AccountId: 011433970860
ContactId: 93637974-ad01-4305-9190-3ce3c719cd97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1359599 ms
Total Talk Time (AGENT): 733569 ms
Total Talk Time (CUSTOMER): 386581 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/93637974-ad01-4305-9190-3ce3c719cd97_20250109T18:03_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I currently have United Healthcare and APL as my secondary insurance, and we submitted, hang on just a second, boys, close that door.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, we, we keep submitting our insurance card through APL to United Healthcare because I'm pregnant and they are obviously like sending bills out that they shouldn't be because technically my deductible is met.
[CUSTOMER][NEGATIVE] And um every time we call we tell them to add this information they say they're gonna contact you it's like a 7 day period wait time this that and the other. I don't know who's not doing their part or if they're like what the disconnect is. Is there any way that you guys can call them or if I'm on the line with you right now?
[CUSTOMER][NEUTRAL] to speak with somebody or something to get this insurance connected with that insurance so that my deductible is what it should be.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You've been providing your providers.
[AGENT][NEUTRAL] That's your that is treating you with our information or your primary.
[CUSTOMER][NEUTRAL] I've, yeah, I've already done all of that as well. I've done that with the providers as well, yeah, but the UnitedHealthcare is asking for a copy of our APL card which I've sent in several times because United Healthcare is saying my deductible is 5000 and it's not, it's $1000 with APL so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this, OK, so I can take a look at your policy information and try to go over some explanations of how this plan works.
[AGENT][NEUTRAL] With you, because this, but first I will need to pull up your policy information and verify some things with you for security.
[AGENT][NEUTRAL] OK, alright, so who am I speaking with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm sorry, you said.
[AGENT][NEUTRAL] What was the last name? [PII], OK, I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know. Hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 08 I'm sorry 01.
[CUSTOMER][NEUTRAL] 828786
[AGENT][NEUTRAL] OK, thank you, so give me one moment please to get your information pulled up.
[AGENT][NEUTRAL] OK, and the, as I stated before, I will need to verify several things with you first for security, and then any information that I do provide for you today would be a verification of your benefits and not a guarantee of payment. So first off, if you could please give me the primary insured's name and date of birth, and then your date of birth.
[CUSTOMER][NEUTRAL] Uh, the holder [PII], my husband, [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then the phone number that we would have for Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what is another number we could have? Oh well, this appears actually, I'm sorry to be your number. The [PII] is, that is your number. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so thank you very much for verifying your information with me, Ms. [PII]. OK, so this policy that you all have, it is a supplemental policy.
[AGENT][NEUTRAL] To your primary insurance and it helps you with your deductibles, co-pays, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So the way the plan works is your provider.
[AGENT][NEUTRAL] Or you, if your provider doesn't file both insurances, would file the claim with your primary insurance company first.
[AGENT][NEUTRAL] And then either the provider or you would file your claim with APL because we do have to have a copy of your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So that we can review.
[AGENT][NEUTRAL] Along with the claim, what has been applied to any areas of the co-pay, deductible or co-insurance amounts.
[AGENT][NEUTRAL] For this to offset.
[CUSTOMER][NEUTRAL] OK, and I've already done all of that. So like I go through, I use my normal insurance and then my secondary insurance is added to cover what else?
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] So I don't, we've already done all of that. So right now, I need you guys to connect with United Healthcare, somehow, some way to get them to
[CUSTOMER][NEUTRAL] Like mingled it all together.
[AGENT][NEUTRAL] OK, now, they're not gonna change what you pay on your deductible to them.
[AGENT][NEUTRAL] This doesn't change that.
[AGENT][POSITIVE] This just helps you with offset what you would owe to a provider in those areas.
[CUSTOMER][NEUTRAL] Right, hang on just a second. I'm gonna add my husband to this call.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Cause he knows more about this than I do.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. Sure.
[AGENT][NEUTRAL] Because we haven't received any claims um for you Miss [PII].
[AGENT][NEUTRAL] Except, well, let's see.
[AGENT][NEUTRAL] We received one back in October and then there's been one, excuse me, that was just received.
[AGENT][NEUTRAL] In January.
[CUSTOMER][NEUTRAL] Alright ma'am, are you there?
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] Hey [PII], are you there? Yeah.
[CUSTOMER][NEUTRAL] OK, can you explain to him what you just said to me about the deductible?
[AGENT][NEUTRAL] OK, so Mr. [PII], this is [PII] with APL. First off, how are you today?
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Good. So I was explaining to Ms. [PII] that this insurance that you all have with APL is a supplemental plan.
[AGENT][NEUTRAL] To your primary health care insurance, and it is designed to help you correct as co-pay with co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Yes, secondary.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] As far as filing a claim with APL that would either be the provider or you all would file your claim.
[AGENT][NEGATIVE] Now, this doesn't check.
[CUSTOMER][NEUTRAL] Right, but we we filed it.
[AGENT][NEUTRAL] OK, this.
[CUSTOMER][NEUTRAL] We filed it every every doctor visit.
[CUSTOMER][NEGATIVE] And we get, we get nothing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on this supplemental policy that you all have with APL office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] They're not all office visits though some of them are ultrasounds, some of them are hospital visits like emergency rooms emerg like so it's not just an office visit of go go and do an annual check, it's office visits for pregnancy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For the most recent received claim, for example, Ms. [PII], that we received for you, it was received from Troy Chiropractic for a data service of 8-13-2024. On your supplemental plan, there is a deductible, an outpatient deductible on this policy also of $1000 per calendar year.
[CUSTOMER][POSITIVE] Right, so you're saving right now that you haven't gotten anything from my pregnancy?
[AGENT][NEUTRAL] This claim was received for that, the last claim we received was for an office visit.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We received that claim 1031-2024 for an [PII] data service that was from Mercy Clinic.
[CUSTOMER][NEUTRAL] OK, so again, I've had several doctors of appointments through Mercy.
[CUSTOMER][NEUTRAL] That I've submitted my APL stuff to them, so you haven't received anything from that?
[AGENT][NEUTRAL] Can you give me one of the dates of service that I can check?
[CUSTOMER][NEUTRAL] Yeah, um, the last one was [PII].
[AGENT][NEUTRAL] No, ma'am, we have not.
[CUSTOMER][NEGATIVE] OK, so this is what I'm trying to say is is that I've submitted APL insurance to [PII]. I've submitted it to United Healthcare. I've done my part, but APL and United Healthcare are not corresponding with each other, and you guys are stating that you're not getting. My, my wife, I'm on a merge phone call with my with my wife and the APL now and that's what they're saying.
[AGENT][NEUTRAL] OK, so the claim either needs to be filed with APL by either the provider that's treating you and if they don't do that or haven't done that then you all can also file the claim. Now with this.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 3 and 4.
[CUSTOMER][NEUTRAL] Uh 26
[CUSTOMER][NEUTRAL] and she is with him.
[CUSTOMER][NEUTRAL] OK, how do I file a claim? I mean, it's not just one claim though. it's. I appreciate, yeah, the, the APL, they're saying that we gotta cover that and then they'll finally start kicking in and I'm like that's not how I've always heard this.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I just wanna make sure I wasn't 100% wrong.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, thank you.
[CUSTOMER][POSITIVE] Alright you have a good one bye.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah. Hey, I just talked to HR, um, she said that is correct, we pay 1000 APL covers the 4.
[CUSTOMER][NEUTRAL] And she gave me, go ahead, she gave me [PII], uh, this carry lady's phone number. She is our actual insurance broker with Brown and Brown. She gave me her phone number for us to give her a call, and [PII] will call them because she said it's always a mess trying to deal with APL.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] I'm not sure what we just no one has filed a claim with us for any dates of service. We haven't received any from a provider for anything other than an office visit, which obviously was not approved, but that was for a date of service in [PII]. We didn't receive it until [PII], correct, we received it from them in [PII], but your date of service.
[CUSTOMER][NEUTRAL] No, we're talking [PII].
[CUSTOMER][NEUTRAL] So, so how, how do, how do I get this information to you guys?
[AGENT][NEUTRAL] OK, so Mr. [PII], are you still on?
[CUSTOMER][NEUTRAL] Because as of as of right now.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No, I was just seeing if Mr. [PII] was still on the line because I need to add an email address on file for him, but I can only do that with him, OK, so what email address would you like to have added for you on your profile?
[CUSTOMER][NEUTRAL] I'm, I'm here.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-hu[PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII] and [PII] is spelled out.
[AGENT][NEUTRAL] Spelled out
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So [PII] dot com. Is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK, so what I'm going to do, Mr. [PII], is I'm going to email you, has, has your HR or your company told you about our portal, the online service center where you can set up a pro.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, but I can, I can, I can email them and get all the information sent to me.
[AGENT][NEUTRAL] Well, now I can do that. I can send you an email in just a moment with the the user guide that explains how to set up your profile. Once you do that, you will be able to see all of the claims that we have received.
[CUSTOMER][NEUTRAL] I can
[AGENT][NEUTRAL] On this policy for any of your family members that are covered, OK, over the last 24 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This user guide will also explain how to submit claims if you all do that. It gives you access to all the explanation of benefits for the claims that we've processed your ID cards, there is a copy of your policy explaining all of your benefits also in this portal and I will also attach.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] And that.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] One of the claim forms for this type of policy, a Medlink claim form for you all as well.
[AGENT][NEUTRAL] Because the first page of the claim form does give instructions with what additional documentation would need to be provided to us if you all are filing the claims yourself.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that email that I will send to you, Mr. [PII] will come from [PII].
[AGENT][NEUTRAL] And I will put APL in the subject line for you.
[CUSTOMER][NEUTRAL] Can we stay on the line while you send that email so we make sure we got it.
[AGENT][NEUTRAL] I'm sorry, there's, what did, I did not understand what you said, Ms. [PII].
[CUSTOMER][NEUTRAL] Can we, uh, stay on the line to make sure that we got it?
[AGENT][POSITIVE] Sure, I'll be happy to send that. Yeah, absolutely. Just one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, get with insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So we we do want you to stop here.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You stay after work or something and then we're OK or whatever you want after hours weekends Friday I think Friday night or after we get off Friday.
[AGENT][NEUTRAL] I have sent that email, Mr. [PII]. It may take a moment to receive it, but I have sent that.
[AGENT][POSITIVE] And I'll be happy to answer any other questions that you all may have.
[CUSTOMER][NEUTRAL] I'm waiting for it to refresh.
[AGENT][NEUTRAL] OK. OK. Yeah, it may take it just a moment to go through the firewalls, especially.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Oh, so with
[AGENT][NEUTRAL] Being your work emails.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And again that email should come from [PII], Mr. [PII], and it will have APL in the subject line. There should be two attachments included in that email. One of them is the user guide for the portal and the other one is that med link claim form.
[CUSTOMER][NEUTRAL] the time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I got an email from care team, uh, online.
[AGENT][NEUTRAL] Mhm. The APL, OK. And again, it should have two attachments, just verify that you did receive 2 attachments with it.
[CUSTOMER][NEUTRAL] Yes, I got an individual user guide and a Medli uh 1222 secured thing.
[AGENT][NEUTRAL] Time for
[AGENT][NEUTRAL] Claim form? Yes sir, that's gonna be the claim form.
[AGENT][POSITIVE] And I'll be happy to answer any other questions that you all have or try to assist you in any way that I can.
[CUSTOMER][NEUTRAL] So when you call it a claim, do we, how do we submit like 20 visits for one claim? Is that how we would do it? It wouldn't be like individual, right?
[AGENT][NEUTRAL] You do not have to do it individually. You do have to provide your primary insurance company's explanation of benefits for each date of service that shows the deductibles, co-pays, and co-insurance amounts, because I know sometimes the primary insurance may not show those on some of their EOBs, um, in their portals and that type of thing.
[AGENT][NEUTRAL] And then we have to have, if you're filing the claim, we'll have to have itemized bills that include your diagnosis code from the provider.
[AGENT][NEUTRAL] It's always easier if the provider will file it for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] But again, if they don't, you can, um, on this claim form, as, as I mentioned, the top section of that form does have instructions.
[AGENT][NEUTRAL] So you can use that as a checklist.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would complete the claim form and then you would attach any of the additional, you know, the itemized bill with the diagnosis and the explanation of benefits from the primary insurance company. And again, that is
[AGENT][NEUTRAL] That information is on there and then make sure to sign that claim form. The user guide that I emailed, it does tell you like what type of files can be uploaded and the maximum size you may have to break up a claim into, you know, multiple uploads, but this our system knows to tie that together.
[CUSTOMER][NEUTRAL] So we just need to make sure that.
[AGENT][NEUTRAL] If you if you
[CUSTOMER][NEUTRAL] Any time we go somewhere for something that they have this copy of this card and they send it all to you guys as well.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Absolutely, and most, most, not all, but most providers will file both the primary and the supplement. They do have to file the primary obviously first and get that explanation of benefits back before they can file with this because we we have to have that to review any of our claims, OK? Um, on this policy, for example, as I mentioned before.
[AGENT][NEUTRAL] The outpatient benefit maximum that this plan pays per covered person per calendar year for covered services is $5000.
[AGENT][NEUTRAL] You do have an outpatient deductible per covered person per calendar year on here on the supplemental policy of $1000 per covered person per calendar year.
[CUSTOMER][NEGATIVE] Yeah, the biggest problem is is that every time I've gone into the doctor's office I've given them the APL information, so I don't know where the disconnect is.
[AGENT][NEUTRAL] Have you
[AGENT][NEUTRAL] Yes, ma'am. I've, have you tried contacting their billing office, Ms. [PII], to find out if it's just a matter of if they don't do that, you know, if they don't file a supplemental plan.
[AGENT][NEUTRAL] Or, or not, you know.
[CUSTOMER][NEUTRAL] No, they do.
[AGENT][NEUTRAL] Because I can again in looking at your profile, give me just one moment to get back to that and again when y'all set this.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Do you guys need me anymore?
[CUSTOMER][POSITIVE] No, you're good. All right bye thank you. Bye uh huh.
[AGENT][POSITIVE] OK. You're welcome, Ms. Cheer.
[AGENT][NEUTRAL] So again, I can see that there, you know, there have been a few claims for office visits and those aren't covered so you know, and again you're gonna be able to see this in the in the portal. There have been some other claims that were received, but again, these are for dates of service in [PII] that we applied any of the benefit amount to that $1000 deductible for that calendar year.
[AGENT][NEUTRAL] We haven't, as of now, yeah, we haven't.
[CUSTOMER][NEUTRAL] OK, so we'll start with this. I'm not.
[CUSTOMER][NEUTRAL] And we've already done all of this so we've been on the phone with people like I don't, so this is like overwhelming honestly so I will.
[CUSTOMER][NEUTRAL] I'll start figuring this out. I'll, I'll call people and then we'll go from there.
[AGENT][NEUTRAL] Now,
[AGENT][POSITIVE] Now, if you, you know, again, if you want to try and call someone, uh, you know, I, I'll be happy to be on the line with you.
[AGENT][NEUTRAL] But again, we just haven't received any claims for you for any date service in [PII] actually.
[CUSTOMER][NEUTRAL] I, I, I hear what you're saying, but we, we send stuff over, so there's a huge disconnect here, so I don't know, but I'll, I'll call I'm gonna, I'm gonna get off here and call.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can try and help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a nice afternoon and if we can help you with anything else, please give us a call.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. You're