AccountId: 011433970860
ContactId: 94b83671-ccc9-4acc-ae60-c3ad9b4aec97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411279 ms
Total Talk Time (AGENT): 135018 ms
Total Talk Time (CUSTOMER): 109839 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/94b83671-ccc9-4acc-ae60-c3ad9b4aec97_20250317T17:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII], and I went to the eye doctors today. I have an APL account. They said this account is not set up with the eye doctors, so they couldn't use it to help me pay my bill. They suggested that I call and see if there's a form that I can fill out or what do I need to do to get reimbursed.
[AGENT][NEUTRAL] Well, APL does not provide vision insurance. So if you do have vision insurance, um, you would just reach out to your HR department to see who provides that, but we don't provide vision insurance at all.
[CUSTOMER][NEUTRAL] It, it was a medical claim, and I, I used my, my Blue Cross and Blue Shield insurance, but I have GA through APL to help with that medical stuff.
[AGENT][NEUTRAL] Right, but is it medical or is it an eye doctor?
[CUSTOMER][NEUTRAL] It's medical. I have, uh, I had a medical condition with my eyes that I needed to see the eye doctor with. He built it medically.
[AGENT][NEUTRAL] OK, may I have your policy number?
[CUSTOMER][NEUTRAL] Absolutely, policy number 02579243.
[AGENT][NEUTRAL] Alright, and hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII]. My email address is [PII]. My mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this is a
[AGENT][NEUTRAL] It's an ophthalmologist or a physician, like an MD.
[CUSTOMER][NEUTRAL] Um, I, I'm not sure. I went to my eye doctor. It
[CUSTOMER][NEUTRAL] I, I am not.
[AGENT][NEUTRAL] The reason that
[CUSTOMER][NEUTRAL] He's a doctor
[AGENT][NEUTRAL] The reason I'm asking is because there, there's a difference in like an MD or an ophthalmologist. Your primary insurance most likely covers vision, but the secondary insurance has its own coverage as well, and APL as a company doesn't provide anything for vision. So it's not just you, it's just we don't provide anything with vision yet.
[CUSTOMER][NEUTRAL] But you provide medical, correct?
[AGENT][NEUTRAL] Right, so if they, if he's considered a physician like an MD, then that's medical. If this is an eye doctor, that's an ophthalmologist, that's different.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, let me, let me Google his name.
[CUSTOMER][NEUTRAL] It's always something.
[AGENT][NEUTRAL] While you're searching for that, just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] Let me know what you see.
[CUSTOMER][POSITIVE] I'm, I'm looking, I'm sorry.
[AGENT][POSITIVE] No, take your time. You're totally fine.
[CUSTOMER][NEUTRAL] He is a doctor and optometrist. He's an optometrist.
[AGENT][NEUTRAL] Right. So, so ophthalmology and vision, just like dental, and it's different coding. So yes, your primary insurance may have coverage for vision also and and they could apply, but as your secondary insurance, as a company as a whole, we don't provide vision insurance. So we would be secondary for all of your medical, urgent care, emergency room.
[AGENT][NEUTRAL] Um, diagnostic testing, medical, not vision.
[CUSTOMER][NEGATIVE] OK, so all the extra money I pay every single 2 weeks is no help.
[AGENT][NEUTRAL] If you
[CUSTOMER][NEUTRAL] This is, they're charging me as a medical. It's medical level 4, medical. So the extra money is
[AGENT][NEUTRAL] Yeah, if you're using it.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEGATIVE] If you're using it for vision and not medical, then it wouldn't be beneficial to you because it's for medical expenses, not vision.
[CUSTOMER][NEUTRAL] OK, but this was a medical claim. I, I don't understand. It is it's a medical claim. They're not billing me for glasses or contacts. They're billing me for a medical condition seen by the doctor.
[AGENT][NEUTRAL] An ophthalmologist.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so
[AGENT][NEUTRAL] So because that's not, so there's like,
[AGENT][NEUTRAL] I don't know how to explain it. Like you have medical insurance.