AccountId: 011433970860
ContactId: 8802035b-17a3-4f71-b1e1-a086f957aa46
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282000 ms
Total Talk Time (AGENT): 140962 ms
Total Talk Time (CUSTOMER): 127742 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/8802035b-17a3-4f71-b1e1-a086f957aa46_20250225T20:41_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII]. Um, I was wondering if you can help me out. Um, I have an APL account for, um, from my office, and I needed to see if this APL could work to pay, um, an out of pocket for diagnostics.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check and see. Um, do you have the group, are you calling on behalf of the group or your policy in specific?
[CUSTOMER][NEUTRAL] My personal mhm.
[AGENT][NEUTRAL] OK, do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, I have a group number and I have, what is this?
[AGENT][NEUTRAL] Outpatient er.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, on their plan it says med link select group medical support or supplement. OK, so it's med.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] In the bottom, all the way to the bottom.
[CUSTOMER][NEUTRAL] All the way to the bottom there.
[AGENT][NEUTRAL] The outpatient er mhm.
[CUSTOMER][NEUTRAL] Outpatient benefit cert, OK 01612786 M for Mary L for Larry 8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] I understand now how it's written sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII]. My address is [PII]. And what else did you need?
[AGENT][NEUTRAL] The email address on file?
[CUSTOMER][NEUTRAL] Um, I would believe it should be [PII].
[AGENT][POSITIVE] Yes, that's the one we have. Thank you. And a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, you can call me at the office [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And uh uh diagnostic testing is gonna take place in a hospital, outpatient facility, or office?
[CUSTOMER][NEUTRAL] Diagnostic center.
[AGENT][NEUTRAL] OK, which is an outpatient facility.
[AGENT][NEUTRAL] OK, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage. If it's an outpatient freestanding uh diagnostic center, um, it's gonna be part of your outpatient maximum which is 2500 per covered person per calendar year. This is to help with the deductibles, co-payment, and co-insurance from your major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, diagnostic procedure, I mean testing is part of the coverage under this outpatient benefit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK perfect so I will call the facility and give them this information then so they can verify my benefits.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So assuming that they don't let's say work with an APL or whatever then I would be able to submit um the receipt of my payment to you guys for reimbursement is that also an option?
[AGENT][NEUTRAL] Um, you can submit a claim. We do not take receipts as a claim submission, but you can submit a claim. Um, the claim, um, form you can find it on our website at [PII].
[AGENT][NEUTRAL] And that claim form and the first page is gonna give you instructions which I'm gonna go ahead and go over them. Um, so we're gonna need an itemized bill with diagnosis code. Um, you, you can get that when you're finalized for your test. Just let them know that you need an itemized bill. Yeah, with the diagnosis code, yes, mhm.
[CUSTOMER][NEUTRAL] Like a super bill kind of thing from the office.
[CUSTOMER][NEUTRAL] Right, mhm.
[AGENT][NEUTRAL] Yes, and then, um, once you get the copy of the explanation of benefits from the primary insurance indicating how much they applied towards the deductible co-payment and co-insurance, you can send us a copy together with that and we can go ahead and process your claim. So it's gonna be the claim form, itemized deal with diagnosis code, and the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] The EOB, OK, perfect, perfect. Hopefully they'll, uh, you know, they'll be able to process it through and alleviate that burden, but if not, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] I understand, yeah, that's the easiest way.
[CUSTOMER][POSITIVE] All right, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Mr. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] All right take care.
[CUSTOMER][POSITIVE] No, that would be it. Thank you so much.
[AGENT][POSITIVE] Yeah, you're welcome. Have a good day. Good afternoon, bye bye.
[CUSTOMER][NEUTRAL] Uh huh mm bye bye.