AccountId: 011433970860
ContactId: 9a989581-27e2-43a3-987f-c9152a828862
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 850809 ms
Total Talk Time (AGENT): 426522 ms
Total Talk Time (CUSTOMER): 257472 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/9a989581-27e2-43a3-987f-c9152a828862_20250408T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I spoke to an agent um yesterday. Her name was [PII], I believe, and she was assisting me in getting a hold of a specialist who was not taking my secondary insurance as uh co-payments. So she was trying to get a hold of, of this um particular physician to try to explain, you know, how the
[CUSTOMER][NEUTRAL] The claim works um and she was gonna help me file a claim. Is that something you can assist me with as well?
[AGENT][NEUTRAL] OK, so you're wanting to find out, [PII] how to go about filing a claim for a visit that you had, is that correct?
[CUSTOMER][NEUTRAL] Yes, so I was providing her a phone number so that she can reach out to the specialist directly and sort of initiate that for me.
[AGENT][NEUTRAL] OK, yes ma'am, I can try and help you with this, [PII] and what is your callback number? Well, first off, what is your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] What is your last name again? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] It is 02450023 ML 8.
[AGENT][NEUTRAL] OK, thank you. Give me a moment, [PII], to get your information pulled up. What I do, I will have to verify several things with you first for security and then almost excuse me, also any information that's provided would be a verification of benefits and not a guarantee of payment. So just one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so first off, if you could please verify the primary insured's name and date of birth and then also your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is the primary holder. His date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][POSITIVE] OK, thank you. Also the home mailing address for you all?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the phone number that we would have on file for your husband.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, what is the date of service, [PII], for your doctor's appointment? The policy, and the reason I'm asking you that is because the policy number that you gave me is not your currently, that's not the correct policy number.
[AGENT][NEUTRAL] That's a policy that was kind of never really active. Mhm.
[CUSTOMER][NEUTRAL] Oh, I was giving you an outpatient a benefit cer certification number. Is that not it?
[AGENT][NEUTRAL] Right. But that, well, that policy is not even active. That policy was issued and turned the same date. So I was gonna give you your correct policy number, but what is your date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so the current policy number that you should have is going to be 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 49.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7672 and that policy went into effect [PII] and it is the one that is currently active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so give me just one moment please to look at some information on this policy.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK. So yesterday, I can see that when you all tried to call the doctor's office, there was no answer. Did you try the three-way in?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so are you wanting to try to call them again with me on the line?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so, yes, ma'am, I don't mind holding.
[AGENT][NEUTRAL] If you want to try and conference them in.
[CUSTOMER][NEUTRAL] OK, yeah, um, would you be able to elaborate um what I'm requesting just because I'm not sure how to.
[CUSTOMER][NEUTRAL] Um, present that over to them. I'm just
[CUSTOMER][NEGATIVE] Trying to get reimbursed for the co-pay that I had to provide on 3 occasions that I visited the office.
[AGENT][NEUTRAL] OK, so first off, [PII], they're not providers are not required to file your secondary insurance. Most do, but in the event that they don't, didn't explain that you can also file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so they, they've never heard of the APL program, um, they weren't familiar with it, so they just dismissed it and had me pay for it. Um, but as a secondary insurance I under or it was under my impression that, um, I don't have, I, I, it covers my co-pay. So.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] If I do pay for it for any reason that I can file a claim and get reimbursed. Is that correct or not necessarily?
[AGENT][NEUTRAL] That is correct. Well, again, we cannot guarantee payment, we will have to just receive the claim and review it, you know, but you do have office.
[AGENT][NEUTRAL] Visit. I mean, that is something that can be reviewed under your outpatient benefit. Again,
[AGENT][NEUTRAL] Because we're not a major medical insurance company, some providers will not file the secondary, so they would leave that up to you to file it.
[AGENT][NEUTRAL] But if you would like to try to call them, uh, I will be happy to try to explain that to them. But if not, I'll be happy to give you
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like the website where you can get your claim form that has the instructions on it for how you would file it.
[CUSTOMER][NEUTRAL] But would you be able to file a claim for me? Because I'm, I don't know how to do that.
[AGENT][NEGATIVE] Oh, no, ma'am. I, we can't do that. Yes, ma'am, we can't do that.
[CUSTOMER][NEUTRAL] You can't file claims. You don't file claims, OK.
[AGENT][NEGATIVE] No, ma'am. No, ma'am. We can't do that. Legally, we can't do that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, um, is it [PII] is that for the explanation of benefits?
[AGENT][NEUTRAL] That's the portal information, but that is, um, that is something that is your husband available uh because we can only give certain pieces of information, um, [PII] to the primary policy holder unless they give us permission.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To provide that to someone else because he would, your husband would set up that profile and then you all would all have access for anyone who's covered under the policy cause this is a family policy. But yes, Mr. [PII] would be who we would have to provide that information to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, that's a security measure.
[CUSTOMER][NEUTRAL] All right, so the website to file for um the claim.
[AGENT][NEUTRAL] Uh-huh. Yes, ma'am. Well, to set up the profile if he's not already done that. Mhm.
[CUSTOMER][NEUTRAL] You need his permission. OK. All right. Let me place you on a brief hold, sorry.
[CUSTOMER][NEUTRAL] Hi, ma'am. I have um the policy holder on the line now for you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, Mr. [PII]. Hi, good morning. This is [PII] with APL. How are you today?
[CUSTOMER][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Good, uh, my wife was the one that, um, that was with you on the phone. So is there anything I need to approve or I need to send an email? OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, so first off, have you set up your profile in our portal before, Mr. [PII], where you can access all of your information and ID cards online with APL?
[CUSTOMER][POSITIVE] I, I believe I did once a long time ago, but I haven't. I, that's what my wife is helping me uh accomplish.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so give me, OK, so give me just a moment because as I was explaining to her, we can only
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Provide certain pieces of information, um, there's only certain things that we can do with you as for security purposes, for example, if you needed to update your address or phone number those are things that we can only do with you. Now I just checked and you have set up your profile.
[AGENT][NEUTRAL] I can provide you your user name.
[AGENT][NEUTRAL] And then if you did not remember your password, you would just have to do the forgot password and set a new password.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] My question to you is, can I upgrade the email to put my wife's email because she's better at this than myself so she could be able to set up everything or it has to be my email?
[AGENT][NEUTRAL] Well, it is already set up. Yes, sir, it is already set up. So the username is.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Yeah, if you could reset that password for me.
[AGENT][NEUTRAL] Well, you would have to do that.
[AGENT][NEUTRAL] I can provide you the username and the website. I can actually email you the user guide for the portal, Mr. [PII] that does explain how to upload claims and in addition it it does tell you how to set up your profile, but you can only set up one and that has already been done. So the user guy would just assist you all in filing claims so the user name that you created.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's not a problem.
[AGENT][NEUTRAL] With [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's your last name. So it's [PII]
[AGENT][NEUTRAL] [PII], but and the DNC and the DNC rather are the only two capitalized lenders.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Now, um, I can, again, I will.
[CUSTOMER][NEUTRAL] And what's, what's the website?
[AGENT][POSITIVE] Secured.
[AGENT][NEUTRAL] [PII]. I thought that you had that one already. You call that off to me?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that again?
[AGENT][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Mr. [PII], if you'll please verify.
[CUSTOMER][NEUTRAL] Where [PII].
[AGENT][NEUTRAL] If you'll verify your email address for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, alright, thank you. So I can email the user guide for the portal that just gives some additional information on how to use it, and if you all would like, Mr. [PII], I can include the claim form for the meddling policy.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] OK. So I'll do that.
[CUSTOMER][POSITIVE] That would be very useful.
[AGENT][POSITIVE] Sure I'll be happy to do that in just a couple of minutes when we get off of our call and the email that you're gonna receive will come from care team.
[AGENT][NEUTRAL] [PII] and I will put [PII] in the subject line so that that's easy to recognize.
[CUSTOMER][POSITIVE] Thank you so much. OK, is there anything else that you need?
[AGENT][NEUTRAL] Oh, you're
[CUSTOMER][POSITIVE] No, no, not at this time. Thank you. Thank you, ma'am. Thank you so much. So I, I am confirming that my wife has, has the permission to move forward, and once you send me that, we'll reset the password, and then we're good to go.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] OK, so I can help her with this one phone call if that is what you're authorizing me for the, but it is for this one phone call. OK, yes, sir. Well, I'll be happy to assist.
[CUSTOMER][NEUTRAL] Please, please.
[CUSTOMER][POSITIVE] I, I truly appreciate that. Thank you so much, OK?
[AGENT][POSITIVE] You're very welcome and have a nice day. You too.
[CUSTOMER][POSITIVE] Thank you have a great day.