AccountId: 011433970860
ContactId: 94dae8c3-a736-4f38-bd4e-f19a31cac482
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676989 ms
Total Talk Time (AGENT): 279864 ms
Total Talk Time (CUSTOMER): 296237 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/94dae8c3-a736-4f38-bd4e-f19a31cac482_20250530T18:20_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] Hey [PII], how are you today?
[AGENT][POSITIVE] I'm doing well. How are you doing?
[CUSTOMER][NEUTRAL] Good. I have a couple of questions. I'm trying to fill out a claim form for um my boyfriend. Is the policy number the same as the um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on I have here.
[CUSTOMER][NEUTRAL] Sorry, I thought I knew my question.
[AGENT][POSITIVE] Oh no, you're fine. Take your time.
[CUSTOMER][NEUTRAL] Is the same, is it the same as the member ID number?
[AGENT][NEUTRAL] Well, APL doesn't have a member ID number, so the policy number will start with a 01 or 02.
[CUSTOMER][NEUTRAL] Or the group ID?
[CUSTOMER][NEUTRAL] OK, so we have managed care and I had called about filing claims or I emailed the claim to the back of what I have and then they sent me these forms that said these had to be filled out. Do I have the wrong forms?
[AGENT][NEUTRAL] Well, let me see what, um, let me pull up the policy. Um, may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and um,
[AGENT][NEUTRAL] Well, on, on the card there, do you see anywhere that says APL like to the top left?
[CUSTOMER][NEUTRAL] Now it says managed care, basic core plus group ID [PII]'s name.
[CUSTOMER][NEUTRAL] Member ID
[CUSTOMER][NEUTRAL] Pharmacy information.
[AGENT][NEUTRAL] It starts with a D
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] Does the member ID number start with a D or what does it start with?
[CUSTOMER][NEUTRAL] It starts with an F like Frank.
[AGENT][NEUTRAL] OK, can you spell [PII]'s first and last name for me?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for the policy. Hold on one moment.
[CUSTOMER][NEUTRAL] I can try to find my emails because originally I emailed because on the card it says email [PII].
[CUSTOMER][NEUTRAL] But I guess that's for providers.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] So then
[AGENT][NEUTRAL] That sounds like a completely
[AGENT][NEUTRAL] He may have insurance with us, but that, because we don't even accept claims through email. So maybe, let me see what type of, trying to see if I can locate him.
[CUSTOMER][NEGATIVE] I'm so confused.
[AGENT][NEUTRAL] OK, I got it. So, is [PII] available for me to verify to speak with you?
[CUSTOMER][NEUTRAL] Yeah, I'm on the policy too as a spouse, but I can put him on if you need me to.
[AGENT][NEUTRAL] Oh no, hold on one moment. I can wait till it comes up.
[CUSTOMER][NEUTRAL] I should be on there.
[AGENT][NEUTRAL] Yes, I see you here. I just need to verify the date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Uh, my birthday or his?
[AGENT][NEUTRAL] Yours and the mailing address?
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment. OK, so the reason why your card says managed care.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, it's because you all went through Business Workers of America. So that's why you're able to send the email, the claim through email because they have like an email line that will help you file the claims with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so the policy number, hold on one moment, I'm flipping through screens, my apologies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 263.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0783.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's your APL policy number. That member ID number is for like if you were to call directly to Business Workers of America, that would be their policy number.
[CUSTOMER][NEUTRAL] OK, so one, is there a way for you to send me a copy of the policy so I have the policy number because I looked through all the emails we've gotten from them and I didn't see the policy number.
[AGENT][NEUTRAL] Mhm. So like a breakdown of like your policy certificate?
[CUSTOMER][NEUTRAL] Yeah, just every so I have a copy of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can um email you a copy.
[CUSTOMER][NEUTRAL] And you said it's 263?
[CUSTOMER][NEUTRAL] OK, you said it's 263-078-3?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so I do fill out this form, right? It says APL, fill it out with the policy number and then.
[CUSTOMER][NEUTRAL] Um, I guess where because looking through the papers.
[AGENT][NEUTRAL] On your um claim form that you, you're looking at, does it say hospital indemnity anywhere?
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It does, OK. I just want to make sure it was the right form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I guess I just we filled this out and send a copy of the detailed bill for which we're looking to have reimbursed is that what we do because there's nowhere to put an explanation or anything, OK.
[AGENT][NEUTRAL] Exactly. Mhm.
[AGENT][NEUTRAL] Right, the itemized bill and then if there is, if you all do have other insurance, the explanation of benefits um for for that insurance if you have it, if not just the itemized bill and the claim form.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, do I have to send a different claim form cause like it's all for one thing because he had to have shoulder surgery and I had called and they said the surgery was covered, but the facility, the doctor did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The surgery at did not take this insurance, as well as the um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As well as the uh anesthesiologist, so my question is, do I have to fill out a different one for each one of those or since it's all a part of the same procedure, do we just fill out one and send all the itemized bills for it or do you need a different form for each provider?
[AGENT][NEUTRAL] Oh, no, um, no, you can just, I would break it down if there's different days maybe, but all, if it's all one day, all the same procedure, just one form.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and then he also had to get acupuncture, but it was on the, on different days, but I have the itemized bill for that so just send a separate one for that one. OK, alright, I guess that's what I'll do.
[AGENT][NEUTRAL] And then the document.
[CUSTOMER][NEUTRAL] And then they said it takes 30 days to find out what will get reimbursed.
[AGENT][NEUTRAL] Well, just in general, we say 7 to 15 business days, um, assuming there's no delays or anything.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] From when we receive it.
[CUSTOMER][NEUTRAL] OK. All right, well.
[CUSTOMER][NEUTRAL] OK, well I guess that in the email to send it to I just wanna make sure.
[AGENT][NEUTRAL] Sure, that's what I'm here for.
[CUSTOMER][NEUTRAL] Is the claim claims at [PII] one.com or no? Where do I send this one to or is that for the.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] So that email address is for Business Workers of America. I, I have a different email address for them, but if that's the email that you've been emailing, I would, I would continue to email that one or I can give you what I have.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well I just wanna know the quickest and the best way to get this to the right person so whatever email that is you tell me.
[AGENT][NEUTRAL] So if you send it to Business Workers of America, they're going to process the claim. If you send it to APL, we're going to process the claim. So it whoever you send it to, I can't, I don't know how they work, but like that turnaround time, that's for APL. So,
[AGENT][NEUTRAL] If you're wanting to send it through email.
[CUSTOMER][NEUTRAL] OK, well, give me yours then.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I send it through email to you or I can't send it to email through email?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, you can't send it through email to us. You can fax it, uh, you can mail it or you can upload it online.
[CUSTOMER][NEUTRAL] I can fax it to you so.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, or upload online. OK, so APL would be pretty fastest, right? to fax it.
[CUSTOMER][NEUTRAL] Or upload.
[CUSTOMER][NEUTRAL] So if I upload it online though, I just have to go to your [PII] and then they'll walk me through it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once you get to the website, you're going to click on sign up to the top right, and that takes you directly to our portal and you'll um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know if you, I'll look and see if you have one set up already. Do you know if you've already set up one?
[CUSTOMER][NEUTRAL] Um, I don't believe so because I didn't do it, so.
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEUTRAL] No, there's no um online service center. So yeah, just click on sign up and then I'm a new user and just follow the prompts.
[CUSTOMER][NEUTRAL] OK, so can I just ask you real quick what's the difference between going through business workers in [PII] where we got the policy and through you? are you affiliated with them then?
[AGENT][NEUTRAL] OK, so basically APL, all of our policies are through the employer, but for people who are like self-employed or contractors, they use Business Workers of America. So the difference is it's a different company, but they, they provide our products.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK, all right, I understand, but it sounds like it'd be better off with the claims to go through you.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] And then if there's any questions about it I can call you back right or look online and see where we're at in the process.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. You can do either or you'll receive a um text message once we receive the claim and then once it's finished processing, you'll receive a text message so you can go online and review it.
[CUSTOMER][NEUTRAL] OK, all right then I.
[CUSTOMER][NEUTRAL] OK, so let me ask you then like when he goes to a provider, I go to a provider and they're trying to see if we have the coverage or if the insurance is gonna cover it, are they calling Business Workers of America or you guys?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, they would be they would be calling us.
[CUSTOMER][NEUTRAL] And what's that number for them to call?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so if we have a provider that we want they wanna see if we're covered or if you'll cover it, they should call this number with this policy number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm. The [PII].
[CUSTOMER][NEUTRAL] OK, OK, well that's.
[CUSTOMER][NEUTRAL] OK, not the member ID and all that stuff in the group, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, and you're gonna email me that policy, correct? You're sending it to [PII]'s email or mine?
[AGENT][NEUTRAL] Uh, let me see which one is on file. I believe it was, hold on, it's glitching. Hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII] [PII] [PII].
[CUSTOMER][NEUTRAL] OK, that's fine like so I know where to look for it, OK.
[AGENT][NEUTRAL] All right. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Nope, I think that's it. I appreciate your help thank you.
[AGENT][POSITIVE] You're very welcome. You're welcome. Thanks for calling API. Have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] there's