AccountId: 011433970860
ContactId: bf8d8ac8-7574-4b56-a43f-b062829012e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1399250 ms
Total Talk Time (AGENT): 360793 ms
Total Talk Time (CUSTOMER): 328212 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/bf8d8ac8-7574-4b56-a43f-b062829012e1_20250207T17:39_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] Uh, hi, [PII]. I'm, I'm, uh, trying to get, um, in the process of having a sleep study, uh, done, and I'm working with a company called Blackstone Medical. Um, they're telling me that they called you yesterday, um, and that, uh, the gap plan that I have here with you guys, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wouldn't cover the copay, um, and I'm, you know, I'm questioning that because I, I can see from the plan that it does cover a sleep study in in my house, so I'm trying to, you know, rectify that with you guys.
[AGENT][POSITIVE] Sure, I would be happy to assist you with those benefits. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do. Um, the policy number 02572509.
[AGENT][NEUTRAL] All right, thank you, sir. And what is your name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Thank you. And Mr. [PII], do you mind verifying your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Um, what else did you say? My phone number?
[AGENT][NEUTRAL] Phone number and email.
[CUSTOMER][NEUTRAL] Oh, the email is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Now we have it looks like it might be your work email on file. Would you like for us to change it to your personal?
[CUSTOMER][NEUTRAL] Yeah, please, I so you probably have [PII].
[AGENT][NEUTRAL] We do.
[CUSTOMER][POSITIVE] Yeah if you could do that that'd be great.
[AGENT][NEGATIVE] And that email again was [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. I have updated that to your personal email. And will this sleep study be performed in your home?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh yes, it will.
[AGENT][NEUTRAL] OK, I'm getting your policy pulled up and let's just verify those benefits.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Give me just one second.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Do you have an active online account?
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] On our portal we have a portal.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] That um is at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can create a login and password and actually click on your policy number, your, your policy document will download.
[AGENT][NEUTRAL] And you can view all the benefits covered on your.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I am looking up a sleep study.
[AGENT][NEUTRAL] So they will cover sleep study in a hospital outpatient facility or a sleep study center, or the person's home.
[CUSTOMER][NEUTRAL] Or sorry
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Right, correct, that's what I'm having. I'm having it done at home.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, do you happen to have their phone number?
[CUSTOMER][NEUTRAL] Um, I do, uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do you happen to know the, yeah, go ahead.
[CUSTOMER][NEUTRAL] Uh, they're called
[CUSTOMER][NEUTRAL] I don't know the, I don't know the person's name. Uh, I know they're, they're they're Blackstone Medical Services, um, but he, he did send me a, um.
[CUSTOMER][NEUTRAL] Like a case number I guess where he called like a reference number.
[AGENT][NEUTRAL] I'll tell you what, do you have a moment to do a 3 way call with them?
[CUSTOMER][NEUTRAL] Sure, of course.
[AGENT][POSITIVE] OK, and then that way if he needs any additional information you can give him that information. Let's just um call them and give them the correct information. I do apologize for that.
[CUSTOMER][POSITIVE] Yeah, no problem, that'd be great.
[AGENT][POSITIVE] Alright, thank you. One moment. Let me get him on the loan on the loan on the line for hang on just a second. Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] No problem, thank you.
[AGENT][NEUTRAL] OK, I called and there was no answer. Let me verify that number [PII].
[CUSTOMER][NEUTRAL] Uh, let me look at that one. Yeah, let me give you, so they called, they texted me and called me from various numbers.
[CUSTOMER][NEUTRAL] Um, let me give you a, yeah, it's crazy. Uh, how about, uh, this one it's 813.
[CUSTOMER][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] 1240
[CUSTOMER][NEUTRAL] Um, that's the representative that gave me the actual uh reference number that, uh, when he called you guys directly.
[AGENT][POSITIVE] All right, let me try that one if you don't mind holding.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Well, that one's not going through. You got another one or would you like to try to get him on the line? Maybe it'll.
[CUSTOMER][NEUTRAL] Yeah, let me, yeah, let me, uh, let me do that right now. Let me put you on hold and try that one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Maybe they're, you know, who knows, blocking my phone number or something who knows, one second.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hey, I'm here.
[CUSTOMER][NEUTRAL] Yeah, I'm just on hold right now, so I just wanna get back to you. I don't wanna keep you on hold one moment just merged all the calls right now.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] Yeah, a lot of our policies don't cover the sleep study in home.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I do apologize if that information was given.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] No, that's, that's quite all right. I think maybe just, you know, notice the communication issue or what have you, uh, you know, wanna make sure I get it straightened out.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I appreciate you holding on, uh, you know, on hold.
[AGENT][POSITIVE] Not a problem. We're here for you.
[CUSTOMER][POSITIVE] Uh thank you so much.
[AGENT][POSITIVE] That's why I like working with APL is we care about our clients and we, you know, whatever we need to do to assist and I like that.
[CUSTOMER][POSITIVE] Yeah, that's great because our company had a, you know, had a different gap plan, uh, and then we had trouble, um, with the other company. Some people, you know, please hold for the next available representative, the proper, uh, information and coverage, so we switched to you guys and so far it's been really good.
[AGENT][POSITIVE] Good. I'm glad to hear that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, always, you know, if, if you want to create that online account you can always pull up your policy documents and view everything that's covered under the plan. You can also check claim status.
[AGENT][POSITIVE] You can even submit claims online.
[AGENT][NEUTRAL] Print policies.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, print additional cards if needed, all that's available online.
[AGENT][POSITIVE] It's a valuable tool if you.
[CUSTOMER][NEUTRAL] OK, fair enough.
[AGENT][NEUTRAL] Kind of keep on top of everything.
[CUSTOMER][NEGATIVE] Yeah, definitely, I'll definitely, um, definitely do that, um, you know, pretty soon now. And so in this case, like if I, if I have like a fucking package in my home if I have a procedure done here, um.
[CUSTOMER][NEUTRAL] You know I have to give them the right information.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So normally the provider will file the claim for you and we pay them a direct if you give them um when you're filling out your paperwork they'll uh it asks if you want them to file with insurance that gives them.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Permission to file the claims with us and we pay them direct. That's usually the easiest way to do it.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, some providers won't file gap policies. If that's the case, then you would need to file for reimbursement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do have a claim form on our claim form for Medlink.
[CUSTOMER][POSITIVE] OK, alright, that works.
[AGENT][NEUTRAL] Their instructions as to what's needed to file a claim.
[CUSTOMER][POSITIVE] Oh, OK, awesome.
[AGENT][NEUTRAL] So it's just whichever you prefer if you wanna pay for it up front file for reimbursement or if you wanna let them do the work.
[CUSTOMER][POSITIVE] Yeah, I know for sure that's uh for sure now I always try to hand it to them you know uh you know at first you know um. Please hold for the next available representative. Saves everyone uh you know the trouble.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Absolutely, because they've already got the documents needed to file a claim too.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Now they'll they'll file with your primary first and then once they receive that information back from them then they'll file with the APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They must be busy.
[CUSTOMER][NEUTRAL] Like a whole time, yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah, every time I got a I got a text or a call I came from a different number, you know, um.
[CUSTOMER][NEUTRAL] So it's hard to know like which which one of them is a lot of times it just happens to test.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, this is a good gap policy. It, it covers a lot of.
[AGENT][NEUTRAL] Uh, benefits
[CUSTOMER][POSITIVE] Yeah, that's great.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] When you um pull up your policy online?
[AGENT][NEUTRAL] Under section 3, it will give you your benefits that are covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And what facilities we cover?
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] If that sleep study comes back and you need to have a CPAP machine or some type of durable and medical equipment.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] That is covered under your plan as well.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] Oh great, so the machine itself is covered?
[AGENT][NEUTRAL] Mhm. It would be covered.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm checking to see sometimes it has to meet the definitions of durable medical equipment, so be sure to check that on your policy as well.
[CUSTOMER][POSITIVE] OK, awesome that the how those machines can be they can be quite pricey.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Right, so a lot of times with the CPAP machine they will give you disposable pieces, the disposable pieces are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just, just, um, in the policy, there's a definition for durable medical equipment and if it
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Complies with that definition, then it could be covered. If your major medical covers, you know, applies to your deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] Well, they, I wonder if they're out for lunch.
[CUSTOMER][POSITIVE] Yeah, maybe, you know, you might be right, you might be right.
[AGENT][NEUTRAL] Seems like they would have.
[AGENT][NEUTRAL] A message though.
[CUSTOMER][NEUTRAL] Yeah like a call back or something like, you know, like when I call you back.
[CUSTOMER][NEUTRAL] The information we'll call you back, what have you.
[AGENT][NEUTRAL] Yeah, if you want to um.
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] I hope that I was, I thought that was somebody. If you want to call them back and if they have questions, then do a three way to one of our representatives.
[CUSTOMER][NEUTRAL] Yeah, I know, right?
[CUSTOMER][NEUTRAL] OK, I, I guess I could do that too, yeah, because this, I mean.
[AGENT][NEUTRAL] And then they can verify that.
[CUSTOMER][NEUTRAL] Yeah, I mean, we've been on hold for, you know, 24 minutes now or during the call, so yeah, OK, I mean, let me do that then I'll go ahead and let you go and then, uh, I just wanted to confirm that it's covered and then I'll just get in touch with them and let them know. Do you have like a case number or something I could refer back to?
[AGENT][NEUTRAL] Um, I don't. You can always use my name for reference, and my name is [PII]
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] And I'm putting it in the notes that your, that your sleep study is covered in the home.
[CUSTOMER][NEUTRAL] Alright, well, we do.
[AGENT][NEUTRAL] And that you're going to call up uh the provider back to let them know and if they need.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Please hold for the next available representative.
[AGENT][NEUTRAL] Verification then you'll call us back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK beautiful thank you so much [PII] thank you for uh for all your assistance. You've been great today.
[AGENT][POSITIVE] It's my pleasure and thank you for calling APL. Mr. [PII], I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you so much. You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.