AccountId: 011433970860
ContactId: 9893dee3-1aa5-406a-bd52-8852e0c465b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 792020 ms
Total Talk Time (AGENT): 430724 ms
Total Talk Time (CUSTOMER): 315714 ms
Interruptions: 10
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/9893dee3-1aa5-406a-bd52-8852e0c465b6_20250122T18:58_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] Yeah, um, I went to, um, did, uh, a procedure at uh for Ladale Eye Institution.
[CUSTOMER][NEUTRAL] And uh because it's subject to, uh, uh, when I pay for it and I need to pay uh deductible, and then the, the people telling me, I, so I paid about $584 then I went home and I'm thinking about, I also have the policy for gap insurance. So I, I submitted my gap insurance to the, to the doctor, I mean, to the clinic. And I just wanna make sure if they file or some, who is gonna pay me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're, you are the insured and you're wanting to see if we have received a claim for you for a procedure that you have, is that correct? Yes, ma'am. Well, I can help you with that. Uh, I can help you. And who am I speaking with, please?
[CUSTOMER][POSITIVE] Yes, correct, correct.
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII], as my last name, and my first name is [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], thank you. And what is your callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] I'm sorry, what were the last 4 numbers one more time?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02483281.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, Ms. [PII], thank you. Give me a couple moments to get your policy information pulled up, and once I do, I will have to verify several things with you first for security and then also any information that is provided would be a verification of benefits and not a guarantee of payment. So give me just a moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] OK, so first off, Ms. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's a [PII].
[CUSTOMER][NEUTRAL] 16.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address.
[CUSTOMER][NEUTRAL] It's [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we have for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address and I'm not sure if this is a personal email or work email.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, so we have something different.
[CUSTOMER][POSITIVE] Uh, it's perfect papers, right?
[AGENT][NEUTRAL] Uh, what is that full email address?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so yes, ma'am. That is the one that we have on file. Is that the one that you would like to have remain on file for you?
[CUSTOMER][NEUTRAL] At work.
[AGENT][NEUTRAL] Do you want to leave that one?
[CUSTOMER][NEUTRAL] Um, well, you can, yeah, maybe my personal, I mean, it.
[AGENT][NEUTRAL] OK, I can only put one. Yes, ma'am, I can only put one. So which one would you prefer to have?
[CUSTOMER][NEUTRAL] I mean that one is my personal ones work.
[CUSTOMER][NEUTRAL] OK, put the, put the, the personal one.
[AGENT][NEUTRAL] OK, so again, what was that email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, correct. [PII] then, yeah.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK, so give me just one moment. It did not retain it, so one second, I'm gonna have to try that again.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so Ms. [PII], that's all the information I'll need to verify with you at the moment, and I did, and I just wanna re-verify since it did not retain it the first time, it's [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, correct, yes.
[AGENT][NEUTRAL] OK, OK, thank you. Alright, so as of right now we have not yet received a claim there's not any claims on this profile for you on on your policy. When did you have your procedure done?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] How long it takes them to file, huh?
[AGENT][NEUTRAL] I would, um, yes ma'am so if for any so did they tell you that they would file with your secondary? OK, so.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, because, um, yeah, when I returned home, yeah, because I didn't have it with me. It's a piece of paper I didn't have with me. So I go, they asked me to go ahead. Otherwise, I cannot get a procedure done. So, um, so when I return home, immediately I called them and uh the, the person dealing with the billing and he loaded on my, uh, thing. So yesterday, it was 111 month checkup. So I make sure
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they have my secondary copy. So I give them the picture, you know, whatever.
[AGENT][NEUTRAL] OK, so on the way this plan works, Ms. [PII] is.
[AGENT][NEUTRAL] The insurance your claim would have to be filed with your primary health care insurance first, because when the claim is filed with APL, we also have to have a copy of your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] To review as well. So it may be that your primary insurance hasn't processed it yet, you know, with the holiday and, and all of that, um, that may take a little bit longer. Um, so your doctor's office may be waiting to get that primary insurance explanation of benefits before submitting to us since we do have to have that. Now,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I would just follow up with them. Have you received anything from your primary insurance company yet stating that your procedure has been reviewed and processed?
[CUSTOMER][NEUTRAL] Um, that's what the next.
[CUSTOMER][NEUTRAL] Yeah, I, I see, I have a statement come out but I did not, I did not see it. So, um, I'm, I'm gonna go log into online and see if that because see if they processed.
[CUSTOMER][NEUTRAL] So if they process that they should uh go ahead and find the secondary, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, and once, right, because if a claim is submitted to APL and we don't have all of the required documentation and reviewing it, you know, we would just, it would still be reviewed, but we would potentially deny it as needing, for example, the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that may, they probably are just waiting on that, but I would, I would follow up with your um doctor's office or the facility to verify if they have received anything back yet from your primary insurance and just re-verify that, you know, once they receive that, they will be filing your claim with APL. If for any reason they don't file it with us, then you can submit your own claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm actually going to email you a document for our portal. We have a portal called the online service center.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, excuse me, and then I'm gonna email you the user guide because it explains how to set up your profile and it also explains how to upload claims information if you were to submit the claim yourself.
[AGENT][POSITIVE] It just gives you instructions on that. If you need any help in setting it up, then you can call us back and we will be happy to help you with that, but I'm fixing to send that to you and the email you're gonna receive, Ms. [PII] will come from care team at [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And I have put APL online service center portal in the subject line for you so that's easy to recognize.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome.
[AGENT][POSITIVE] But do you have any other, yeah. Oh, certainly, it was my pleasure. So is there anything else?
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it.
[CUSTOMER][NEUTRAL] Mhm. No, no, I'm done. Yeah, yeah, I'm just.
[CUSTOMER][NEUTRAL] I just want to know how this is gonna work because I've never used this before.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And, uh, you know, yeah, yeah. So, so, uh, let me ask you.
[AGENT][NEUTRAL] Yeah, so again, you know, if they told you they will file that's probably what they're waiting on, you know, but if for any reason your provider doesn't file, which you know some providers won't file the supplemental, that's why I asked if they had told you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know one of my husband's, um, uh, yeah, when I had to go, you know, do myself, but
[CUSTOMER][NEUTRAL] Um, this, this is a decent big, you know, institutions, or institution. So I think they will. I just probably just like you said, take a look, take time due, due to the those holiday days and stuff. And also, I have a question. So in, for the future, if I go into things like that, so if I submit with my, are they gonna uh go ahead and just take as, oh, OK, this is the pay or deductible and then you don't need to pay right now.
[AGENT][NEUTRAL] Yes, ma'am. It's just my, mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Well, we, we can't determine that. Yes, and that is, that is something that is up to each provider as to how they handle that. Most of the time when you present, always present your APL information along with your primary insurance information.
[CUSTOMER][NEUTRAL] So I should give the one in front.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Most providers will call us to verify that your policy is active and eligible, that you're eligible, you know, and to get benefit information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the type of procedure you're having and then they make that determination, you know, they'll see if you've used any of your benefits yet on this policy, that type of thing. Um, but as far as, you know, whether that you have to pay them or not, that's something that we're not involved in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, that's strictly up to the provider.
[CUSTOMER][POSITIVE] All right. Thank you so much. Uh, that, that's very clear. Thank you. Thank you so much. I appreciate it.
[AGENT][NEUTRAL] OK. Well, you are certainly very welcome. And again, you did have an, it was an outpatient procedure you said on [PII].
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] OK, OK. I thought that's what I understood you to say.
[CUSTOMER][NEUTRAL] It's in, it's in, um, it's so funny that so, so when, uh, a year ago, and I had the same procedure and but uh in doctor's office, um, so, so they did not take any double. That's not subject, but I don't know why this time they said yes. So I, I didn't expect it. I had to pay, you know, so that's why, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said this was at the Florida Eye Institute.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK. So, yes, ma'am. So we just um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] As of now, I was just rechecking, but there hasn't. I was seeing if we had received a call from a provider checking your benefits, but I don't see where that has occurred either, but um anyway.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm, OK, OK, yeah, OK, thank you. Mhm.
[AGENT][NEUTRAL] And since I have updated your email, one last thing, since I've updated your email to your personal email address when you set up your profile in the online service center, you will need to use your personal email because for security, it will reject you if you try to use your work. OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, absolutely.
[CUSTOMER][POSITIVE] Yeah, yeah. OK. No problem. Thank you so much. I appreciate.
[AGENT][NEUTRAL] Alright then, well.
[AGENT][POSITIVE] You are certainly so welcome and thank you again for calling APL. Yes, ma'am.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK, bye-bye.
[AGENT][NEUTRAL] Bye bye.