AccountId: 011433970860
ContactId: a0f9f32b-2c61-41fd-b3c0-52549eef5152
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 835890 ms
Total Talk Time (AGENT): 457777 ms
Total Talk Time (CUSTOMER): 319446 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/a0f9f32b-2c61-41fd-b3c0-52549eef5152_20250206T21:19_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] Hi [PII], my name is [PII] and I was calling to ask the question, if I have APL insurance, I mean, you know, the whatever, yeah, coverage, what is, I'm not sure what it covers. I've had this forever, but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it possible, OK.
[AGENT][NEUTRAL] Well, I can help you with your coverage and go over your benefits with you. Um, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, my number is [PII].
[CUSTOMER][NEUTRAL] And where would I find my policy? I see a group number.
[AGENT][NEUTRAL] It should say um policy certificate number or it may say member ID. It should start with a 01 or 02.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have a, if this plan is the mid link.
[CUSTOMER][NEUTRAL] Select group and med supplement. I don't know, and it says in hospital benefit part number and outpatient number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, just the numbers. I don't need the ML 7 or 8.
[AGENT][NEUTRAL] The numbers are your policy number.
[CUSTOMER][NEUTRAL] OK, it is
[CUSTOMER][NEUTRAL] Oh OK, I'm sorry, 01699444.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Do you need that last number at the end?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No, I'm not sure which number, but no, that pulled up your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] [PII], I just need you to verify your, your last name, your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Last name is [PII]. Date of birth [PII]. And what else did you say?
[AGENT][NEUTRAL] Um, your mailing address and email address.
[CUSTOMER][NEUTRAL] Uh, mailing address is [PII] I'm at [PII] and [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So your policy number, um, you actually have, so this policy number is no longer active. It was effective from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And then [PII] for you, a new policy began. Um, so I have that policy number for you and I'm getting ready to pull it up now so I can go through the coverage. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I got the wrong card, that's what it is.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So the um the policy number is 247.
[CUSTOMER][NEUTRAL] 247
[AGENT][NEUTRAL] 3001.
[CUSTOMER][NEUTRAL] 300124730001
[AGENT][NEUTRAL] Mhm. And so your policy, well, you know what, let me pull it up like this. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so your policy has inpatient benefits and outpatient benefits. So inpatient benefits is anytime you're admitted to the hospital may be confined um over 18 to 24 hours. So for that, the policy will pay up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there's no deductible. And then for your outpatient benefits, which is more like your urgent care emergency room, um, if you have like an outpatient surgery, um, diagnostic testing, like MRIs, CAT scans, that's all under outpatient. Um, the policy will pay up to $300 per day. So each day it resets for $300 to use towards those expenses.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] So question for you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It, so it does, what if you, what if I was in the hospital in [PII]? I can't claim those now?
[AGENT][NEUTRAL] Oh, wait a minute.
[CUSTOMER][NEUTRAL] I don't even know why
[AGENT][NEUTRAL] So there's no timely filing limit. So even if you have a claim from [PII], we would just file it under that old claim number, but you can file your claim at any time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so how do I, so what is this insurance, I mean, what, what does it cover? I think I'm trying to say cause I read, I was reading something on it and it was saying something about like how do I know if what I was in the hospital for is covered? Is it just cause I was in the hospital?
[AGENT][NEUTRAL] So, so we pay towards your co-pay, your deductible, and your co-insurance of coverage charges after primary. So like if basically I just tell all my customers, anytime you give your primary insurance, just go ahead and give our card to so that they will bill your primary first and then they'll automatically bill a second, that way you don't get any bills um until at least after we process the claim if there's anything left over, um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] But you can um
[AGENT][NEGATIVE] I just totally lost my train of thought.
[CUSTOMER][NEUTRAL] So what about the one in
[CUSTOMER][NEUTRAL] So like in January, when I was in the hospital in [PII], I think.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That wouldn't be on this policy number though you said.
[AGENT][NEUTRAL] Right, that wouldn't be on the new one, that would be on the one that's on your card. So basically anything anything on or before [PII] will go to the old policy.
[CUSTOMER][NEUTRAL] The one from
[CUSTOMER][NEUTRAL] And and how do you know what's covered like you said, if I, because I.
[AGENT][NEUTRAL] So it goes by place of service, not really what's done. So if you, you know, like if you go into the hospital and you're admitted, go ahead and hand in that card for your inpatient benefits and the outpatient is not really a service, so I can't say like if you go for
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, just as long as I go there and let me ask you a question, is it, do I have to submit a form like let's say when I was in the hospital, right? I know one of my insurances say you have to get a UBO4 form or a 1500 form. Do I have to get that for you guys?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Now that I'm trying to get paid for when I was in the hospital.
[AGENT][NEUTRAL] Yes, so anytime you file a claim with us, you're going to need your Medlink claim form, which can be found on our website [PII], and then as soon as the page populates to the top right corner, you'll see where it says claims and forms that will take you to um all the forms. You'll only need
[CUSTOMER][NEUTRAL] Or what do I have to you uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You say you
[CUSTOMER][NEUTRAL] I'm sorry, you said AMP [PII]?
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][POSITIVE] Like the store
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh, I see public. OK, I said public like [PII] store.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK, so I fill out a claim form.
[AGENT][NEUTRAL] Mhm. So you'll need your Medlink claim form, your itemized bill, which if it is a hospital will be that you bill for or um just the itemized bills, their 1500, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, so claim form, itemized bill, and then the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now you have two options. Mhm.
[CUSTOMER][NEUTRAL] The EOB right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Depending on the facility, you can give them a call and say, hey, I have a secondary insurance for, um, you know, such and such data service, can you bill them? If they give you a hard time about it, then yes, you do have the option to file a claims um on your own and then just moving forward, I would just give the card so that they, the provider will file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. This is like new. I've been paying for stuff. I don't even know what, you know. Have you ever, do you see a claim or something I tried to file before?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEGATIVE] I just, I don't know what I got. I just pay for everything. I'm so sickly all the time.
[AGENT][NEUTRAL] So not under the new one. let me see if you have any claim, if we've processed anything.
[AGENT][NEUTRAL] And we process 2 claims on your old policy.
[CUSTOMER][NEUTRAL] You did?
[AGENT][NEUTRAL] Mhm. Um, let's.
[CUSTOMER][NEUTRAL] What you know what data service that was, so I won't be maybe I already did it. I don't know. Was it denied or something?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yeah, so the first one we received was for data service [PII] from Cleveland Clinic. That one was, it was denied, but it was denied requesting the explanation of benefits. So you, if you um can get it, you can still submit that and have this continue processing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, and that's under the old policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the next 10 well, you know what, hold on, it looks like they resubmitted it, they resubmitted that one. OK, so,
[CUSTOMER][NEUTRAL] What that means.
[AGENT][NEUTRAL] No, you res um this one was resubmitted, so there was a payment of $2500.
[CUSTOMER][NEUTRAL] It was? Where when?
[CUSTOMER][NEUTRAL] Who y'all paid it to?
[AGENT][NEUTRAL] Uh, hold on one second, let me see.
[AGENT][NEUTRAL] How was it paid? Hold on one moment.
[CUSTOMER][NEUTRAL] That's funny. Maybe I got, I don't know.
[AGENT][NEUTRAL] It was paid direct deposit.
[CUSTOMER][NEUTRAL] Oh, I gotta go see. I don't know.
[AGENT][NEUTRAL] Um, it would have been issued to you around [PII]. Let me see what we have on file.
[CUSTOMER][POSITIVE] That is fun.
[AGENT][NEUTRAL] Looks, uh, I don't see the bank name, um.
[CUSTOMER][NEUTRAL] It it do it end in my account ending [PII].
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK, I gotta go see that. Now I haven't spent money, don't know I got it.
[CUSTOMER][NEUTRAL] That's so tickle.
[CUSTOMER][NEUTRAL] So that's the one that I was gonna try to pull up the file. So y'all gave me $2500?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEUTRAL] Oh wow, OK, that I, OK, that's when I was in the hospital then, the 2 because it ran over to the end of the year and then I, it was some of in January too, right?
[AGENT][NEUTRAL] Right, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so other than when you say, now let's go with the diagnostic so I can get an understanding of that because I, I'm always doing, but is it just that I go get diagnostic test done or is it certain tests? You say it's just that I went there, right?
[AGENT][NEUTRAL] Um, let me see if it, because some policies do specify what's considered diagnostic, um, so let me see if this one does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I appreciate your help.
[AGENT][POSITIVE] Oh, you're very welcome.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] No, it doesn't, um, this one doesn't specify. So it's just any, once we see the coding, any diagnostic testing, um, that's done in the hospital outpatient facility.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You say it has to be an outpatient facility, right?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] One time I gave my card for this and, and they didn't, I don't know if they billed, I mean, you know.
[AGENT][NEUTRAL] Anytime that happens.
[CUSTOMER][NEUTRAL] I turned that card in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Anytime that happens, just give them our phone number um and have them call us to verify benefits. A lot of places are not familiar with American public life, but once they call us and they we verify benefits, they have all the information they need, but they'll, they quickly turn away. So I would um just give them our number and your policy number and we'll verify.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so one more question. If, if I go on my EOBs and show that I had a diagnostic test done, do I send that in since it's and then I fill out the form?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, so you'll always need, yeah, you'll have to fill out the form anytime you file a claim and then yes, you can send in your explanation of benefits, but you'll still need to get that itemized bill.
[CUSTOMER][NEUTRAL] From, uh, from a quest, I mean like from a diagnostic place, they give you that too?
[CUSTOMER][NEUTRAL] Uh I might as well, like if I just had diagnostics outside, like out, is then you said that fall under the outpatient?
[AGENT][NEUTRAL] Really
[AGENT][NEUTRAL] Yeah, when you say diagnostic, you're, you're speaking of like diagnostic testing, not like labs or anything.
[CUSTOMER][NEUTRAL] Yeah, like, um, diagnostic like what do I get down there? Like the ultrasound or a breast, a mammogram, is that diagnostic?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so that's all mammograms are considered wellness, but yes, basically, but that's still all it's done at an outpatient facility, so they still have the itemized bill for billing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK and then and then the um one more thing the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like a DX scan type. That's a that's it done in a diagnostic place, right? Um, so,
[CUSTOMER][POSITIVE] I gotta see how to fill this out, but OK, you really helped me with the other payment thing because now I have to do that. I know I got it. That's funny, but just my memory probably. thank you so.
[AGENT][POSITIVE] It's OK. That's what we're here for. You're very welcome.
[CUSTOMER][POSITIVE] I appreciate you're the best thank you so much.
[AGENT][POSITIVE] Thank you. Well, I'm glad I could assist you. And [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Can you tell me how long I've had the insurance? You know how you told me like from [PII], did I have it prior or I was not with you guys then?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no, you weren't with us prior to the [PII] policy.
[CUSTOMER][POSITIVE] [PII]. OK, sounds good. Alright, thank you so much and I appreciate you.
[AGENT][POSITIVE] You're very welcome. And again, all the information provided was a verification of benefits, not a guarantee of payment, and thank you so much for calling APL Ava. I hope you have a good evening.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.