AccountId: 011433970860
ContactId: 7bcdf7be-7426-43cc-bb64-7b2cbe954d4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 920780 ms
Total Talk Time (AGENT): 304232 ms
Total Talk Time (CUSTOMER): 294299 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/7bcdf7be-7426-43cc-bb64-7b2cbe954d4d_20250401T14:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there. Um, let me give you my, uh, should I give you my group number?
[AGENT][NEUTRAL] Well, first, I'll need your name and a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Great. So my name is [PII]
[AGENT][POSITIVE] OK. Thank you, [PII] and what's a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. Thank you. And now I need your policy number. It's the outpatient certificate number on your card?
[CUSTOMER][NEUTRAL] Outpatient, um, OK, it's 01618423.
[CUSTOMER][NEUTRAL] ML.
[CUSTOMER][NEUTRAL] And I can't see the other one cause I haven't gotten a new card, so it's like.
[AGENT][POSITIVE] OK, I was able to find you in our system.
[CUSTOMER][NEUTRAL] I don't know if there's like a 2.
[AGENT][NEUTRAL] And please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And my billing address is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And verify your email address to make sure that we have the correct one on file.
[CUSTOMER][NEUTRAL] Um, it could be [PII]. Is that the one or?
[AGENT][NEUTRAL] Yeah, that's the one we're showing.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. And yes, sir. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, so, um, I went to go get some labs done and I was wondering if, if gap kicks in, um, like on certain tests or whatnot.
[AGENT][NEUTRAL] OK, let's see
[CUSTOMER][NEUTRAL] Because I, I see that I, I got a bill from Quest and then I'm wondering if my gap covers that.
[AGENT][NEUTRAL] OK. Yes, I'm showing that um independent labs such as Quest is covered under your policy. Um, just make sure that your primary insurance covered the charges as well because if your primary insurance doesn't cover a charge, then we don't cover it either. And that will be covered under your outpatient benefit and for outpatient services, we cover up to 3000 per calendar year after your primary insurance processes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. Well, I know that the insurance did, but then there's a partial that they didn't, so I'm wondering if that's where you guys would kick in.
[AGENT][NEUTRAL] Um, yeah, we cover the portion that goes towards the copay, the co-insurance, and the deductible. Those are the only portions we'll cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do I know like this particular invoice if you have even seen it or.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] You know, if you guys um.
[CUSTOMER][NEUTRAL] Uh, you know, like, cause that's happened to me that sometimes, you know, like I've
[AGENT][NEUTRAL] OK. Well, have you said
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Have you set your policy up online?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. Well, let me give you our website and once you set your policy up online, you'll have access to all of your um policy and um claim information. And of course, you can always give us a call to check the status of your claim.
[CUSTOMER][NEUTRAL] OK, but I wouldn't like send you this, this copy of this bill and have someone check it.
[AGENT][NEUTRAL] Um, you can file the claim. Normally the provider files the claim themselves, but if the provider doesn't file a claim, if you wanna file the claim after you set your policy up online, you'll see where to upload that documentation and file the claim yourself, and what we'll need is the EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your primary insurance company because we don't cover anything till after your primary insurance processes the claim. And once they process the claim, we'll need to see the explanation of benefits, so we'll know how much to cover those charges that went towards the copay, the co-insurance, and the deductible.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] Correct. So, yeah, I just wanna make sure. So, uh, so where do, where do I go online to?
[AGENT][NEUTRAL] OK, the website is, it is secured, that's [PII]
[CUSTOMER][NEUTRAL] To register.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] When you go there, you'll see a blue button. The button may say register here or it may say new user. You'll click on that button and then oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on one second. Let me, let me see if, hold on one second, OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I just might as well do it while we're there just in case I can follow.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK, so when I, when I'm here it asked me for log in a new user, so I put new user?
[AGENT][NEUTRAL] Yes sir, select new user.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let the system know that you're an individual.
[CUSTOMER][NEUTRAL] And would I be an I'm a, I'm an employer group, right? I, I'm an individual with ADP, but cause it asked me am I an individual with APL insurance and this is I'm an employer or group.
[AGENT][NEUTRAL] Um, you're an individual.
[CUSTOMER][NEUTRAL] Who offers, so I should probably say.
[CUSTOMER][NEUTRAL] I'm individual, OK.
[AGENT][NEUTRAL] You're at the end of it, yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem, hold on let me just.
[CUSTOMER][NEUTRAL] Yeah, because it's searching to see if I already have an account I'm assuming.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] So what information did you put in there? You just put in there that you're an individual and?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Shit, it's telling me to.
[CUSTOMER][NEUTRAL] I put an individual.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Can I put my phone
[CUSTOMER][NEUTRAL] Yeah, like, um,
[CUSTOMER][NEGATIVE] This is my 2nd attempt, like, once it says searching, um, like the last time it told me oops.
[CUSTOMER][NEUTRAL] Apparently something happened.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And that's after you um put in, well, we'll select that you're an individual?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Correct, an individual and then I put, it says it asked me for my last name which I put it in, it asked me for my Social Security, my residential zip code.
[CUSTOMER][NEUTRAL] Um, this is oops, there has been an error. It looks like we're experiencing tech technical difficulties. Please contact our customer service, which would be you.
[AGENT][NEUTRAL] Mm. Yeah, try one more time and I'll also uh check our system, check our messages to see if we're having any issues. One moment. I'm gonna place you on a brief hold one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that'd be great. OK. Oh, perfect. Thanks so much.
[AGENT][POSITIVE] Mhm. No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, ma'am. Well, thanks for your patience.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yes, we are actually having issues with the website. Um, I was advised to let you know to try again in about an hour or so and if we're still having the same issues.
[CUSTOMER][NEUTRAL] Actually, I just
[CUSTOMER][NEUTRAL] Really, it, it actually um just let me in.
[AGENT][POSITIVE] Oh wow. OK.
[CUSTOMER][NEUTRAL] 988624 [PII].
[CUSTOMER][NEUTRAL] Let's see
[AGENT][POSITIVE] OK, yeah, cause they're working on it.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Alright, let's
[CUSTOMER][NEUTRAL] Right, it says it's submitting.
[AGENT][NEUTRAL] It's submitting.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] What is this? Oh great.
[CUSTOMER][NEUTRAL] Well, I, I hope so.
[AGENT][NEUTRAL] Yeah, I know, before I let them know that it's working, but they are working on it, so.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Jesus.
[CUSTOMER][NEUTRAL] It says your account has successfully being created, so I put log in.
[CUSTOMER][NEUTRAL] So,
[AGENT][POSITIVE] OK, great. And
[CUSTOMER][NEUTRAL] And [PII] and then I'll put.
[AGENT][NEUTRAL] Have you set your password and
[CUSTOMER][NEUTRAL] Yeah, I did.
[CUSTOMER][NEUTRAL] 15. OK.
[CUSTOMER][NEUTRAL] All right, same password.
[CUSTOMER][NEUTRAL] Um, it says text message.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's the issue. You're gonna receive status pay via text.
[CUSTOMER][NEUTRAL] It's my number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I should send you a code.
[CUSTOMER][NEUTRAL] Let's do that.
[CUSTOMER][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I think I'm in. All right.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So, where would I check this particular
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Coverage like on like for instance, this particular bill that I received from
[AGENT][NEUTRAL] Well, I'm not showing, I'm not showing that they filed a claim with us, so it wouldn't be online, but do you see um where it says claims history?
[CUSTOMER][NEGATIVE] It says my claims and this is upload document or process in the last 24 months.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir. You should, if they filed the claim with us, you can click on that and um you'll see all of your claims that have been filed with us, but I'm not showing if they filed the claim with us yet.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and if it hasn't
[AGENT][NEUTRAL] If they haven't filed
[CUSTOMER][NEUTRAL] OK, and if it hasn't, I would just upload file?
[AGENT][NEUTRAL] Yes, sir, you would upload file if they haven't filed a claim.
[AGENT][NEUTRAL] Have you let them
[CUSTOMER][NEUTRAL] OK, and then when it says to enter a claim enter claim details, would that be?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] That would be the EOB that you receive from your primary insurance company for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then my other thing is it says it asks for the policy coverage and then it gives me two things to select. One is a Medlink 9 group med.
[CUSTOMER][NEUTRAL] And then there's another one called Meddling Selectro med.
[AGENT][NEUTRAL] Um, yours would be the Medlink 9. The Medlink, the group select is the old policy. That's the one that um expired back in July.
[AGENT][NEUTRAL] And your new policy.
[CUSTOMER][NEUTRAL] So this is, I, I used the first one with the 2 is the 2551.
[AGENT][NEUTRAL] Yeah, the one that starts with 2556079. That's the active policy, the Medlik 9. Yes, sir.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Got it. OK, perfect. And then.
[CUSTOMER][NEUTRAL] OK, so I guess what I'm gonna have to do is scan this document, create a PDF and then just upload it.
[CUSTOMER][NEUTRAL] I would just scan them.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Is that the EOB or is that just a receipt? Because if it's a receipt, that's not enough information. Um, the claim would deny. We would need the EOB from your primary insurance company.
[AGENT][NEUTRAL] For that date of service.
[CUSTOMER][NEUTRAL] So I would have to then, what would I have to do? I would have to first call my insurance company.
[AGENT][NEUTRAL] Yes, sir. Call your primary insurance company and see if they, uh, see if the quest has filed a claim with them for the date of service. If they have, um, let them know also how to go online because you should be able to go online and create an account with them and get a copy of your explanation of benefits. And once you print out a copy of that, then you can upload it, um, upload it online and file the claim with us cause we'll, that's what we'll need in order for you to file the claim. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Awesome. OK, I, I understood now. OK, so let me do that and then, but thank you so much for your help. I really appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK. OK. I thank you again, [PII], for calling ATL. Have a great day. Mm bye.
[CUSTOMER][POSITIVE] Thank you, ma'am. Bye-bye.