 791739 ms
Total Talk Time (AGENT): 323540 ms
Total Talk Time (CUSTOMER): 392569 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/75cbdfbb-58fe-41c9-8db8-e12c82060c0e_20250227T23:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII], and, um, sorry, one sec.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Um, I had, I just recently, uh, got you guys, uh, through my job.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] I realized when I went and I've been seeing the specialist that um when I went to input all my information on their portal um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It didn't go through the first time.
[CUSTOMER][NEUTRAL] Um, and then he had scheduled me, my doctor scheduled me for a CAT scan. I went and had that went for the follow-up, and I, when I went in for that follow-up, I was like, hey, I have a secondary or a supplementary insurance.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEGATIVE] And I said it's not on my portal, so, um, they're still saying that uh on the portal it's showing that I still owe $80 for the co-payment from the initial appointment, um, and they just called me and they're saying that I've not found that I don't have it, but I was like, well, I didn't have a copayment for.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, a CAT scan or the follow up and I just had an MRI today and uh I didn't have a copayment for that so I was wondering what was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Going on with that initial.
[CUSTOMER][NEUTRAL] 1st $80 co-payment.
[AGENT][NEUTRAL] Yes sir, I can um check your claim for you um and look and see [PII], what is your policy number?
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, would that be, oh, it is 02573216.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] My what? I'm sorry?
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] Thank you sir and then also for security reasons can you verify your address, phone number and email for me?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, my address is [PII], and you said my phone number?
[AGENT][NEUTRAL] Yeah, yes, sir, your phone number?
[CUSTOMER][NEUTRAL] What was it?
[CUSTOMER][NEUTRAL] Oh it's uh [PII] and my email is [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying your policy and the number that you gave me, if we get disconnected, is that a good call back number?
[CUSTOMER][NEUTRAL] Yes, ma'am, that's my cell phone number.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, thank you so much. I appreciate it.
[AGENT][NEUTRAL] Have they sent in a claim for you already?
[CUSTOMER][NEUTRAL] They've been since the uh she said they've done it uh since they've been trying every day since the [PII] to for that $80 co-payment.
[CUSTOMER][NEUTRAL] Um, so I told them I just got off the phone with them. I was like, well, I said that's weird. I said because it's covered the CAT scan, the follow up, the MRI, so.
[AGENT][NEUTRAL] Mhm. Right.
[AGENT][NEUTRAL] Right, and I'm not showing that a claim has been submitted on the policy that there's never been a claim submitted um let me give you, you might they might have.
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Old information I'm not sure, but let's give you information to give to them so they can submit your claim.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me give you the payer ID number.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Would that be
[CUSTOMER][NEUTRAL] Would that be the 60801?
[AGENT][NEUTRAL] Yes, OK, and then we also have a fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you're that, would that be the [PII]?
[AGENT][NEUTRAL] Yes, that's correct and then we also have a mailing address if they want to mail it in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that would be [PII].
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] So it looks like it looks like the claim just needs to be sent in.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Now if this just becomes too much of a hassle, I'll just pay the $80. I just know that it's, I just found it weird that.
[CUSTOMER][MIXED] They're having an issue with that one, but the last 3, it's covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, well, we haven't even and received a claim now you can also file the claim yourself if you wanna do that.
[CUSTOMER][NEUTRAL] Uh, I can.
[AGENT][NEUTRAL] Yes, we have an online service center.
[AGENT][NEUTRAL] Let me give you that um that address to the online service center. It's secured S E C U R E D.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You said what was it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. OK. And then one other question.
[AGENT][NEUTRAL] And you can sign up for the online service center and submit the claim yourself if you would like to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then one other question I'm all new to this. I, I had state Medicaid for the longest time and then I just enrolled in, uh, with.
[CUSTOMER][NEUTRAL] You guys and then the health insurance portion for my business.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How much does uh do does do I have with you guys? I mean how does that work?
[AGENT][NEUTRAL] Uh, your benefits?
[CUSTOMER][NEUTRAL] No one's ever explained it to me. Yes, ma'am.
[AGENT][NEUTRAL] OK, so as you know it's a supplemental insurance policy and this is just to verify your benefits it's not a guarantee of payment, it helps um.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It helps with deductible, co-pay, and co-insurance. So if you go in the hospital for more than 18 hours, you have an in-ho inpatient benefit amount of $5000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have an outpatient benefit amount of $1000 per calendar year to help with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does not look like it covers office visits, so.
[AGENT][NEUTRAL] That means that you can go to an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Sweet, sweet. So I know I'm, I'm actually supposed to be having surgery, uh.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Probably here next 3 weeks. Next, hey, shut the door, please. Hey.
[CUSTOMER][NEUTRAL] We have cats. Shut the dang door, please. I'm on the phone. I'm on the phone. OK, OK, OK, guys, I'm trying to talk to this lady. She's trying to help me understand what I don't understand.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, so as far as like my surgery goes, does, does that help cover like,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like the after like physical therapy or how does, I, I'm just asking because I don't know how this stuff works.
[AGENT][NEUTRAL] Let me see if you have um physical therapy on your policy. I'm gonna pull your policy up real quick.
[AGENT][NEUTRAL] And read it
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And see what it says about physical therapy for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this policy is for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up your certificate real quick and see if it says anything about physical therapy for you.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] And so and this why I'm pulling it up just to let you know so when you file your claim.
[AGENT][NEUTRAL] Of course you'll need the claim form. The claim form that you're gonna need is called Medlink.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll need to send in your explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] With they paid their part.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll also need to send in an itemized statement from the facility that has your diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Got it. I'm writing all this game. I will.
[AGENT][NEUTRAL] OK, you do have.
[AGENT][NEUTRAL] You do have physical therapy in an office center or clinic in which a licensed physical therapist provides physical therapy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Oh, OK, cool.
[CUSTOMER][POSITIVE] See, I'm glad I'm asking questions.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, me too.
[CUSTOMER][NEGATIVE] I try to ask, I ask the ladies at work and they're like, well, you know, I'm like you guys are no help.
[CUSTOMER][POSITIVE] I got to experience this though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Now, on the physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the physician's charges are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What would that be covered on that that would be covered on the uh insurance.
[AGENT][NEUTRAL] That'd be like uh the physician, if there's a physician, um, physician's fee is not covered under the physical therapy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] But the deductible co-pay or co-insurance is what this plan covers.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, got it, got it, got it, got it.
[AGENT][NEUTRAL] And also to help you when you get into the online service center and you sign up for it, there's a copy of your policy in uh it's a direct portal to your policy so you'll be able to get a copy of your card and a copy of your policy there also.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sweet, thank you so much, man. You helped me out so much today.
[AGENT][POSITIVE] You're very welcome. You're very welcome.
[AGENT][NEUTRAL] I'd like to help all I can because I know it could be confusing sometimes.
[CUSTOMER][NEUTRAL] We're just like like
[CUSTOMER][NEUTRAL] I, I, I still don't understand the insurance portion and I'm like.
[CUSTOMER][NEUTRAL] OK, I'll figure this out 11 at a time, and this came up and they're telling me this. I was like, OK, I'll deal with this first and then I'll deal with the insurance portion next.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Your primary insurance, yeah, just ask them to explain your benefits to you. Tell them to break it down for you that you, you need to know in detail.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes I will thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Hopefully they'll be able to do that for you.
[CUSTOMER][NEUTRAL] And you have it.
[CUSTOMER][POSITIVE] I hope so too. We, we have, uh, we got Aetna now for they just switched again.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] I've heard they're a pretty good company so hopefully they can explain it to me as well as you did with this.
[CUSTOMER][NEUTRAL] This insurance, so
[AGENT][POSITIVE] Well, you're welcome and if you get stuck or you have any questions anymore, you know, just please pick up the phone and call us and any of us girls will help you, OK?
[CUSTOMER][POSITIVE] Yes ma'am, I appreciate you guys so much.
[AGENT][POSITIVE] It's no problem at all, [PII] and I hope everything goes well for you with with your surgery.
[CUSTOMER][NEUTRAL] Uh, it'll be the 3rd 1, so I'm hoping it is.
[AGENT][NEUTRAL] Well, I, I hope it all goes well and you won't have to have any more after this.
[CUSTOMER][NEUTRAL] all
[CUSTOMER][NEUTRAL] Yeah, no, this is an ongoing situation since I was a sophomore in high school, so yeah, yeah, yeah, so.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, ma'am. So thank you so much.
[AGENT][POSITIVE] You're welcome. You, you take care you have a good night and thank you so much for calling APL.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you man you too.
[AGENT][NEUTRAL] All right, bye bye, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And so.
[CUSTOMER][NEUTRAL] What?