AccountId: 011433970860
ContactId: 8cf4ad65-9be5-41d9-adbf-1cfe9252b1d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1058660 ms
Total Talk Time (AGENT): 533494 ms
Total Talk Time (CUSTOMER): 474956 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/8cf4ad65-9be5-41d9-adbf-1cfe9252b1d5_20250206T14:27_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] Yeah, hi, I was just curious on something on coverage excuse me, excuse me, on whether or not something is covered.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Yep, it's uh I'm looking at my.
[CUSTOMER][NEUTRAL] Claim number.
[CUSTOMER][NEUTRAL] Uh, policy number 02473446.
[AGENT][NEUTRAL] Thank you. And do you mind verifying your name, date of birth, and current mailing address, please, sir?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. My wife [PII] is the, the, uh,
[CUSTOMER][NEUTRAL] The insured and uh.
[CUSTOMER][NEUTRAL] [PII]. We just recently moved here. That's why I had to think about it and you said my date of birth?
[AGENT][NEUTRAL] Yes, sir, please.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] How about that? My son was born on [PII].
[CUSTOMER][NEGATIVE] Get out of here.
[AGENT][POSITIVE] Absolutely, and what is a good call back number in case we get disconnected please sir?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] All right, Mr. [PII], I have got your policy pulled up, and what type of services are you, um,
[CUSTOMER][NEUTRAL] Oh, I'm having problems and I, and I went to a podiatrist.
[AGENT][NEUTRAL] Needing benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] You know he's uh
[CUSTOMER][NEUTRAL] We put some, you know, uh, ones in my shoes and they seem to work so I'm considering ordering some um what are the things that go in your, uh.
[AGENT][NEUTRAL] The prosthetic inserts, um.
[CUSTOMER][NEUTRAL] In his shoes, I can't think of the word.
[AGENT][NEGATIVE] Well you, well, you made me prosthes my gosh, I can't think of it either.
[CUSTOMER][NEUTRAL] Uh it's a
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You know what I'm talking about, the ones that go in your shoes, uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, those little things you slip in there to help you, yeah, I got you.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] So let me take.
[CUSTOMER][NEUTRAL] And I know, I don't know what my primary picks up, but I'm, you know, you guys are my secondary.
[AGENT][NEUTRAL] That's correct. Now, we do cover durable medical equipment, so it would depend on if it falls in the, within the definition of durable medical equipment according to the policy guidelines.
[AGENT][POSITIVE] But you can definitely.
[CUSTOMER][NEUTRAL] Well, that's what I'm
[CUSTOMER][NEGATIVE] Yeah, that's what that's why I'm calling to see if it is I don't wanna order them or or if I do order them I wanna know exactly how much I'm in for if you know what I mean by out of pocket.
[AGENT][NEUTRAL] Right. Exactly.
[AGENT][NEUTRAL] Let me just get that policy certificate pulled up and let's take a deeper look and see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bear with me just one moment.
[CUSTOMER][NEUTRAL] Orthotics.
[AGENT][NEUTRAL] That's it. Look at you.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hold on, I googled it.
[AGENT][POSITIVE] I'm impressed. Google or not, I'm impressed.
[CUSTOMER][NEUTRAL] I put in a few inserts and uh orthotics came up.
[AGENT][NEUTRAL] Gotcha. OK. Let me take a look at durable medical equipment and see if the orthotics is covered. I'm so glad you did that cause that was gonna be bothering me.
[CUSTOMER][NEUTRAL] Well, yeah, alright then.
[AGENT][POSITIVE] Thank you for making my day better.
[CUSTOMER][NEUTRAL] As, as you're looking then I'll give you 5 quick seconds on where April Fools came from because it's not like [PII], which is [PII] or [PII] or [PII] birthday, right? It's not religious related or so back in the old days, I went from a lunar calendar in about the, you know, 1200s to a Bulgarian calendar which we use now, which is 12 months and you know, dates and so on.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK. In the old days, in spring, people from the outside, uh, small towns and villages outside the big cities would travel by moonlight, the first moonlight of, of spring to come in and pick up all the planting materials to bring back home, and they would travel because there were no lights on the moonlight, OK? Well,
[CUSTOMER][NEUTRAL] When they did, when they switched calendars from the, and that was [PII], and they would come in and party and then we with all the planning supplies. When they switched to the Bulgarian calendar and then [PII] became [PII], right? There were no faxes, texts or any, you know, email or anything. So all the people in the small towns and villages.
[CUSTOMER][NEUTRAL] You know, first full moon of spring.
[CUSTOMER][NEUTRAL] They come into the big cities and they think they're gonna party for [PII]'s, not knowing.
[CUSTOMER][NEUTRAL] That [PII]'s happened 3 months ago.
[CUSTOMER][NEGATIVE] And that's the people that came in, they're the fools of April, and that's where it comes from.
[AGENT][POSITIVE] How about that? I have never, I'm so glad you shared that.
[CUSTOMER][NEUTRAL] Well, I'm [PII]. It took me years to figure it out. I've always wanted and, uh, you know, and that's what it is. So the Bulgarian calendar versus the lunar calendar.
[AGENT][POSITIVE] That is so cool. I.
[AGENT][MIXED] I love learning things, but I love little tidbits of odd information, not that that's odd, but you know, just.
[CUSTOMER][NEUTRAL] Yeah, yeah, but yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I like, yeah, you know, yeah, so, uh, anyway, just to give you the heads up on that stuff, uh.
[AGENT][NEUTRAL] Now, I can tell you that, um.
[AGENT][NEUTRAL] Under the, the, for the orthotics, under the definition of durable medical equipment, it looks like it would be covered and the definition is the durable medical equipment can withstand repeated use.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] Is not disposable.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It is not useful to a person in the absence of a sickness or injury.
[CUSTOMER][NEUTRAL] Nope.
[AGENT][NEUTRAL] That might be the only thing, you know, cause I don't know if it would be considered a sickness or an injury. Um, is,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Well, yeah, I, I'm having a problem with my, my hips, yeah.
[AGENT][NEGATIVE] Your foot is sick.
[AGENT][NEUTRAL] Yeah, um, it's not implantable and it's covered under the other medical plan.
[CUSTOMER][NEUTRAL] OK, yeah, pick up.
[AGENT][NEUTRAL] So, that's the definition of the that's covered under the DME benefit on your plan. Now I can't guarantee payment, but I can um advise that you do have that durable medical equipment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Information, uh, I'm sorry, coverage, and I would definitely give your policy to your provider and let them file a claim with us to see if we can cover some of that.
[CUSTOMER][NEUTRAL] Uh right.
[AGENT][POSITIVE] Benefit some of that
[CUSTOMER][NEUTRAL] Uh, he's kind of, hey, being a dentist and being a podiatrist are the best things because you know they really don't deal with insurance and uh you know I'll give you everything to file and you know but I can't uh guarantee anything. I'm not a I'm not an insurance office so anyway anyway, right, alright, so now my question is, is if I get two pairs versus one pair.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] You know, because I do have more than one pair of shoes and I move one pair around everywhere is drag, you know.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Do they cover two pairs or one pair or how do I, uh
[AGENT][NEUTRAL] So, uh, when, when you have like anything that happens to say like two arms, you have a benefit for the right arm and a benefit for the left arm. It's not the same.
[CUSTOMER][NEUTRAL] OK, so, but the orthotics come in a pair.
[CUSTOMER][NEUTRAL] Should they'd be putting one under each foot anyway. The question is, am I entitled to a second pet?
[AGENT][NEUTRAL] Yes, because that was 2nd pair. You would be covered for one for the right foot and one for the left foot.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] That would be one pair, you don't understand my question.
[CUSTOMER][NEUTRAL] And I realized you're giving me your best effort it's not an absolute. I understand that.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm and I'm checking further so we're getting more information.
[CUSTOMER][NEUTRAL] Yeah, I hear you typing away.
[AGENT][NEUTRAL] Yeah, I'm just checking because.
[AGENT][NEGATIVE] I don't want to give you any.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] And true information wanna see if we can get to the bottom of this for sure.
[AGENT][NEUTRAL] So let me tell you under your DME it is a per calendar day benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the maximum we can pay is $300 towards your deductible or co-pay or co-insurance of your major medical.
[AGENT][NEUTRAL] And so if you got say both pairs on one day.
[AGENT][NEUTRAL] The maximum we can pay is $300. If you get a pair today.
[AGENT][NEUTRAL] And then a pair
[AGENT][NEUTRAL] Next week.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Then it could be $300 per day.
[CUSTOMER][NEUTRAL] OK, now what, OK, so I can go with one, it's fine, but if he changes my prescription later, 3 months, 4 months, 5 months or something, then that would be covered as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's correct, cause it would be a different day, it would be benefits for a different calendar day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and this is calculated on an annual basis?
[AGENT][NEUTRAL] So you
[CUSTOMER][NEUTRAL] Or on
[AGENT][NEUTRAL] Yeah, your benefit is per calendar day for outpatient.
[CUSTOMER][NEUTRAL] My policy
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Cool
[AGENT][NEUTRAL] And also just to let you know um now your wife may want to set up, let's see if y'all have an account online we have a portal.
[AGENT][NEUTRAL] And you can actually view your policy benefits as well as.
[AGENT][NEUTRAL] Claims and print additional cards.
[AGENT][NEUTRAL] No, we, she does not have.
[AGENT][NEUTRAL] An account online, yeah, actually we don't have her email address and she would not be able to set one up without an email. I can add her email if you know it.
[CUSTOMER][NEUTRAL] Sport
[CUSTOMER][NEUTRAL] Of course. You're ready? [PII].
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I have added that so if y'all want to create a login and password, then um you can view those benefits just click on the policy number and it'll download your policy and you can view the DME benefits and you know kind of like the definition that I gave you that will be listed there as well.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] OK, not a problem.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Still looking.
[AGENT][NEUTRAL] She was researching that as well.
[AGENT][NEUTRAL] But according to the definition, it looks like it would be covered. I just can't guarantee payment on a claim until we have the claim in house.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah, OK, now for me to submit a claim, I hit the receipt. Do I need to hit a claim form?
[AGENT][NEUTRAL] So actually it's, if the doctor will file that for you, we can pay them direct that way the money is not.
[CUSTOMER][NEUTRAL] Specifically
[CUSTOMER][NEUTRAL] He wants right now he.
[AGENT][NEGATIVE] He won't file it.
[CUSTOMER][NEGATIVE] No, he doesn't do
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK. So what we're going to need.
[CUSTOMER][NEGATIVE] He says he'll help me file but you know his office ain't doing it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] I'm just not gonna reply to that cause it won't be nice.
[CUSTOMER][NEUTRAL] So my question is, you know, do I need a.
[AGENT][NEUTRAL] Yes, sir. So what, what you'll need is an itemized bill from them with a diagnosis code.
[CUSTOMER][NEUTRAL] Yeah, right?
[AGENT][NEUTRAL] And procedure code.
[AGENT][POSITIVE] You can actually um.
[AGENT][NEUTRAL] Actually, you're pro you're gonna need that from the
[AGENT][NEUTRAL] Are they going to provide those orthotics for you or are you going, is it going to go through a durable medical provider, equipment provider?
[CUSTOMER][NEUTRAL] Uh, well, I don't, you know, I.
[CUSTOMER][NEUTRAL] I'm assuming and I strongly believe he does not making it in his office or anything like that if you know what I mean um so I'm assuming he's sending it out to a third party provider that probably also lets him mark it up $100 but that's just part of business and life, you know, so, uh.
[AGENT][NEUTRAL] Yeah. So.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right. So they might file the claim for you. We do get claims from durable medical equipment providers.
[CUSTOMER][NEUTRAL] OK, like Centric or one of those guys I know um.
[AGENT][NEUTRAL] Exactly. So you might even wanna call the doctor's office back and ask him who's going to be providing these orthotics.
[CUSTOMER][NEUTRAL] OK, but, uh, the right now assuming that, uh, he, you know, that he's not that they don't do it that way, you know, and my, uh.
[AGENT][NEUTRAL] And if you can get the phone number and provide your policy information.
[CUSTOMER][NEUTRAL] So I gotta get a diagnostic uh you know the code that you were talking about on the thing, but how do I fill it? Is there a form that I need to uh submit also with the uh the billing information?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On our website at [PII]. Now that's not even, you don't need to register just to go to the site for claim forms. Under the claim form,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a form for medlink M E D L I N K.
[AGENT][NEUTRAL] That is your policy type. That's the product you have, and you'll complete that Medlink claim form. There's also instructions as to what's needed to file the claim, so we'll need the itemized bill with the diagnosis code and procedure code from the provider, and we'll need a copy of your explanation of benefits from your primary insurance showing what they applied to the deductible copay or co-insurance for those orthotics.
[CUSTOMER][NEUTRAL] Alright, so I applied first to my uh.
[CUSTOMER][NEUTRAL] My Blue Cross Blue Shield and then once I get the uh the explanation of benefits from them then I send it over to you.
[AGENT][NEUTRAL] Let me ask you
[AGENT][NEUTRAL] And I didn't mean to interrupt you. Do you have, um, Florida Blue?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, that makes it even better. Let's just scratch all that and you're gonna, this is super simple. Under the Blue Cross website, there is, they have a health statement, H E A L T H.
[AGENT][POSITIVE] It's under their claims. That's all I need is that help statement. Blue Cross, Florida Blue is lovely and the fact that they put diagnosis codes and procedure codes on their health statements. So we don't even need that from the provider, from your doctor or the durable medical provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So whether they uh so if Florida Blue sends me back and they have explanation of benefits and if they cover nothing or uh you know 70 or 80% of it that's fine the rest of it will automatically get forwarded to you or do I still need to forward it to you through the uh what we're talking about?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, you would need to submit that because um Florida Blue will not send that to us. So if you'll get that meddling claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And the Florida Blue health statement. Make sure it's the health statement, just a regular EOB does not have that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But get the health statement and submit that claim form and help statement to us.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And then benefits, um, if it's payable will be reimbursed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it will go to your w[PII] because she's the policyholder. So you'll have to work out a deal with her.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Um, at, at [PII], after 33 years we're fine so that's a, you know, we're 3033 the end of the month actually, yeah, so uh yeah, so, OK, last, uh.
[AGENT][NEUTRAL] Got you
[AGENT][POSITIVE] Oh, that's, that's, that's wonderful.
[CUSTOMER][NEUTRAL] Uh, last question, you guys changed your name or you purchased?
[AGENT][NEUTRAL] So it's the same. We've all, it's it's still American Public life. They just shortened it for marketing, make it easier.
[CUSTOMER][NEUTRAL] APL
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I know my policy wouldn't change until the renewal date like it does every year, but you know I just didn't know when I go to the doctors, but I don't need to notify my doctors because they'll, they'll apply to you guys as secondary insurance after the same thing you automatically get a rejection. So my policy number is obviously from giving it to you and so on everything's staying the same, it's just a quick name change, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's right. Just, just that, it went from American Public life to APL.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right, terrific alrighty thank you very much.
[AGENT][POSITIVE] And if y'all, it's been a pleasure and if y'all create that online account you can upload the claim documents directly on on the policy online.
[CUSTOMER][NEUTRAL] Yeah, that's what we're gonna do so.
[CUSTOMER][NEUTRAL] I just needed to know my order of operations here and the first thing is to order it and then get the the right thing and then submit it to Blue Cross Blue Shield and then um.
[CUSTOMER][POSITIVE] Once they reply back to me then I can figure out what to do. Hopefully they'll pick up 100% so we'll go from there and then it makes this a non, uh, a non-event conversation outside of the pleasantness of it, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Anyway.
[CUSTOMER][POSITIVE] Thank you very much and have a wonderful day.
[AGENT][POSITIVE] Well, it's been such a pleasure to assist you, and your birthday is coming up, so happy birthday in just a little while.
[CUSTOMER][POSITIVE] Same to you, son, so excellent. All righty, have a good one bye bye.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] And it's been a pleasure. Call us if you need anything, Mr. [PII] and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] I sure will bye bye.