AccountId: 011433970860
ContactId: 93f788f7-15e9-476e-8885-154d068c15f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 743119 ms
Total Talk Time (AGENT): 467464 ms
Total Talk Time (CUSTOMER): 225096 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/93f788f7-15e9-476e-8885-154d068c15f1_20250519T16:59_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], my name is [PII]. Um, I had a question. I have the uh APL supplemental insurance.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And uh my daughter received the bill um from her um primary care physician.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I didn't know, you know, we already use our primary insurance first for that the outstanding balance is that something that I pay up front and then submit to you guys for reimbursement?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII]. So you're, OK, so you're wanting to find out about possibly filing a claim for, is it an office visit from your daughter's doctor?
[CUSTOMER][NEUTRAL] Or how does that work?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir. Well, I can
[CUSTOMER][NEUTRAL] Yeah, yeah, it was her [PII].
[AGENT][NEUTRAL] OK, well, yes sir, I can help you with this. Uh, what I'll need to do first is to pull up your policy information and verify several things with you for security, and then I can take a look at your policy to see if office visits would be something, you know, that this plan could help you with.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] OK, so first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let's see, do you want the payer ID?
[AGENT][NEUTRAL] No, sir, there should be an this depends on the type of coverage you have as to how this is gonna be worded. Uh, you may see a policy certificate. There may be a hospital like inpatient.
[AGENT][NEUTRAL] In hospital or an outpatient certificate number?
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I see the certificate numbers, um, there's an outpatient benefit certificate number.
[AGENT][NEUTRAL] OK. What is that number? Yes, go ahead and give me that one.
[CUSTOMER][NEUTRAL] OK, that one's 02597336 ML 8.
[AGENT][NEUTRAL] OK, thank you. So one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and um Mr. [PII], any information again that I do provide will be a verification of benefits and not a guarantee of payment. So first off, if you'll please verify your date of birth and then your daughter's name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the daughter that we're talking about is [PII] and her date of birth is January.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and your home mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you on file is the same as the one you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry, repeat that one more time.
[AGENT][NEUTRAL] The phone number that you gave me is also the one that we have on file for you, so that is the best phone number that we should have, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct. Mhm.
[AGENT][NEUTRAL] OK, thank you and I do need to add an email address for you on file so what email would you like to have added?
[CUSTOMER][NEUTRAL] It's gonna be my last name, so it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the letters [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so your last name [PII], is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so on this is a supplemental policy that goes along with your primary health care insurance to help you with your co-pays, deductibles and co-insurance amounts of coverage services. Now on this policy though, office visits are not covered.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If you go for to an office, um, say for a visit, but you're also rendered some form of treatment in the office, we could review the treatment under your outpatient benefit, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK, so I'd have to look and see exactly what the charges were on the statement from the pediatrician, um, several kids on the plan. I know one was like a maybe a strep test.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the other one might have been just like a sick visit, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So again we could now you can submit the claim for us to review um have you, I'm assuming you have not set up your profile in our portal called the online service center.
[CUSTOMER][NEUTRAL] Um, but.
[AGENT][NEUTRAL] So that you can have access.
[CUSTOMER][NEUTRAL] Correct, yeah, that's what I'm trying to, uh, but right, I don't know what to do with it, you know, I mean, do I pay it first and then submit it to you guys for review, or?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Either way, what I recommend is, what I always recommend is that with this supplemental policy, that whenever you go for any type of medical service, always present your APL card along with your primary healthcare insurance card because most providers will file and take care of everything for you so that you don't have to do it. They'll call.
[CUSTOMER][NEUTRAL] Does the, you know.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] To, you know, get general benefit information?
[CUSTOMER][NEUTRAL] So do you have
[CUSTOMER][NEUTRAL] Do you have claims submitted to you because we did uh we did provide this card to the pediatrician.
[AGENT][NEUTRAL] Sir.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, sir, we haven't, we don't have any on file for her at this time. I checked that, um, and I don't see where anyone has called to check her eligibility either.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so step one would be to get them to submit it to you guys.
[AGENT][NEUTRAL] It's easier if they will, but I'm going, yes, because it has to be filed obviously with your primary healthcare insurance first and then with APL because we have to have a copy, whether it's
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Well, it doesn't matter if they file it or you file it. When the claim is filed to us, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Along with the claim for review, but it just, yes, it's easier if the provider will file it for you.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Now I'm gonna email you a user guide for our portal so that you can set that up when you have an opportunity because that will give you access to your ID cards, policy information, and then also claims information.
[AGENT][NEUTRAL] You'll be able to see any claims that we have received on anyone that's covered under your policy. You can also file claims with us through that portal and I will also include one of the Medlink claim forms.
[AGENT][NEUTRAL] In case you end up filing the claim, it is the form you would need to use and the first page does have instructions at the top of what other documents you will need to submit for review.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Now, the email that I will send to you in just a few minutes, it shouldn't go to your junk or spam folder, I don't think Mr. [PII], but if you hadn't seen it soon, uh, I would check there. But it's going to come from [PII].
[AGENT][NEUTRAL] And I will put [PII] in your subject line.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that that's easy to recognize, OK?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, and then if you could so just for future reference when we're using this supplemental insurance, what's the best way to go about it? Just give it to the provider at the time of service and let them know that this is our in their insurance to submit any outstanding bills after the primary's been billed.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, because again, most providers will call, for example, they would call and say, you know, um, I need to check eligibility and benefits for [PII] and so we'll verify what information would tell them, you know, either your policy is active with the effective date, you know, we're gonna pretend it is. So yes, the policy is active, effective.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date. And then we would ask them what type of benefit information they were needing inpatient, outpatient or office and they say, oh, it's an office visit.
[AGENT][NEUTRAL] At that point, you know, we would tell them, well, an office visit is not a covered benefit under this policy. However, if he receives some type of treatment, we can review that.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And then they would, you know, and then we give them what your outpatient benefit maximum is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood, yeah, I thought when I was looking at this policy it had coverage for like if you go to, you know, an urgent care center for example.
[AGENT][NEUTRAL] Yes, urgent care can be reviewed under your outpatient benefit.
[AGENT][NEUTRAL] And again, that just goes back to however it is filed and once we get the claim for review. But an urgent care, yes, that is something that would fall.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Under your outpatient benefits.
[CUSTOMER][NEUTRAL] Even though that's not a hospital.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, yeah, I guess that's worth using because to me urgent care center would still be kind of like an office, you know.
[AGENT][NEUTRAL] It depends if they bill as an office visit, yeah, even at an urgent care, if it's billed as an office visit, then that would not be covered. But typically, the, they don't, typically, it's billed a little differently at urgent care, but yes, urgent care and emergency room visits.
[CUSTOMER][NEUTRAL] As opposed to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Outpatient surgery, whether that's done at a hospital facility or a freestanding surgery center, any like diagnostic testing, again, at a freestanding facility or at a hospital.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Those are things that can be reviewed. Physical therapy could be reviewed. You also have an independent lab writer, so if they were to send lab work out, to say Laborp or an, an independent, we can review that type of um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, you know, that type of expense for you.
[CUSTOMER][POSITIVE] Got you. OK, OK, great.
[AGENT][NEUTRAL] Does that make a little more sense? And, and on this policy, you have an outpatient benefit maximum per calendar year per covered person of $4000 for covered outpatient services with no deductible.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right, yeah, that, no, that makes sense again. I just, I wasn't quite sure how to use it, so it sounds like it's the best way to use it give it to the office that's doing the billing and have to submit it for me and that doesn't work then I can do it myself and when I do it myself I'm usually attempting to.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, you know, basically I've already paid it and I'm trying to get reimbursed if I do it myself, is that correct?
[AGENT][NEUTRAL] Uh, essentially, if there are benefits payable and you file the claim because we will pay to whomever files it unless there is some other type of assignment of benefits set on the claim. It would be whoever files it first.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, so if I file it you guys wouldn't pay the office directly you would pay me then it'd be my responsibility to pay them.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got you. OK, OK, no, I appreciate, yeah, I'll look forward to the email that you send out and then uh we'll go from there.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, that'll be coming to you in just a couple of minutes. So is there anything else, Mr. [PII] I can help you with?
[CUSTOMER][POSITIVE] OK great
[CUSTOMER][POSITIVE] Uh, no, that's it. Thanks for your info today.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.