AccountId: 011433970860
ContactId: 8706eec6-f6a2-450e-af47-218930cb2ed7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1309079 ms
Total Talk Time (AGENT): 449639 ms
Total Talk Time (CUSTOMER): 498120 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/8706eec6-f6a2-450e-af47-218930cb2ed7_20250220T14:08_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]. I'm currently, I'm covered by you guys and um I had a question because I've actually never really utilized this benefit that I have and I have a procedure coming up.
[CUSTOMER][NEGATIVE] And when um I presented my doctor with um my information, they told me that they didn't really take this coverage and that that I would have to contact you guys to like file a claim, but I've never done this before and I'm not even sure um how it works.
[AGENT][NEUTRAL] OK, um, well, I can definitely help you with your coverage. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Yes, my policy number is 022.
[CUSTOMER][NEUTRAL] 861
[CUSTOMER][NEUTRAL] 19.
[AGENT][POSITIVE] And a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that, and I just need you to verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And then um one more thing, you also have your email, but it looks like your work email?
[CUSTOMER][NEUTRAL] Oh, the [PII], um, my personal email is, well, uh, my work email is [PII].
[AGENT][NEUTRAL] OK. And did you wanna add your personal email?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and what email address would that be?
[CUSTOMER][NEUTRAL] It'd be my first name, [PII]
[CUSTOMER][NEUTRAL] [PII]. Last name [PII]
[CUSTOMER][NEUTRAL] The number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I've updated your um email address. So this is your Medlink um supplemental insurance, so we pay towards the copay, deductible and co-insurance of coverage charges after your primary. Um, now if the they they more than likely, um, were just unfamiliar with the name.
[AGENT][NEUTRAL] Um, you can either let them know that you've reached us and to give them our phone number and your policy number to have them call us to verify benefits. Um, but if you wanted to file the claim on your own, you definitely could. Um, you can, you can fax the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mail it or send it electronically?
[AGENT][NEUTRAL] Um, to file the claim, you'll need your Medlink claim form, which will be on our website.
[AGENT][NEUTRAL] A like apple,
[AGENT][NEUTRAL] M like Mary.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once you get to our website, you're gonna click on claims and forms and then just scroll down until you see um the Medli claim form is there in alphabetical order. Um, so you might have to change the page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll also need the itemized bill from the provider.
[AGENT][NEUTRAL] Depending on if it's a hospital or like an office facility, they may call it a universal bill or an itemized bill, but it's the same type of document.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh you guys even cover for dental?
[AGENT][NEUTRAL] This is for dental
[CUSTOMER][NEUTRAL] No, no, it's, it's not for gentle, but I was just looking at the website and the form.
[AGENT][NEUTRAL] We have dental products. This policy you have is only for medical.
[CUSTOMER][NEUTRAL] Oh OK, OK, got it.
[AGENT][NEUTRAL] Um, OK, so the itemized bill, the claim form.
[AGENT][NEUTRAL] And then the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Which is why it's better for them if, if I would really push to have them give us a call.
[CUSTOMER][NEUTRAL] Yeah, that's the, yeah, cause it sounds like it's a lot.
[AGENT][NEUTRAL] And they're supposed to bill, so they're supposed to bill your primary and then, you know, primary apply and then after they get the explanation of benefits and everything from primary, they're supposed to bill us directly next, um.
[AGENT][POSITIVE] And it just, I mean, it just seems a little easier when they do it, you know, so that the patient doesn't have to try to get all the paperwork and all the leg work.
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] I have a procedure coming up tomorrow and my copay is uh about.
[CUSTOMER][NEUTRAL] Like a few dollars shy from $200. That's why I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Trying to figure this out before the procedure, um.
[AGENT][NEUTRAL] Do what's their phone? I mean, we can call them together if you like. Do you have their phone number?
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Do I have your number? Just give me 1 2nd.
[AGENT][NEUTRAL] And before we call them, let me look at the benefits. What is this an outpatient procedure?
[CUSTOMER][NEUTRAL] Yes, it's an outpatient procedure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Um, I'm just pulling up your benefits now so I can look at outpatient.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so for outpatient, the policy covers up to $500 per day.
[AGENT][NEUTRAL] Um, which includes surgery in a hospital outpatient facility or free-standing outpatient surgery center. So, um, once they get the paperwork and they see what you've paid for the
[AGENT][NEUTRAL] Co-pay or the deductible, um, it could be reimbursed up to that $500 per day.
[CUSTOMER][NEUTRAL] Got it. I have their number.
[AGENT][NEUTRAL] OK, and what is that number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's uh Doctor [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Palm Beach Urology Para espanol oprima el Nueve. If this is a true medical emergency, please hang up and dial [PII] or go to the nearest hospital. If you wish, you can also go online to request an appointment at [PII], and one of our schedulers will call you back as soon as possible. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] At this time, your call may be recorded for quality assurance purposes. If this is a doctor or hospital, press 2. For surgery or office procedure related inquiries, press 3. To make or change an appointment, press 4.
[CUSTOMER][NEUTRAL] If you're calling regarding a medication or any kind of clinical issues, press 5 to leave a message for the nurse. If you're a patient of Doctor [PII], press 1. For Doctor [PII], press 2. For Dr. [PII], press 3. For Dr. [PII], press 4. For
[AGENT][NEUTRAL] Ms. [PII], did you say your doctor was Doctor [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I thought so, that's why I selected. I just wanted to make sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You have reached out to Lopez procedure coordinator. Sorry I missed your call, but please leave your name, date of birth, and.
[AGENT][NEGATIVE] No, won't work. Hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Palm Beach Urology Para espanol oprima nueve. If this is a true medical emergency, please hang up and dial [PII] or go to the nearest hospital. If you wish, you can also go online to request an appointment at [PII], and one of our schedulers will call you back as soon as possible. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] At this time, your call may be recorded for quality assurance purposes. If this is a doctor or hospital, press 2. For surgery or office procedure related inquiries, press 3. To make or change an appointment, press 4. If you're calling regarding a medication or any kind of clinical issues, press 5. To leave a message for the nurse, and please be advised that all calls are returned within 24 hours. But if this is an actual emergency, hang up and dial [PII].
[CUSTOMER][NEUTRAL] For questions related to a bill that was received, press 6. For medical records, press 7.
[AGENT][NEUTRAL] That was a long message.
[CUSTOMER][NEUTRAL] We have not received a valid response. Please try again. Thank you for calling Palm Beach Urology Para espanol oprima el Nueve. If this is a true medical emergency, please hang up and dial [PII] or go to the nearest hospital. If you wish, you can also go online to request an appointment at [PII], and one of our schedulers will call you back as soon as possible. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] At this time, your call may be recorded for quality assurance purposes. If this is a doctor or hospital, press 2. For surgery or office procedure related inquiries, press 3. To make or change an appointment, press 4.
[CUSTOMER][NEUTRAL] Babe, I'm
[CUSTOMER][NEUTRAL] I must be on my way.
[CUSTOMER][NEUTRAL] The time.
[CUSTOMER][NEUTRAL] The train is going.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] You dear
[CUSTOMER][NEGATIVE] But I'll be lonely without.
[CUSTOMER][POSITIVE] and I'll need your love to see me through.
[CUSTOMER][POSITIVE] So please believe me, my heart is in your hand.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Good morning, Palm Beachology. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from American Public Life. Um, we have a mutual patient and she's needing some assistance with verifying her benefits. She has a procedure tomorrow.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] those peoples.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Has a what?
[AGENT][NEUTRAL] She has a procedure tomorrow with Doctor [PII]. So I'm just calling to verify benefits. She was told that the um insurance
[AGENT][NEUTRAL] Um, I guess you all weren't familiar with it. I'm not sure, but she has active coverage. It's a supplement to her.
[AGENT][NEUTRAL] Primary, I just need to give someone benefits for her.
[CUSTOMER][NEUTRAL] What is the date of birth?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Her date of birth is [PII].
[CUSTOMER][NEUTRAL] Name
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what type of insurance is she on?
[AGENT][NEUTRAL] So, for she has primary and secondary, um, for her primary insurance it's Florida Blue.
[AGENT][NEUTRAL] Her secondary insurance is a Medlink um supplemental gap insurance. It pays towards her co-pays, deductibles and co-insurance. So it will help with her co-pay.
[CUSTOMER][NEUTRAL] Or the blue HMO.
[AGENT][NEUTRAL] Um, I don't have information on the primary other than Florida Blue. I'm calling with the secondary insurance.
[CUSTOMER][NEUTRAL] Oh, we need to know whether it's an HMO or a PPO, I mean.
[AGENT][NEUTRAL] Well, you should already have her, her primary insurance on file.
[CUSTOMER][NEUTRAL] OK, so we have, OK, and then what is the secondary? It may not be something that we.
[AGENT][NEUTRAL] I'm just calling for a second.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] File to what is it called?
[AGENT][NEUTRAL] It's a Medlink, M E D L I N K.
[AGENT][NEUTRAL] It's a supplemental insurance plan?
[CUSTOMER][NEUTRAL] That's for.
[CUSTOMER][NEUTRAL] That's not like an emergency or anything?
[AGENT][NEUTRAL] For an emergency, well, she has inpatient and outpatient benefits for her procedure tomorrow. It could cover up to $500 per day. Um, well, that's the benefit, but that it's towards outpatient surgery, um, so she can utilize these benefits. I'm just trying to give them to you also so that it's billable after primary.
[CUSTOMER][NEUTRAL] The actual insurance is called Medlink. That's how it is on the card.
[AGENT][NEUTRAL] Right, it's a Medlink.
[AGENT][NEUTRAL] S
[CUSTOMER][NEUTRAL] That link one word or is there a space between?
[AGENT][NEUTRAL] Medin is one word, MED.
[AGENT][NEUTRAL] And then L I N K.
[CUSTOMER][NEUTRAL] I don't pull that up, but that's an option with our.
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK, so you're just, so your office just doesn't bill to secondary insurance?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Or is it like a payer ID or something I can give you?
[CUSTOMER][NEUTRAL] Not if it's nothing that we are.
[CUSTOMER][NEUTRAL] Not anything that
[CUSTOMER][NEUTRAL] I put in MED. Let me see.
[CUSTOMER][NEUTRAL] Find anything else just.
[CUSTOMER][NEUTRAL] Option that says medi med link.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I would say it's like a nonpar nothing that that we would yes it is.
[CUSTOMER][NEUTRAL] Specified as something else where on the back of the card where does it say that the claims go to?
[AGENT][NEUTRAL] So the claims come to American public life.
[CUSTOMER][NEUTRAL] At a
[CUSTOMER][NEUTRAL] And what is the claims address for that insurance?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I do have that as an option.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me, and then what is her member ID number?
[AGENT][NEUTRAL] It is 228.
[CUSTOMER][NEUTRAL] 228.
[AGENT][NEUTRAL] 6119.
[CUSTOMER][NEUTRAL] 119.
[AGENT][NEUTRAL] Yes, the phone's breaking up, but I did, I don't know if you got it all. 228-611-9?
[CUSTOMER][NEUTRAL] Right, so try again. I have 228-6119 is what I heard.
[AGENT][NEUTRAL] You OK? OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes, that's her um policy number.
[CUSTOMER][NEUTRAL] Alright, so we've got the Blue Cross Blue Shield, and then I did add that as a secondary.
[AGENT][NEUTRAL] OK, so, um, Ms. [PII], after they bill Blue Cross, they'll go ahead and bill us and then we'll apply or, you know, let you know the decision after the claim is processed.
[CUSTOMER][NEUTRAL] All right sounds good well now it says.
[CUSTOMER][NEGATIVE] Policy not in coverage list.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] It says policy not in coverage list.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is that? I mean, I don't.
[AGENT][NEUTRAL] What does that mean for your system?
[CUSTOMER][NEUTRAL] Yeah I guess that is something that we that we are not.
[AGENT][NEUTRAL] There's certain policies APL provides or APL has that you all will bill to but not others.
[AGENT][NEUTRAL] Is that what's happening?
[CUSTOMER][NEUTRAL] We have a parent company, Genesis Care, and I don't know if this is like considered usually if if it's something that we can't file to it will say non par but I'm gonna leave it there so that you know when her blue cross is processed.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, either Blue Cross will go ahead and submit it to the secondary or it will come back to us to submit.
[AGENT][NEUTRAL] Right, it usually comes back and then the, the provider has to submit it. OK.
[CUSTOMER][NEUTRAL] OK, I mean, we all we can it's there now, so we do have that option versus what we had before we didn't have it so um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hopefully it will work out for.
[AGENT][POSITIVE] Alright, well, thank you very much for helping me for helping us. What was your name?
[CUSTOMER][POSITIVE] You're very proud
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] [PII]. All right. Thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome have a good rest of your day.
[AGENT][NEUTRAL] You also.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][POSITIVE] And Mr. [PII], you're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Alrighty bye now.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so they have your policy now. Um, I don't know about their system, but it's in there now. So once, once Blue Florida Blue processes and pays, they should be automatically sending it to us, um, they being the provider after um Blue sends everything back, so it's now on file for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, um, would they be charging me the co-pay tomorrow or?
[AGENT][NEUTRAL] Yes, you would still have to, you would still have to make the payment, um, anything they require upfront on the back end is when everything would be, once we receive the claim, we'll process it and could be, you know, reimbursed.
[CUSTOMER][NEUTRAL] How does that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much cause I, I tried to give them the information and they just flat out told me no, we don't take that, and I'm like, oh, you have to call them. I'm like, oh, OK.
[AGENT][NEUTRAL] Yeah, it's, it's, that's an easy way out if they're unfamiliar with it, but it's just a matter of asking um the right questions, which you wouldn't know because you're the insured and shouldn't have to.
[CUSTOMER][POSITIVE] Yeah. Thank you so much for advocating for.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] That's all you've been great help.
[AGENT][POSITIVE] Well, thank you and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.