AccountId: 011433970860
ContactId: 8110efd1-da89-459a-ac8c-87cc12ccc386
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 775179 ms
Total Talk Time (AGENT): 190730 ms
Total Talk Time (CUSTOMER): 389031 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/8110efd1-da89-459a-ac8c-87cc12ccc386_20250210T17:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, what do you need from me so I can ask a question? Do you want my policy number?
[AGENT][NEUTRAL] Well, first, I'll need your name and a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, my name is [PII]
[CUSTOMER][NEUTRAL] Phone number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now I need the policy number.
[CUSTOMER][NEUTRAL] OK 01792105.
[AGENT][NEUTRAL] And please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] [PII] um I'm not sure which email you have it's probably it's either [PII] or [PII].
[AGENT][NEUTRAL] OK, that's the one we have at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And yes, ma'am. How can I help you?
[CUSTOMER][NEUTRAL] Well, um, I am having.
[CUSTOMER][NEGATIVE] A um an excision done on Wednesday where I guess they're they're removing some pre-cancer um and they called to verify benefits and somebody told them that they do not pay that they only pay for accident and sickness and this that's not right. I don't understand why they were told that because we have a plan with you we've had it for multiple years.
[CUSTOMER][NEUTRAL] Um, we have nothing but a out of pocket or deductible expense with Blue Cross, and APO comes and picks up the 1st 5000 of that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that your understanding?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yes, ma'am. I'm showing that for outpatient benefits, including outpatient surgeries, we do cover up to 5000 for the co-pay, the co-insurance, and deductible after the primary insurance processes the claim for covered services. So if the service is not for um illness or an injury, then it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What do you consider an illness or an injury? That's what I'm, I don't understand what you're saying.
[AGENT][NEUTRAL] Um, it has to be related to.
[CUSTOMER][NEUTRAL] Would that not
[CUSTOMER][NEUTRAL] A medical procedure, right?
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I mean if I'm going in, I went to the dermatologist and the dermatologist referred me over to the surgery center of the dermatology to have this excision done that should be covered if my Blue Cross is covering it, you guys should cover it, right?
[AGENT][NEUTRAL] Yes, but it has to be related to an illness or an injury. Again, we can't guarantee payment over the phone. We have to um see the claim first that we receive from the provider and we have to go by the diagnosis code. If the diagnosis code shows that it's just for um
[AGENT][NEUTRAL] For
[AGENT][NEGATIVE] If it's not related to an illness or an injury, then it wouldn't be covered.
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] The diagnosis code, it has to be related to an illness or an injury or it would not be covered. So if it's related to an, an illness, then yes, ma'am, it would be covered. But if it's just for screening or
[AGENT][NEUTRAL] Um, it sounds like and
[AGENT][NEUTRAL] Let me see. Let me look at the notes and see what type of questions they were asked.
[AGENT][NEUTRAL] You said that we received a call from the provider?
[CUSTOMER][NEUTRAL] I received a call from SSM Health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've already had one done. I don't think they've filed. I, I, I looked online. I don't show that you guys have the claim yet because we're probably waiting on Blue Cross to finish processing it, um.
[CUSTOMER][NEUTRAL] But uh I I guess I need to get into Blue Cross's website and I guess if the diagnosis is on there you'll be able to tell me right?
[AGENT][POSITIVE] Yes ma'am, I will.
[CUSTOMER][NEUTRAL] Bro, [PII].
[CUSTOMER][NEUTRAL] OK, let me get in here and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Find the claim from Blue Cross because I'm sure you guys don't have it yet.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, well, I know you don't have it. I'm already looking on the website. Um, uh, it was 2 weeks ago, so it was February.
[CUSTOMER][NEUTRAL] I think it was [PII] I think.
[AGENT][NEUTRAL] OK. Yeah, we don't have it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, not yet.
[CUSTOMER][NEUTRAL] OK, a second, I'm almost in and I will pull that and take a look at it.
[CUSTOMER][NEUTRAL] Waiting for it to give me my code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] January.
[CUSTOMER][NEUTRAL] When did I have that procedure? I gotta make sure which one's switch here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Let's look at the EOB.
[CUSTOMER][NEUTRAL] Uh, well, one, just get a diagnosis on here.
[CUSTOMER][NEUTRAL] This is for laboratory services. Let me look at one of the other claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you for being patient, OK.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Looks like there's only one so far.
[AGENT][NEUTRAL] And if the diagnosis code isn't coming up on the EOB, you can call the doctor's office and get that information and give us a call back and we can let you know over the phone.
[CUSTOMER][NEUTRAL] Yeah, it's um.
[CUSTOMER][NEGATIVE] It should show up on here but it's not.
[CUSTOMER][NEGATIVE] I'm looking at the actual EOB, but it doesn't really.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And it's just lab services it's like they didn't send the office visit charge yet.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And I do show recent claims here on file that has the diagnosis code that's related to your skin. Is it um for these same services?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, that's what I, I maybe I need to get back in and look. Let me look, let's go to APL.
[CUSTOMER][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Come on, nothing ever wants to work when you want it to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Exactly. Yeah, mine does the same thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I'm right here. OK, my account.
[CUSTOMER][NEUTRAL] Let me go into claims.
[CUSTOMER][NEGATIVE] Didn't want to sign me in because I was already in.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, the only thing I showed they received [PII], so no, that would have been that's the original dermatologist there and you guys paid those.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Yeah, and I'm, I'm saying if, if the procedure you're about to have is related to this, then it looks like something that we will cover because going by the diagnosis code is related to an illness, so it would be covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it's for the same procedure, uh, for the same condition, rather.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It is the same condition, yes, so how?
[CUSTOMER][NEGATIVE] How do I get the doctor's office to know this so they're not gonna, I mean I told her I said I may need to have somebody just call you back because I mean they're trying to get me to pay all this money out of pocket and I know that's not right I mean.
[AGENT][NEUTRAL] And I apologize. We don't call the provider's office, but um yeah, they can give us a call back and uh give us the diagnosis code and we can also let them know over the phone. But just um have them to call us back and give us a diagnosis code and we can let them know over the phone if it's related to them.
[CUSTOMER][NEGATIVE] that just doesn't make any sense.
[CUSTOMER][NEUTRAL] So she didn't
[CUSTOMER][NEUTRAL] So she didn't give you a they didn't give a diagnosis when they called the last time.
[AGENT][NEUTRAL] I'm not showing that in the notes. I'm not showing that in the notes and if they did tell them over the phone that it has to be related to an illness or an injury, then, no, ma'am, they didn't give a diagnosis code.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] OK, would you be, would you be willing to hold for one second? She gave me her direct line and I'll call and ask her what that diagnosis code is.
[AGENT][POSITIVE] Yes ma'am, I can help.
[CUSTOMER][POSITIVE] Thank you, appreciate it. Hang on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the day of their appointment or if they're coming in for an injection. For more information on new patient visits, physicians, fees, and office locations, please visit our website at [PII]. Again, thank you for holding. We'll be right with you.
[CUSTOMER][NEUTRAL] Thank you for holding. We appreciate your continued patience. Someone will be with you momentarily. Did you know since establishing the Oklahoma Allergy and Asthma Clinic in [PII], the clinic's name has changed twice. In [PII], it was named the Bay Hay fever and Asthma Clinic. In [PII], the name changed to the Oklahoma Allergy Clinic, and then in [PII], it became the Oklahoma Allergy and Asthma Clinic.
[CUSTOMER][NEUTRAL] While our name has changed throughout the years, our dedication to providing excellent patient care will always remain the same. For more information, please visit our website at [PII].
[CUSTOMER][NEUTRAL] Thank you for calling the Oklahoma Allergy and Asthma Clinic. All of our representatives are currently assisting other patients. Your call is very important to us, so please remain on the line, and your call will be answered in the order in which it was received. All of our physicians are board certified allergy immunologists specializing in the evaluation and management of allergies and asthma in adults and children.
[CUSTOMER][POSITIVE] We're proud to be one of the oldest, largest, most respected, and advanced allergy and asthma centers in the [PII]. For more information, please visit us online at [PII].
[CUSTOMER][NEUTRAL] OK, are you there?
[AGENT][NEUTRAL] Yes, I'm still here.
[CUSTOMER][NEUTRAL] OK, I'm sorry she I had to leave her a voicemail so I'm gonna go ahead and let you go and I will just do my best to get um a diagnosis and call back um very frustrating um so.
[CUSTOMER][NEGATIVE] But anyway, yeah, so they said accident and sickness is what they told her, which is really throwing everybody off so.
[CUSTOMER][NEUTRAL] Um, but I will see what I can find out and move forward with that, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, we're here to [PII] central time. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, that is it, thank you.
[AGENT][POSITIVE] OK, I thank you again for calling APL mhm. Have a good day.
[CUSTOMER][NEUTRAL] Uh huh bye.